There are two kinds of Hypothalamic Amenorrhea, primary and secondary. Primary refers to females that have not yet had their periods by the age of sixteen. Secondary, is when a woman who previously had normal periods, temporarily or permanently stops menstruating. While many women skip an occasional period, amenorrhea is diagnosed if a woman has missed three or more in a row. This secondary amenorrhea, also known as “Functional” amenorrhea is what will be addressed in this paper. Hence, “Hypothalamic amenorrhea” can technically be defined as the cessation of menstruation due to a dysfunction of hypothalamic signals to the pituitary gland resulting in a failure of ovulation or stimulation of ovulation. Typically, young women who are affected by the condition have no obvious structural abnormalities of the hypothalamus or the rest of the brain, pituitary gland, or ovaries. This common type of functional amenorrhea is a diagnosis of exclusion. Hyperprolactinemia, primary deficiency of gonadotropin-releasing hormone, and other hormonal and electrolyte abnormalities must be ruled out. Affected women are reportedly more likely to be underweight, athletic, engaged in “intellectual” professions, or exposed to social stress than women without the disorder.1
In addition, hypothalamic amenorrhea may be preceded by a history of irregular menses and may last several months to years. When it occurs in association with weight loss or intense exercise, hypothalamic amenorrhea is considered to result from energy deficiency. Deficits in nutrients, hormonal perturbations, or both may signal to the brain, leading to the disruption of the pulsatile secretion of gonadotropin-releasing hormone and luteinizing hormone as well as disruption of the menstrual cycle. On the other hand, hypothalamic amenorrhea has also been described in nonathletic women of normal weight — a variant that may be associated with psychogenic factors such as stressful life events or adverse childhood experiences.2 An association between menstrual aberrations and stressful situations has long been recognized. For example, women frequently start their menstrual periods on their wedding days or when their husbands return home from military service. Women hospitalized for depression are commonly reported to have amenorrhea. Fifty percent of women in concentration camps developed amenorrhea which persisted throughout their detention. In addition, it has been repeatedly demonstrated that a considerable number of women develop menstrual aberrations, and as high as 20% develop amenorrhea when undergoing the stress of separation.3 There are examples of it happening at the time of breaking up with a significant other/life partner, desertion by a parent, and leaving home. Moreover, psychogenic amenorrhea, like exercise-related amenorrhea, has been associated with subtle deficits in calorie and macronutrient intake, as well as with neuroendocrine abnormalities. Thus, a central signal related to energy deficit may be the common factor underlying the two forms of hypothalamic amenorrhea.4
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