Hypothalamic Amenorrhea V PCOS

Hypothalamic amenorrhea (HA) accounts for around 30% of cases of secondary amenorrhea in females. It is caused by deficient secretion of hypothalamic gonadotrophin-releasing hormone (GnRH), which in turn slows or inhibits the communication from the brain and ovary, preventing follicle growth and ovulation, HA is predominantly caused by significant weight loss, intense exercise, undereating or stress.

In HA there are significantly lower levels of follicle stimulating hormone, luteinizing hormone and estrogen.

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine/metabolic disorders in women. PCOS is defined by a combination of signs and symptoms of elevated androgens and ovarian dysfunction in the absence of other specific diagnoses. Click here for more on accurate diagnosis. Although the exact cause of PCOS is not yet fully understood, insulin resistance, chronic low grade inflammation and genetics all play a role in PCOS. Along with this, continuous high levels of LH stimulate the ovaries to produce androgens (think testosterone) which further inhibits ovulation.

So where's the confusion?

Both HA and PCOS can present the same but they are different! Both can present with menstrual irregularities and both can present with polycystic 'appearing' ovaries, in fact this study share that polycystic ovarian morphology has also been reported in 30-50% of women with functional hypothalamic amenorrhea!

How can you look out for the difference between the two?

PCOS can look like:

Menstrual irregularities, acne, hirsutism (excess body hair), hair loss, anxiety, weight gain around the abdomen (It is important to note, you do not have to have excess body fat to have PCOS).

HA can look like:

Absent/irregular periods, possible acne, stress, anxiety, weight loss

Blood tests will be a great place to start. PCOS is a diagnosis of exclusion, so HA must be ruled out before a diagnosis of PCOS. As I mentioned earlier, LH:FSH ratio tends to be continuously elevated in PCOS, where as in HA LH:FSH ratio tends to be lower. Fasting insulin can also to be higher in PCOS and lower in HA.

It is also important to know that it is possible to have both HA and PCOS at the same time. But the starting place would be to work on recovery from HA first.

It is important to have an accurate diagnosis, to start with the correct treatment plan.

Ailish 🌻