Symptoms of Hypothalamic Amenorrhea

Symptoms of hypothalamic amenorrhea

In this article you’ll discover the key symptoms of hypothalamic amenorrhea. This is especially important if you have been diagnosed with PCOS, as many women are misdiagnosed with PCOS when in fact they have hypothalamic amenorrhea. 

What is hypothalamic amenorrhoea?

Hypothalamic amenorrhoea (HA) is a condition that stops your periods due to disruption of the hypothalamic pituitary ovarian axis (HPO). 

Amenorrhoea is the medical term for the lack of a period. It is the most common cause of secondary amenorrhoea accounting for around 30% of cases. Secondary amenorrhoea is defined as the cessation of menstruation for 3–6 months in women with previously normal and regular periods, or for periods 6–12 months in women with previous infrequent or prolonged cycles.

Hypothalamic amenorrhoea can impact women at any time in their reproductive years. However, it predominantly impacts women in their teens and 20s as the HPO axis has not yet developed a strong connection. By contrast, women in their 30s have had more of a chance to strengthen this connection.  

What is the HPO axis?

Hypothalamic amenorrhoea is a condition that stops your periods due to disruption of the hypothalamic pituitary ovarian axis (HPO axis). So let’s dive into the HPO axis in a bit more detail.

Essentially the HPO axis is the communication pathway from the brain to the ovaries. The HPO axis is comprised of the following: 

  • Hypothalamus – This is part of the brain responsible for maintaining balance in the body. One of its main roles is connecting the nervous system and endocrine system. 
  • Pituitary gland– Influencing all parts of the body, the pituitary gland has a major role in hormone function by telling other glands to release certain amounts of hormones. 
  • Ovaries – The ovaries are the primary female reproductive organs. They have many important functions including the secretion of hormones and releasing of eggs for possible fertilisation each month. 

Hypothalamic amenorrhoea occurs when the hypothalamus, a gland in the brain that regulates many of the body’s processes, slows or stops releasing gonadotropin-releasing hormone (GnRH). 

GnRH is responsible for a healthy and normal menstrual cycle. This hormone stimulates the pituitary gland in the brain to produce follicle stimulating hormone (FSH), the hormone responsible for follicular development in the ovary and causing oestrogen production by the ovary. It also stimulates the pituitary gland to produce luteinizing hormone (LH), which helps to mature the egg and triggers the release of the egg for ovulation. 

Therefore, when the HPO axis is disrupted and GnRH is slowed or stopped, it can stop your menstrual cycle and lead to missing periods, one of the main symptoms of hypothalamic amenorrhea.

What causes HPO axis disruption?

Hypothalamic amenorrhoea is predominantly caused by stress, too much exercise, poor nutrition (usually not consuming enough calories) or a combination of these factors. It is important to note that it is a reversible condition. 

There may also be a genetic predisposition towards hypothalamic amenorrhoea. Other less common, but well recognised, causes of hypothalamic amenorrhoea include chronic disease, illnesses that cause malabsorption such as coeliac disease, IBD and hyperthyroidism. 

Let’s have a look more in depth at some of these causes of HPO axis disruption.


Stress causes a lot of hormonal imbalances in the body due to the disruption of the HPO axis. One of these is the release of the hormone corticotropin-releasing hormone (CRH) from the hypothalamus which can decrease the production of GnRH. 

Chronic stress can therefore suppress the natural pulsatile GnRH secretion which can stop you from ovulating and therefore from having a period.


This can include not getting enough calories in your diet as well as not consuming enough micronutrients and macro-nutrients such as carbohydrates or fats. This is because when your body is deprived of energy and nutrients it starts to save energy by reducing non essential bodily functions such as menstruation. Weight loss or weight gain can also cause HA due to this being an added stress to the body and the hormonal system.


Whilst exercise is generally recommended for your health and wellbeing, excessive exercise when the body is already in a low body weight state can be harmful. This again is due to the body having to conserve energy by shutting down non essential functions such as menstruation. 

In addition, excessive exercise also lowers a hormone called leptin. This is responsible not only for curbing hunger but also regulates GnRH levels by stimulating it. Lower levels of leptin result in lower stimulation levels for GnRH production.

What are the main symptoms of Hypothalamic Amenorrhea?

The main symptom of hypothalamic amenorrhea is a missing period for three months or more. Although there are many accompanying symptoms due to the low oestrogen and progesterone that result from HA.

The full list of symptoms of hypothalamic amenorrhoea include:

  • Missing periods
  • Low libido
  • Mood changes
  • Anxiety
  • Poor sleep
  • Low energy
  • Hirsutism (like in PCOS)
  • Presence of cysts in ovary (like in PCOS)
  • Acne (like in PCOS)
  • Vaginal dryness
  • Dysregulated appetite (often increased hunger)
  • Depression
  • Head hair loss
  • Headaches
symptoms of hypothalamic amenorrhea

PCOS versus HA - signs and symptoms.

It is important to highlight that some of the above symptoms of hypothalamic amenorrhea are similar to PCOS.  As previously mentioned PCOS can often be misdiagnosed due to its current diagnostic criteria. 

It’s important to know whether PCOS or hypothalamic amenorrhea are the real cause of your missing periods as the treatment approaches for each condition are very different.

The key difference is that with PCOS you will be guaranteed to have high androgen levels in testing. Whereas, with hypothalamic amenorrhea  it is more likely you will have lower androgens, as well as low estrogen and low progesterone.

Read more about the differences between PCOS and hypothalamic amenorrhea.

Next steps for hypothalamic amenorrhoea

If you suspect you may have hypothalamic amenorrhea, we recommend testing your hormones with our Advanced Hormone Test. This is a comprehensive, at-home hormone test which looks at not only your reproductive hormones but also your stress hormones and other important markers for nutrition, inflammation and gut dysbiosis.

Testing allows your FUTURE WOMAN practitioner to confirm that you’re missing periods are due to hypothalamic amenorrhoea rather than PCOS, and also what the root cause of this might be. 

Your personalised plan (included for free with your test) will provide you with evidence-based recommendations for supplements, diet and lifestyle changes to reverse your symptoms from a qualified nutritionist and hormone expert.

Read more about our treatment approach for hypothalamic amenorrhoea.

Key takeaways

  1. Hypothalamic amenorrhoea is caused by disruption to the HPO axis
  2. The main symptom is missing periods, but other symptoms of hypothalamic amenorrhea can include low libido, poor sleep and mood changes.
  3. Stress, poor nutrition, under eating and over exercising are the main causes of HPO axis dysfunction.
  4. Hypothalamic amenorrhoea and PCOS can present with similar symptoms, but have very different treatment protocols. This is why it’s important to test your hormones to know for sure which one you have.
  5. The Advanced Hormone Test is our recommended test for hypothalamic amenorrhoea.

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