Stopped Getting Your Period? Here’s What You Need to Know

Photography:Kantha Bae

By Judy Cho

Whilst some of us may rejoice at the idea of not having a period or experiencing premenstrual syndrome (PMS) symptoms, losing our period should signal a red flag.

What is hypothalamic amenorrhea (HA)?

Hypothalamic amenorrhea (HA) is a female health condition where women lose their menstrual periods (amenorrhea) for three months or longer.

The condition is caused by stress such as excessive physical activity, undereating, and psychological stress. When the body is under too much stress, the hypothalamus (an area of the brain) stops sending signals via the hypothalamic-pituitary axis to the reproductive organs. When this signalling stops, we cannot produce enough female sex hormones for menstruation to occur.

Individuals who have or had a history of restrictive eating, intense training, type A personality traits, and poor sleep habits are at greater risk for developing HA. Women do not have to be underweight to develop this condition. HA can occur at any weight and with or without weight loss.

When this signalling stops, we cannot produce enough female sex hormones for menstruation to occur.

How do I know if I have HA?

HA requires a diagnosis of exclusion and all other reasons for amenorrhea must be ruled out before a proper diagnosis can be made. Amenorrhea may occur due to pregnancy, polycystic ovarian syndrome, premature ovarian failure, breastfeeding, menopause, and the use of certain medications (including mood stabilisers and the oral contraceptive pill). Additionally, HA is masked by hormonal contraceptive methods including the oral contraceptive pill and Mirena.

Investigating for HA requires physical examinations (such as a pelvic ultrasound), blood tests, pregnancy tests and health questioning. Although a delicate topic, in-depth health questioning on recent or past weight loss, eating patterns, personal stress and exercise habits are crucial to determine the cause of HA.

Furthermore, for adolescents or women who have lost their periods for six months or longer, a dual-energy x-ray absorptiometry (DXA) scan is recommended. Amenorrheic individuals have a 15% reduction in bone mineral density compared to non-amenorrheic individuals.

What’s the issue with HA?

Our period is our 5th vital sign and having healthy periods is essential for good mood, energy, skin, cardiovascular and bone health.

HA results in hypoestrogenemia and inadequate estrogen levels can result in infertility, early-onset osteopenia or osteoporosis, cardiovascular complications, and mood disorders. It’s important to treat HA as early as possible to prevent these from occurring.

Our period is our 5th vital sign and having healthy periods is essential for good mood, energy, skin, cardiovascular and bone health.

How to treat HA?

To heal from HA, one must address the root cause/s including low body weight, psychological stress, excessive exercise, and under-eating. Hence treatment will often require women to increase their energy (kJ) intake, reduce their physical activity (both intensity and duration) and gain weight.

However, with any lifestyle change, this can feel difficult and scary. A support network including a multidisciplinary team of healthcare practitioners, friends, family, and online support groups is vitally important. Social support is crucial for accountability and maintaining behavioural changes.

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