Hypothalamic amenorrhea



I

Izabella

Guest
I have been diagnosed with HA and I'm pretty confused about treatment options. A little background:
I lost myperiods 2 years ago due to low bodyfat and excessive exercise. At the time, I was told it
was my low dose birth control pill that stopped my periods and killed off my libido, but when I went
off the pill the periods didn't return and haven't for over a year. My bodyfat and exercise level
and food intake have been normal and healthy for a year and there has been no sign of hormone
production. The Provera challenge didn't work, natural estrogen/progesterone made me want to hurl
myself off a bridge, so much to my dismay, I've been put on a triphasic BCP. Thyroid and PCOS have
been ruled out, its just a problem with the hypothalamus not pulsing GnRH.

Dilemma: I have read that exercise/low bodyfat causes HA because the continuous elevated cortisol
has been and continues to inhibit GnRH pulse. I have been told by a Reproductive Endocrinologist
that an opioid blocker like Naltrexone could easily restore GnRH pulse, but from what I read about
this drug, in the doseage he recomended, it increases cortisol levels. Gah? I have also read that
cortisol blockers could restore GnRH pulse. I'm so confused. I'll try anything at this point, I just
want to know how it works. Rant: I don't believe for a second that being on the BCP will somehow
trick my system back into working, since it also shutts down GnRH pulse. I have learned far more
about this subject than I should in an attempt to help myself, since my doctor's reaction is simply
"you're just one of those women who don't get periods, enjoy it! But no libido huh, that must suck"
(jerk). I've also been to naturopaths, acupuncture, reike, Chinese medicine practitioners, and
ingested the nastiest tasting herbs and tinctures on the planet to no avail. I must admit though
that I feel better after 2 days on the BCP than I have with anything else, but still no libido yet.
I have cured my eating disorder and happily gained 20 pounds in less than a year - no problem.
Getting a straight answer has been a nightmare.

I have read that some of you here have gone through this as well, any advice would be very much
appreciated.

Sincerely, Izabella
 
[email protected] (Izabella) wrote in message news:<[email protected]>...
> I have been diagnosed with HA and I'm pretty confused about treatment options. A little
> background: I lost myperiods 2 years ago due to low bodyfat and excessive exercise. At the time, I
> was told it was my low dose birth control pill that stopped my periods and killed off my libido,
> but when I went off the pill the periods didn't return and haven't for over a year. My bodyfat and
> exercise level and food intake have been normal and healthy for a year and there has been no sign
> of hormone production. The Provera challenge didn't work, natural estrogen/progesterone made me
> want to hurl myself off a bridge, so much to my dismay, I've been put on a triphasic BCP. Thyroid
> and PCOS have been ruled out, its just a problem with the hypothalamus not pulsing GnRH.
>
> Dilemma: I have read that exercise/low bodyfat causes HA because the continuous elevated cortisol
> has been and continues to inhibit GnRH pulse. I have been told by a Reproductive Endocrinologist
> that an opioid blocker like Naltrexone could easily restore GnRH pulse, but from what I read about
> this drug, in the doseage he recomended, it increases cortisol levels. Gah? I have also read that
> cortisol blockers could restore GnRH pulse. I'm so confused. I'll try anything at this point, I
> just want to know how it works. Rant: I don't believe for a second that being on the BCP will
> somehow trick my system back into working, since it also shutts down GnRH pulse. I have learned
> far more about this subject than I should in an attempt to help myself, since my doctor's reaction
> is simply "you're just one of those women who don't get periods, enjoy it! But no libido huh, that
> must suck" (jerk). I've also been to naturopaths, acupuncture, reike, Chinese medicine
> practitioners, and ingested the nastiest tasting herbs and tinctures on the planet to no avail. I
> must admit though that I feel better after 2 days on the BCP than I have with anything else, but
> still no libido yet. I have cured my eating disorder and happily gained 20 pounds in less than a
> year - no problem. Getting a straight answer has been a nightmare.

