Functional Hypothalamic Amenorrhea - Where's My Period?

Hypothalamus-pituitary-ovarian axis - the hormone connection to estrogen and progesterone

Amenorrhea: the absence of your period.

And then amenorrhea is divided into 2 categories: primary and secondary.

We’re going to talk about secondary amenorrhea, which can be observed as: the absence of a period for 3 months in women who had previously had REGULAR cycles, or the absence of a period for 6 months in women who had already been experiencing IRREGULAR cycles.

Functional hypothalamic amenorrhea (FHA) is the loss of a period caused by under-eating (or even not eating enough carbohydrates)/disordered eating, excessive exercise and/or stress. This leads to disruption of the hypothalamic-pituitary-ovarian (HPO) axis – yes, another axis! And women with normal, ‘healthy’ BMIs can also experience this – this does not simply apply to underweight women. This disruption can lead to estrogen deficiency – with potentially disastrous effects on mental health (women with FHA have shown greater susceptibility to anxiety and depression) (1), cardiovascular health, bone health and fertility. (2)

While FHA is considered a diagnosis of exclusion (your healthcare provider should work to rule out other causes, like PCOS, pregnancy, thyroid dysfunction, etc.), it’s important to consider in women who have lost their period in times of extreme mental or physical stress or during ketogenic, low-carb, or extremely restrictive dieting. Losing your period during a diet is not a good sign – period (literally)!

Low estrogen in premenopausal women is not normal and should always be addressed at the root cause.


(1)  PMID: 11476778

(2)  PMID:  28658709

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