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Physical Causes of Functional Hypothalamic Amenorrhea and Diagnosing the Condition

Functional hypothalamic amenorrhea is a multi-organ disorder that affects the intestinal tract, brain, thyroid, adrenal glands and overall health. Featured in this video is Dr. Vitaly Kushnir, a physician at Center for Human Reproduction in New York, NY.

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So as I mentioned before, it’s a condition where the energy balance is very important. And the key things that dictate the energy balance is how much nutrition is taken in, so the intestinal system is closely involved, and when someone eats a normal diet their ghrelin levels – this is a hormone that comes from the intestinal tract and from the stomach – go up, and these hormone levels signal to the brain that there is a normal energy balance. The same way, when someone has normal stores of fat in their body, fat adipose tissue, their leptin levels that signal that there is normal amount of fat in the body and this signals to the brain.

When there is a deficiency of the hormones and there is an imbalance in those hormones, either because someone is not eating enough calories or because they are not absorbing enough calories they are eating, then the brain sees abnormal levels of these hormones and it recognises that maybe this is not a very good time to become pregnant. So what the brain does is it starts to generate less GnRH, which is an important hormone in the hypothalamus and that drives FSH and LH signalling from the pituitary gland and those we can actually measure in the blood stream.

So one of the hallmarks of Functional Hypothalamic Amenorrhea is that many of these women will have very low levels of FSH and LH, as well, and those hormones signal to the ovary to ovulate, so then the ovary doesn’t ovulate, so then the estrogen levels will be low. The low estrogen levels, along with some of the lack of nutrition, is what can cause problems with the bones.

Now there are several other organ systems that are involved in this, and one of them is the thyroid gland and the other one is the adrenal gland. The adrenals are the glands that sit just above the kidneys and these glands are very important in reproduction and also in the body’s stress response.

So what happens in Functional Hypothalamic Amenorrhea is that patients develop what is called a thick euthyroid condition and they have slight, slight, not severe, but slight thyroid abnormalities, and also they have over-excessive excretion of cortisol from their adrenal gland because it’s a chronic stress condition: so their body responds to this by constantly secreting cortisol. Those two things further contribute to some of the bone mineral loss problems. So it’s really a multi-organ disorder that affects the intestinal tract, the brain, the thyroid, the adrenal glands, the ovaries and the patients overall health.

In order to fix it we really have to get at the root cause of the problem. So when we start to evaluate this we have to guide it against the patient’s history but it’s important to measure all those things I just mentioned; FSH levels, LH levels, TSH, prolactin levels, anti-mullerian hormone levels, as well as electrolytes and liver function tests, and complete blood count.

In some patients with Functional Hypothalamic Amenorrhea, the cause can be due not due to an imbalance in their energy but due to a central problem in the brain like a brain lesion or a brain tumor. So it’s important if there’s any suspicion of this to get imaging of the brain, particularly if there are specific symptoms that point in this direction, and that is usually an MRI of the brain. Not every patient needs an MRI but it’s a good idea. I also routinely order a dexa scan and that’s a scan, and that’s a scan of the bones, to look at the bone density of the patient before starting patients on treatment.