Er, why don't you provide the minimal information, such as how old you are? And what were your FSH
and LH levels doing during that year you weren't having periods, but weren't taking hormones either?

If your FSH is very high all the time and you're not having periods, you're in (perhaps premature)
menopause. If your FSH is low all the time even when you're not on hormones, it might be a pituitary
or a hypothalamic problem. They have to GIVE you GnRH to find out. If you're even interested in
mechanisms (which you probably are not unless you're interested in getting pregnant).

Hormone replacement is a matter of finding what your body likes. Libido is controlled by
testosterone not the stuff in BCPs, so if you want to mess with that you have to take small doses
separately. They are available for women.
 
Age 28 BLoodwork: fsh 4 lh 1 prolactin 8 estradiol 54 prog. 1.2 free test .6

As the title of my message suggests, this IS a hypothalamic problem.

I was on the pill when I lost my periods, so nobbody did hormone bloodowrk. It was obvious that it
was bodyfat and exercise related (I was 102 pounds, 12% bf)

I think it's silly that they won't *give* someone GnRH pulse unless they want to get pregnant. That
would be nice to have a baby, but the

-which is needed to conceive. I have read every endocrinology test and study on amenorrhea I can get
my hands on, and unfortunately, I likely know more than you do about this topic. They won't give
testosterone repolacement to someone my age.

Thanks for responding though.

[email protected] (Steve Harris [email protected]) wrote in message
news:<[email protected]>...
> [email protected] (Izabella) wrote in message
> news:<[email protected]>...
> > I have been diagnosed with HA and I'm pretty confused about treatment options. A little
> > background: I lost myperiods 2 years ago due to low bodyfat and excessive exercise. At the time,
> > I was told it was my low dose birth control pill that stopped my periods and killed off my
> > libido, but when I went off the pill the periods didn't return and haven't for over a year. My
> > bodyfat and exercise level and food intake have been normal and healthy for a year and there has
> > been no sign of hormone production. The Provera challenge didn't work, natural
> > estrogen/progesterone made me want to hurl myself off a bridge, so much to my dismay, I've been
> > put on a triphasic BCP. Thyroid and PCOS have been ruled out, its just a problem with the
> > hypothalamus not pulsing GnRH.
> >
> > Dilemma: I have read that exercise/low bodyfat causes HA because the continuous elevated
> > cortisol has been and continues to inhibit GnRH pulse. I have been told by a Reproductive
> > Endocrinologist that an opioid blocker like Naltrexone could easily restore GnRH pulse, but from
> > what I read about this drug, in the doseage he recomended, it increases cortisol levels. Gah? I
> > have also read that cortisol blockers could restore GnRH pulse. I'm so confused. I'll try
> > anything at this point, I just want to know how it works. Rant: I don't believe for a second
> > that being on the BCP will somehow trick my system back into working, since it also shutts down
> > GnRH pulse. I have learned far more about this subject than I should in an attempt to help
> > myself, since my doctor's reaction is simply "you're just one of those women who don't get
> > periods, enjoy it! But no libido huh, that must suck" (jerk). I've also been to naturopaths,
> > acupuncture, reike, Chinese medicine practitioners, and ingested the nastiest tasting herbs and
> > tinctures on the planet to no avail. I must admit though that I feel better after 2 days on the
> > BCP than I have with anything else, but still no libido yet. I have cured my eating disorder and
> > happily gained 20 pounds in less than a year - no problem. Getting a straight answer has been a
> > nightmare.
>
>
>
>
> Er, why don't you provide the minimal information, such as how old you are? And what were your
> FSH and LH levels doing during that year you weren't having periods, but weren't taking
> hormones either?
>
> If your FSH is very high all the time and you're not having periods, you're in (perhaps premature)
> menopause. If your FSH is low all the time even when you're not on hormones, it might be a
> pituitary or a hypothalamic problem. They have to GIVE you GnRH to find out. If you're even
> interested in mechanisms (which you probably are not unless you're interested in getting
> pregnant).
>
> Hormone replacement is a matter of finding what your body likes. Libido is controlled by
> testosterone not the stuff in BCPs, so if you want to mess with that you have to take small doses
> separately. They are available for women.
 
