Hypothalamic Amenorrhea Diagnosis

Hypothalamic Amenorrhea Diagnosis

In this article, you’ll discover the correct diagnosis of hypothalamic amenorrhea.

Hypothalamic amenorrhoea (HA) is a condition that stops your periods due to disruption of the hypothalamic-pituitary-ovarian axis (HPO). HA predominantly impacts women in their teens and 20s as the HPO axis has not yet developed a strong connection, although it can impact women at any time in their reproductive years. 

In this article, you’ll discover how hypothalamic amenorrhoea is diagnosed and how to distinguish it from polycystic ovarian syndrome (PCOS) through testing.

Learn more about what HA is and what causes it here. 


Hypothalamic amenorrhoea is a diagnosis of exclusion meaning that other causes of the missed periods need to be ruled out. These include pregnancy, PCOS, thyroid disease, and hyperprolactinaemia, a condition where you have too much prolactin. 

Read more about the common causes of missing periods.


To diagnose hypothalamic amenorrhoea in the UK, your GP will usually order blood tests that include:

  • Thyroid function tests – to exclude thyroid disease
  • Prolactin levels – to exclude raised prolactin levels
  • LH and FSH levels – which will be low in HA (but LH is likely raised in PCOS)
  • Estrogen levels – this is not always done by the GP but can be useful in diagnosis 

Although these blood tests hold value there are many other important markers we would look to test at FUTURE WOMAN, including androgens such as testosterone and DHEA-S that are often not tested by the GP. These markers can make the difference between an incorrect and correct diagnosis. 

Your GP may also wish to perform a pelvic ultrasound, looking for signs of PCOS (cysts on the ovaries) or any other structural abnormality in the womb that may be causing the missed period.

Diagnosing PCOS vs Hypothalamic Amenorrohea

Many women are misdiagnosed with PCOS when in fact they have hypothalamic amenorrhoea. The symptoms can be very similar – such as missing periods.

In PCOS we typically see high androgen levels such as testosterone and normal, high or low estrogen and low progesterone. 

For a hypothalamic amenorrhoea diagnosis, we would look for low androgen levels, low estrogen and progesterone. This is why it is vital to test your hormones.

Read more about the differences between PCOS and HA.

Hypothalamic Amenorrhea Diagnosis vs. PCOS


So how do we approach a hypothalamic amenorrhea diagnosis at FUTURE WOMAN?

We offer comprehensive urine testing that looks at your overall hormone levels such as estrogen, progesterone and androgens to understand if it is more likely to be PCOS or HA driving your symptoms. 

We also assess the functioning of the hypothalamus through testing the HPA axis (hypothalamic-pituitary-adrenal axis). 

We usually recommend our Advanced Hormone Test for women struggling with suspected Hypothalamic Amenorrhea.

What do our FUTURE WOMAN tests reveal about HA?

If your periods have gone missing, then we will be particularly focused on the following markers for a hypothalamic amenorrhea diagnosis. These markers are available in all our FUTURE WOMAN hormone tests:

  • Estrogen 
  • Progesterone 
  • Androgens (including the 5a pathway) 
  • DHEA and DHEA-S

These markers are important for a correct HA assessment. 

With PCOS, we would expect to find high androgens and DHEA/DHEA-S. However, with hypothalamic amenorrhoea, we would expect to find these hormones at the lower end or below the optimal range. 

In addition to the above, we would also look to your stress hormones (such as cortisol), nutrients and inflammation, to see if we can identify the root cause of HA. All of these markers, along with your reproductive hormones, are available with the Advanced Hormone Test. Included with all our FUTURE WOMAN tests is a personalised health plan created by one of our nutritionists to get you started on your journey to a regular period again. We also recommend working with one of our nutritionists on a 1-1 basis for further support.

Remember there are also other reasons for a missing period that is not HA or PCOS and our tests will help to uncover the root cause for you with our testing. 

Learn more about how we approach treatment for hypothalamic amenorrhoea.

Key takeaways

  • Hypothalamic amenorrhoea is a condition that stops your periods due to disruption of the hypothalamic-pituitary-ovarian axis.
  • For a proper diagnosis of hypothalamic amenorrhoea, it is important to test your hormones.
  • Hypothalamic amenorrhoea is often misdiagnosed as PCOS due to the current diagnostic criteria for PCOS. 
  • PCOS is characterized by high androgen levels, whereas HA is characterized by low overall hormone levels, including androgens.
  • We recommend the Advanced Hormone Test for any clients struggling with missing periods.

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