The idea of not having a period can seem pretty appealing: no running around looking for a tampon, no worries about stains, no cramps. However, skipping periods unexpectedly, when there’s no obvious reason — like pregnancy — behind their disappearance, is a medical problem, even if you greet it with a sigh of relief. For people who’ve recently undergone a lot of stress, are working out more than usual, or aren’t taking in enough calories, the resulting lack of energy can lead to the loss of a period, which is called hypothalamic amenorrhea.
People can stop having periods for a variety of reasons; some birth control, for instance, can stop periods, and you can skip menstruation on the combined Pill by opting to take active pills continuously. Dr. James Stelling, a reproductive endocrinologist at Island Fertility at Stony Brook Medicine, tells Bustle that amenorrhea is "the medical term for when a women goes an extended period without getting a period"; hypothalamic amenorrhea is just one kind. However, it’s a diagnosis with its own particular dangers.
Hypothalamic amenorrhea is also known as stress amenorrhea, says Dr. Stelling, because usually the person has experienced some kind of stress that has stopped their periods. This isn’t just stress in terms of a hard time at work, although that can lead to amenorrhea as well — stress caused by excessive exercising or weight change can also lead to this loss of period.
"Essentially the body is going into survival mode, telling the brain that the body’s energy is best spent elsewhere," Dr. Michael Cackovic, OBGYN at The Ohio State University Wexner Medical Center, tells Bustle. Stress, low calorie intake and low body fat deprive your hypothalamus, a part of your brain that controls the pituitary gland, to release the hormones that cause ovulation and periods, he says. Turning periods off is a pretty drastic measure for the body, but for the hypothalamus, it’s a sensible measure. People who are under a lot of stress aren’t likely to be able to carry a pregnancy, and the brain is sensing that and preventing that from happening.
Hypothalamic amenorrhea is more common than you might think. The condition is responsible for around one-third of the cases where women have stopped menstruating, according to Dr. Cackovic. There are other causes beyond exercising, severe stress, caloric restriction, or eating disorders: serious chronic medical conditions or digestive issues that prevent proper nutrition can bring it on, too. Some people also develop growths on their pituitary or hypothalamus that can interfere with their function.
And this interference can have consequences in the long term. "One of the main clinical concerns in women with hypothalamic amenorrhea is bone loss due to low estrogen levels," Dr. Cackovic says. The hormones released by the pituitary gland set off the production of estrogen and progesterone in the body, and without them, not only do you have no periods, you also have lower hormone levels overall — and that’s bad for your bones. This is why osteoporosis is such an issue for post-menopausal people, who have experienced a drop in estrogen and therefore a higher rate of bone loss. You need hormones to keep your bones strong, and without them your skeleton’s at risk. Low estrogen levels can also cause vaginal dryness and painful intercourse. For younger women, the biggest issue caused by hypothalamic amenorrhea may be fertility. The lack of ovulation that occurs in hypothalamic amenorrhea, says Dr. Stelling, "can make conception impossible."
Treating hypothalamic amenorrhea depends on what caused the stress in the first place. If you notice that your period has disappeared, it’s important to check in with your doctor about what could be behind the change — and what can help.
If you or someone you know has an eating disorder and needs help, call the National Eating Disorders Association helpline at 1-800-931-2237, text 741741, or chat online with a Helpline volunteer here.
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