Age 28 BLoodwork: fsh 4 lh 1 prolactin 8 estradiol 54 prog. 1.2 free test .6

As the title of my message suggests, this IS a hypothalamic problem.

I was on the pill when I lost my periods, so nobbody did hormone bloodowrk. It was obvious that it
was bodyfat and exercise related (I was 102 pounds, 12% bf)

I think it's silly that they won't *give* someone GnRH pulse unless they want to get pregnant. That
would be nice to have a baby, but the

-which is needed to conceive. I have read every endocrinology test and study on amenorrhea I can get
my hands on, and unfortunately, I likely know more than you do about this topic. They won't give
testosterone repolacement to someone my age.

Thanks for responding though.

[email protected] (Steve Harris [email protected]) wrote in message
news:<[email protected]>...
> [email protected] (Izabella) wrote in message
> news:<[email protected]>...
> > I have been diagnosed with HA and I'm pretty confused about treatment options. A little
> > background: I lost myperiods 2 years ago due to low bodyfat and excessive exercise. At the time,
> > I was told it was my low dose birth control pill that stopped my periods and killed off my
> > libido, but when I went off the pill the periods didn't return and haven't for over a year. My
> > bodyfat and exercise level and food intake have been normal and healthy for a year and there has
> > been no sign of hormone production. The Provera challenge didn't work, natural
> > estrogen/progesterone made me want to hurl myself off a bridge, so much to my dismay, I've been
> > put on a triphasic BCP. Thyroid and PCOS have been ruled out, its just a problem with the
> > hypothalamus not pulsing GnRH.
> >
> > Dilemma: I have read that exercise/low bodyfat causes HA because the continuous elevated
> > cortisol has been and continues to inhibit GnRH pulse. I have been told by a Reproductive
> > Endocrinologist that an opioid blocker like Naltrexone could easily restore GnRH pulse, but from
> > what I read about this drug, in the doseage he recomended, it increases cortisol levels. Gah? I
> > have also read that cortisol blockers could restore GnRH pulse. I'm so confused. I'll try
> > anything at this point, I just want to know how it works. Rant: I don't believe for a second
> > that being on the BCP will somehow trick my system back into working, since it also shutts down
> > GnRH pulse. I have learned far more about this subject than I should in an attempt to help
> > myself, since my doctor's reaction is simply "you're just one of those women who don't get
> > periods, enjoy it! But no libido huh, that must suck" (jerk). I've also been to naturopaths,
> > acupuncture, reike, Chinese medicine practitioners, and ingested the nastiest tasting herbs and
> > tinctures on the planet to no avail. I must admit though that I feel better after 2 days on the
> > BCP than I have with anything else, but still no libido yet. I have cured my eating disorder and
> > happily gained 20 pounds in less than a year - no problem. Getting a straight answer has been a
> > nightmare.
>
>
>
>
> Er, why don't you provide the minimal information, such as how old you are? And what were your
> FSH and LH levels doing during that year you weren't having periods, but weren't taking
> hormones either?
>
> If your FSH is very high all the time and you're not having periods, you're in (perhaps premature)
> menopause. If your FSH is low all the time even when you're not on hormones, it might be a
> pituitary or a hypothalamic problem. They have to GIVE you GnRH to find out. If you're even
> interested in mechanisms (which you probably are not unless you're interested in getting
> pregnant).
>
> Hormone replacement is a matter of finding what your body likes. Libido is controlled by
> testosterone not the stuff in BCPs, so if you want to mess with that you have to take small doses
> separately. They are available for women.
 
