Functional Hypothalamic Amenorrhea (FHA)

Amenorrhea = no menstrual period

Oligomenorrhea = infrequent or scanty menstrual periods, specifically fewer than 6-8 periods a year. 

When a woman burns more calories than she takes in by eating, her body will sense a "caloric deficit" and try to conserve its fuel for the more important vital organs, such as the heart, lungs, and kidneys. Your reproductive system will be last in line. 

Excessive exercise (women athletes), eating disorders (anorexia nervosa, bulimia nervosa), disordered eating (excessive dieting) and emotional stress are the most common causes of Functional Hypothalamic Amenorrhea (FHA) or Functional Hypothalamic oligomenorrhea. 

** NOTE: FHA and PCOS often co-exist. Please see the PCOS webpage 

Your appointments at Natural Women's Health with me will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol as outlined below. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model Charting is very important. Your CrMS chart will help direct me to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate. 

First Appt: I will take a comprehensive medical history. You will be asked to begin charting your menstrual cycles using the Creighton Model System (CrMS). Please choose a Fertility Care Practitioner by clicking the button below and begin to chart your cycle. 

Note: If I have a very high suspicion that you may have Functional Hypothalamic Amenorrhea/Oligomenorrhea, by the history you give during this visit, I may wish to order a baseline ultrasound and few labs prior to seeing your charting, such as FSH, LH and estradiol (E2). The ultrasound and labs must be done together on day 3-5 of your next menstrual cycle to be of much benefit. I may also order a Brain MRI to be sure that there is not an abnormal growth near your hypothalamus. This would be very unlikely, but the proper protocol would be to check. If your estrogen comes back low, I would want to order a DEXA scan to be sure you do not have early osteoporosis. Estrogen is directly responsible to help us maintain strong healthy bones. 

Second Appt:  You will be asked to return to Natural Women's Health  for a follow-up appointment with me after you have charted two full menstrual cycles. Together we will review your Creighton Model Chart, a GYN physical examination will be preformed, and additional laboratory tests & imaging studies will be ordered. Some tests will be specifically timed to your Creighton model chart. We will also look for certain "biomarkers" in your menstrual cycle to help guide your medical management. 

Third Appt:  You will return to the office two weeks later to review the results of your laboratory and imaging studies. Depending on your results, you may be asked to undergo additional testing, start medications and/or perhaps make an appointment with another specialist such as a dietician, a bone specialist, an endocrinologist, and or psychologist/psychiatrist. 

Follow Up Appts:  You will return to the office every two months to monitor and/or make adjustments to medications and your treatment plan. 

After 6 months, if life style changes and medical management have been unsuccessful, you will be referred to Dr. Naomi Whittaker, MD who is a NaPro surgeon. You will undergo an evaluation. Dr. Whittaker will review your Creighton Model Charting as well as the medical management you have received thus far. Together you will formulate a surgical treatment plan.