Functional Hypothalamic Amenorrhea in Women

Written by Jennifer Vitello

Functional hypothalamic amenorrhea (FHA), a form of amenorrhea and chronic anovulation, is one of the most common types of secondary amenorrhea. Whereas primary amenorrhea is an endocrine disorder usually associated with a pathology in the hypothalamus-pituitary-ovary axis, secondary amenorrhea may stem from functional causes such as nutritional deficiencies, excessive exercise or stress. It can be difficult to diagnose and to cure. Western treatments usually consist of a blend of therapies—nutritional, hormonal (which may or may not be effective) and psychological. However, none address the root cause. Ayurvedic chikitsa considers both the samprapti and the overall lifestyle of the patient and works with the individual to heal from the inside out.

A Healthy Woman’s Reproductive Cycle

The menstrual cycle is the monthly series of changes a woman’s body goes through in preparation for the possibility of pregnancy. It begins at puberty, ranging from the ages of 10 to 16, and ends at menopause at an average age of 51.1

The ovaries are the main reproductive organs of the female body. Each ovary contains a collection of follicles or immature eggs. Each month, the ovaries alternate releasing a mature egg— a process called ovulation. Over the course of a woman’s life, approximately 400-450 eggs will mature and ovulate while the rest will degenerate via atresia.

The egg travels through the fallopian tube to reach the uterus. The uterus receives the fertilized or unfertilized egg from the fallopian tubes. Each month, the tissue lining the uterus grows in preparation of pregnancy. If the egg is fertilized, it will try to implant itself into the endometrium. If fertilization doesn’t occur, the lining of the uterus sheds through the vagina. This is a menstrual period. The vagina is a tubal tract made of muscle and lined with a mucous membrane. It connects the uterus to the outside of the body. It provides lubrication to allow for easier intercourse and provides a pathway for menstrual fluids to exit the body.2

The menstrual cycle, which is counted from the first day of one period to the first day of the next, isn’t the same for every woman. Menstrual flow might occur every 21 to 35 days and last two to seven days. For the first few years after menstruation begins, long cycles are common. However, menstrual cycles tend to shorten and become more regular as women age.3

Hormones are responsible for the regulation of a menstrual cycle. The flow of hormones that affect the female reproductive system begin in the hypothalamus, flow to the pituitary gland and then to the ovaries. Beginning at puberty, gonadotropin-releasing hormone (GnRH) or luteinizing hormone-releasing hormone (LHRH) is secreted by the hypothalamus to the pituitary gland. LHRH stimulates the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones act on the ovaries. LH affects the development of the follicle, stimulating it to grow and mature and release when it’s ready. FSH works with the LH to stimulate the growth and development of the follicle.

As the follicle matures, it releases estrogen and progesterone. Estrogen is responsible for the maturity of the female sexual organs and breast development. Estrogen levels fluctuate throughout the menstrual cycle. Progesterone is secreted in response to FSH and LH. It’s responsible for the thickening…

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