Age: 28 Bloodwork: fsh 4 lh 1 prolactin 8 estradiol 54 prog. 1.2 test .6

low FSH. As the title of this entry suggests, this is a hypothalamic problem - not menopause. It is
obvious that it came about from over exercise and low bodyfat. My periods stopped while I was on the
pill (I was on them for 13 years), so nobody bothered to do hormone bloodwork because it would be
masked by the synthetic hormones.

I have read everything I can get my hands on about endocrinology and hormones, which in fact, I am
very interested in. Unfortunately, they won't giveme GnRH unless I want to conceive, which I do,
but I lack

before I go and take something that they will only give to those wishing to conceive (lthough it
would be something that could kick my hypothalamus back into gear - conception or not) They won't
give me testosterone shots at my age either.

Fortunately, I just signed up to be a guinnea pig at the University of Toronto to be part of a study
that may help women in my situation.

> Er, why don't you provide the minimal information, such as how old you are? And what were your
> FSH and LH levels doing during that year you weren't having periods, but weren't taking
> hormones either?
>
> If your FSH is very high all the time and you're not having periods, you're in (perhaps premature)
> menopause. If your FSH is low all the time even when you're not on hormones, it might be a
> pituitary or a hypothalamic problem. They have to GIVE you GnRH to find out. If you're even
> interested in mechanisms (which you probably are not unless you're interested in getting
> pregnant).
>
> Hormone replacement is a matter of finding what your body likes. Libido is controlled by
> testosterone not the stuff in BCPs, so if you want to mess with that you have to take small doses
> separately. They are available for women.

[email protected] (Steve Harris [email protected]) wrote in message
news:<[email protected]>...
> [email protected] (Izabella) wrote in message
> news:<[email protected]>...
> > I have been diagnosed with HA and I'm pretty confused about treatment options. A little
> > background: I lost myperiods 2 years ago due to low bodyfat and excessive exercise. At the time,
> > I was told it was my low dose birth control pill that stopped my periods and killed off my
> > libido, but when I went off the pill the periods didn't return and haven't for over a year. My
> > bodyfat and exercise level and food intake have been normal and healthy for a year and there has
> > been no sign of hormone production. The Provera challenge didn't work, natural
> > estrogen/progesterone made me want to hurl myself off a bridge, so much to my dismay, I've been
> > put on a triphasic BCP. Thyroid and PCOS have been ruled out, its just a problem with the
> > hypothalamus not pulsing GnRH.
> >
> > Dilemma: I have read that exercise/low bodyfat causes HA because the continuous elevated
> > cortisol has been and continues to inhibit GnRH pulse. I have been told by a Reproductive
> > Endocrinologist that an opioid blocker like Naltrexone could easily restore GnRH pulse, but from
> > what I read about this drug, in the doseage he recomended, it increases cortisol levels. Gah? I
> > have also read that cortisol blockers could restore GnRH pulse. I'm so confused. I'll try
> > anything at this point, I just want to know how it works. Rant: I don't believe for a second
> > that being on the BCP will somehow trick my system back into working, since it also shutts down
> > GnRH pulse. I have learned far more about this subject than I should in an attempt to help
> > myself, since my doctor's reaction is simply "you're just one of those women who don't get
> > periods, enjoy it! But no libido huh, that must suck" (jerk). I've also been to naturopaths,
> > acupuncture, reike, Chinese medicine practitioners, and ingested the nastiest tasting herbs and
> > tinctures on the planet to no avail. I must admit though that I feel better after 2 days on the
> > BCP than I have with anything else, but still no libido yet. I have cured my eating disorder and
> > happily gained 20 pounds in less than a year - no problem. Getting a straight answer has been a
> > nightmare.
>
>
 
[email protected] (Izabella) wrote in message news:<[email protected]>...
> Age 28 BLoodwork: fsh 4 lh 1 prolactin 8 estradiol 54 prog. 1.2 free test .6
>
> As the title of my message suggests, this IS a hypothalamic problem.
>
> I was on the pill when I lost my periods, so nobbody did hormone bloodowrk. It was obvious that it
> was bodyfat and exercise related (I was 102 pounds, 12% bf)
>
> I think it's silly that they won't *give* someone GnRH pulse unless they want to get pregnant.
> That would be nice to have a baby, but the

> -which is needed to conceive.

