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 and a pelvic ultrasound will ordered which should be done on day 5-7 of your next menstrual cycle. I will also  order FSH/LH and estrogen labs, which must be done on day 3 of your next menstrual cycle.  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 learn how to schedule your first Introductory Session.  

Note: If I have a very high suspicion you have FHA, 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 osteopenia or osteoporosis. Estrogen is directly responsible to help us maintain strong healthy bones. 

Second Appt: You will be asked to return to the office in one month for a follow-up appointment to review the results of your imaging and lab tests. Together we will also review your Creighton Model Chart and look for specific biomarkers in your menstrual cycle. Please upload an image of your CrMS chart two days prior to all follow up visits and send to me via the portal. 

A full GYN physical examination will be preformed (unless you have had a recent well woman exam), and additional laboratory and/or imaging tests may be considered to continue to guide your medical management. 

Third Appt:  You will return to the office in one month to review the results of your laboratory and imaging studies and your CrMS chart. At this time, we will consider ordering a progesterone and estrogen panel, which will be specifically timed to your CrMS chart. Click the "Laboratory Tests" button below for more detail. Depending on your results, you may be asked to 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.