Many people are aware that having irregular periods negatively affects hormones and fertility, but did you know that not having a period can affect your bone health? For example, hormonal conditions like hypothalamic amenorrhea (HA), increase the risk of low bone density and fractures. If you are struggling with an irregular or absent cycle, this is just another reason to investigate your hormones, and get on a plan to feel better. 

What is hypothalamic amenorrhea? 

HA is a hormonal condition that is diagnosed when absent periods are due to decreased food intake, low food intake relative to high activity level, and/or high stress. When the body isn’t getting what it needs to function properly, it will stop ovulating & menstruating to ensure that energy is going towards the functions that are needed to survive. This means that blood work will often reveal low levels of hormones (ex. FSH, LH, estradiol). Blood work is a necessary part of understanding this condition, as we want to confirm the diagnosis and rule out other causes of absent periods (ex. PCOS). HA can be common among athletes, and occurs when the energy intake (ie. food) is less than the energy output (ie. exercise). HA can also be common in those with diagnosed eating disorders, or disordered eating behaviours. The ripple effects of HA can be felt throughout many different body systems, including bone. 

Why are we concerned about bone health? 

After learning more about HA, bone health may seem like the least of our concerns. However, it deserves just as much attention as hormones. You need estrogen to support bone health, and this hormone is low in those with HA. This means that those with HA are at higher risk of developing low bone density, which can lead to fractures. Fractures are painful, take time to heal, and can have a negative impact on quality of life. For athletes, fractures can be particularly difficult. For these reasons, bone density scans are recommended for people with HA to better understand their risk, and help guide treatment recommendations that support bone health. 

Getting better 

There are therapies, like hormone replacement, that can help improve bone density, but the most important treatment will be addressing the underlying reason that HA developed. In conditions like HA, the phrase “treating the root cause,” is quite important. Only giving “hormone balancing herbs,” or the birth control pill is not appropriate for this condition. Instead, addressing the root causes (ex. Undereating, over-exercising) is a necessary part of recovering from HA. The problem with options like the birth control pill, especially if it is being used to “regulate the cycle,” is that it will mask the symptoms of the underlying diagnosis. It doesn’t address the reasons why someone developed an irregular period (ex. underfueling), withdrawal bleeding can give people a false sense of security, and importantly, it does not improve bone density as well as other therapies. If you think you might have HA, it is time to get support. If you have HA, but haven’t discussed bone health with your provider, now is the time. Finding a provider that will talk to you about your relationship to food, exercise, and stress is important. Also, make sure to ask about bone scans, and discuss how to support your bone health while you recover. 

If you would like to learn more about this topic, please don't hesitate to book in for a naturopathic appointment at Juniper Family Health. We are here to help!

References

Ackerman KE, et al. Functional hypothalamic amenorrhea: evaluation and management. UpToDate, 2022. 

Gordon CM, Ackerman KE, Berga SL, et al. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:1413