COMMENT:

You don't need GnRH to raise your testosterone. Why pay thousands of dollars for something that
costs a few dollars?

I have read every endocrinology test and
> study on amenorrhea I can get my hands on, and unfortunately, I likely know more than you do about
> this topic. They won't give testosterone repolacement to someone my age.

Maybe just not to someone of your arrogance. Or your lack of forthcoming (since you've yet to GIVE
your age in two messages, and despite a request). If your testosterone levels test low for a woman,
and you have libido problems, you can somewhere find a doctor to give you replacement to

out your phonebook.

Second option is that you can always take DHEA-S, which is OTC. If your T is really low as a female,
this should raise it significantly.

SBH

Menopause. 2003 Sep-Oct;10(5):390-8.

function in premenopausal women.

Goldstat R, Briganti E, Tran J, Wolfe R, Davis SR.

Jean Hailes Foundation Research Unit, Clayton, Victoria, Australia; and the Department of
Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School,
Prahran, Victoria, Australia.

SUMMARY: OBJECTIVE Circulating testosterone in women declines during the late reproductive years
such that otherwise healthy women in their 40s have approximately half the testosterone level as
women in their 20s. Despite this, research showing the benefits of androgen replacement has been
limited to the postmenopausal years. In view of the known premenopausal physiological decline in
testosterone, we have evaluated the efficacy of transdermal testosterone

premenopausal women presenting with low libido.DESIGN Premenopausal women with low libido
participated in a randomized, placebo-controlled, crossover, efficacy study of testosterone cream
(10 mg/day) with two double-blind, 12-week, treatment periods separated by a single-blind, 4-week,
washout period.RESULTS Thirty-four women completed the study per protocol, with 31 women (mean age
39.7 +/- 4.2 years; serum testosterone 1.07 + 0.50 nmol/L) providing complete data. Testosterone
therapy resulted in statistically significant improvements in the composite scores of the
Psychological General Well-Being Index [+12.9 (95% CI, +4.6 to

(95% CI, +6.5 to +25.0), P = 0.001] compared with placebo. A mean decrease in the Beck
Depression Inventory score approached significance [-2.8 (95% CI, -5.7 to +0.1), P = 0.06]. Mean
total testosterone levels during treatment were at the high end of the normal range, and
estradiol was unchanged. No adverse effects were reported.CONCLUSIONS Testosterone therapy
improves well-being, mood,

function in premenopausal women with low libido and low testosterone. As a

well-being during their late reproductive years, further research is warranted to evaluate the
benefits and safety of longer-term intervention.

PMID: 14501599 [PubMed - in process]

Decreased testosterone in regularly menstruating women with decreased libido: a clinical
observation.

Guay AT.

Drive, Peabody, MA 01960, USA.

Much more information is available concerning decreased libido in postmenopausal than in
premenopausal women. Even less is known about androgen deficiency in younger women. We measured
total and free testosterone levels in 12 consecutive premenopausal women complaining of decreased
libido. Of the 12 women, 8 had low or immeasurable levels of testosterone despite having regular
menstrual periods. Androgen precursor hormones, DHEA-S and Androstenedione, were low-normal to high-
normal. Treatment with oral DHEA, 50 to 100 mg per day, restored

desire in 6 of the 8 women, gave partial improvement in one, and failed in another. Possible
significance and etiological mechanism are discussed.

PMID: 11554213 [PubMed - indexed for MEDLINE]

J Reprod Med. 2001 Mar;46(3 Suppl):291-6.

