Functional hypothalamic amenorrhoea

What functional hypothalamic amenorrhoea is

Functional hypothalamic amenorrhoea is the disappearance of periods because the brain — the hypothalamus — puts the brakes on the hormonal axis that controls them. There's no lesion: there's a body in energy-saving mode. The most common causes are an energy deficit — eating less than you burn, sometimes without realising it —, intense physical exercise and sustained stress; often a combination of all three.

It's a common diagnosis in young women and athletes, and it's reversible. But it isn't trivial: a prolonged lack of oestrogen at a young age mainly affects bone, which is at a key stage of formation.

When to book an appointment

• You've gone three months or more without a period and the pregnancy test is negative.
• Your period disappeared when you increased training or lost weight.
• Cycles that are spacing out more and more during a stressful period.
• You're an athlete and your periods have always been «a problem you're glad not to have»: it isn't one.

How we investigate it

It's a diagnosis of exclusion: before attributing amenorrhoea to the hypothalamus, pregnancy and other hormonal causes need to be ruled out — thyroid, prolactin, polycystic ovary syndrome, ovarian insufficiency—. A detailed history of diet, training, sleep and stress, hormone testing and an ultrasound.

How we treat it

Treating it properly means treating the cause: restoring the balance between what you eat and what you burn, adjusting training and addressing stress. That's why it's a team approach, with Nutrition and Psychology at the centre itself when needed. Prescribing contraceptives «to bring the period back» doesn't solve the underlying problem — it can mask it — and that's a conversation we have with you with complete honesty.