Testosterone deficiency in women.

Davis S.

Jean Hailes Foundation, 173 Carinish Road, Clayton, Victoria, 3168, Australia.
[email protected]

enhancing

stimulation. Testosterone is also associated with greater well-being and with reduced anxiety and
depression. Clinical and biochemical definitions of T deficiency have not been established; hence,
the prevalence of this condition is not known. However, surgically menopausal women are among the
populations most likely to experience T deficiency, a syndrome characterized by blunted or
diminished motivation; persistent fatigue; decreased sense of personal well-being; sufficient plasma
estrogen levels; and low circulating bioavailable T (either a low

hormone binding globulin (SHBG) ratio or free T in the lower one-third of the female reproductive
range); and low libido. Exogenous estrogen, particularly when administered orally, increases SHBG,
which, in turn, reduces free T and estradiol (E2). After oophorectomy, levels of T and its
precursor, androstenedione, decline by approximately 50%. T replacement continues to be evaluated as
an adjunct to estrogen replacement therapy, particularly for women with androgen deficiency
symptoms, surgically menopausal women and women with premature ovarian failure. In the United
States, oral methyltestosterone is the common product currently approved for androgen replacement in
women. The best product specifically designed for women has yet to be determined, as standardized,
long-term, randomized, control clinical studies are lacking and product refinement continues.

Publication Types: Review Review, Tutorial

PMID: 11304877 [PubMed - indexed for MEDLINE]

Fertil Steril. 2003 Jun;79(6):1341-52.

Comparative effects of oral esterified estrogens with and without

function in

Lobo RA, Rosen RC, Yang HM, Block B, Van Der Hoop RG.

Department of Obstetrics and Gynecology, Columbia University, College of Physicians and Surgeons and
New York Presbyterian Hospital, New York, New York 10032, USA. [email protected]

relative androgen insufficiency after menopause. We sought to characterize the hormonal effects of
the combination of oral esterified estrogens and methyltestosterone

desire. DESIGN: Double-blind randomized trial. SETTING: Healthy volunteers in a multicenter research
environment. PATIENT(S): Postmenopausal women taking

INTERVENTION(S): 4 months of treatment with 0.625 mg of esterified estrogens (n
= 111) or the combination of 0.625 mg of esterified estrogens and 1.25
mg of methyltestosterone (n = 107). MAIN OUTCOME MEASURES: Baseline and end-of-study

hormone-binding

as rated

combination of esterified estrogens and methyltestosterone significantly increased the concentration
of bioavailable testosterone and suppressed SHBG. Scores measuring

baseline with combination treatment and were significantly greater than those achieved with
esterified estrogens alone. Treatment with the combination was well tolerated. CONCLUSION(S):
Increased circulating levels of unbound testosterone and suppression of SHBG provide a plausible
hormonal explanation for the

combination of esterified estrogen and methyltestosterone.

Publication Types: Clinical Trial Multicenter Study Randomized Controlled Trial

PMID: 12798881 [PubMed - indexed for MEDLINE]
 
Like you, I haven't had a period come on its in one year. The last period I had was November 11, 2012. I have been to specialist after specialist with no luck. The closest answer to my loss of period is Hypothalamic amenorrhea. The endocrinologist told me based on everything that has gone on in my life this is how the stress has manifested itself. Now the real question is how do I get my period back. I went on provera once, didn't work. the cocktail of estrogen and provera did work but I got bad side effects and could no longer continue that treatment. I tried provera one more time. This 10 day cycle of the 10mg pills did work! That was in September. It is now coming on November and I haven't had a period again. How do I get it back?
I have gained weight, I do yoga almost everyday but the endocrinologist said this shouldn't affect the return of my period.
I was told the longer I go without a period the harder it will be to get it back.
How do I get it back?
I am worried that this will affect my fertility. I just want some more clear answers..
I keep being told not to stress, but how do I not stress about this?