Queen of Hearts Fertility Care & NaProTechnology

Queen of Hearts Fertility Care & NaProTechnologyQueen of Hearts Fertility Care & NaProTechnologyQueen of Hearts Fertility Care & NaProTechnology
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Queen of Hearts Fertility Care & NaProTechnology

Queen of Hearts Fertility Care & NaProTechnologyQueen of Hearts Fertility Care & NaProTechnologyQueen of Hearts Fertility Care & NaProTechnology
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Functional Hypothalamic Amenorrhea (FHA)

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 

Just a bit of Anatomy & Physiology....

  • The name, Functional HYPOTHALAMIC Amenorrhea or Functional HYPOTHALAMIC Oligomenorrhea tells you that the location of the problem is in the HYPOTHALAMUS. 
  • The hypothalamus is an area very deep in the center of your brain that is responsible for making an important hormone called Gonadotropin Releasing Hormone (GnRH). 
  • When a woman expends more calories than she takes in via her diet, her body will decrease or stop producing  GnRH. 
  • When GnRH is not secreted or minimally secreted, it will cause low FSH, Low LH, low estrogen, and low progesterone due to the downstream effect shown in the diagram above. 
  • FSH (Follicle Stimulating Hormone) is required in order to grow a healthy ovarian follicle which matures the woman's egg. 
  • LH (Luteinizing Hormone) is required for the egg to be released by the ovary during normal healthy ovulation. 
  • Thus, normal levels of FSH, LH, estrogen and progesterone are all required for a healthy ovulation and pregnancy to occur.

Can you handle a little more?

  • This picture may look the same as the first image, but look closer. You will see the title "Hypothalamic-Pituitary-Thyroid Axis" is different.  
  • The hypothalamus is also intimately involved in regulating thyroid hormone function, which is often also affected in women with FHA. 
  • Thyrotropin Releasing Hormone (TRH) is synthesized and secreted in the hypothalamus. 
  • When TRH is not being secreted or it is minimally secreted, it will result in low Thyroid Stimulating Hormone (TSH) being secreted by the pituitary gland, which is located deep in the brain. 
  • Low TSH results in low thyroid hormone synthesis by the thyroid gland. 
  • The thyroid gland (located in your neck region) will use iodine, to make thyroid hormones T3 and T4. 
  • T4 is made in much greater quantity than T3, but only T3 is "active". 
  • T4 is converted to T3 in the liver, kidney, brain and muscle cells. 
  • Almost every cell in the body will take up T3, which will regulate metabolism. "Metabolism" is when each cell uses oxygen and glucose, delivered to it via the bloodstream, to make energy to sustain life. 
  • So, we could say that our thyroid hormones help to regulate our metabolism. In reality, they do much, much more.....
  • High T4/T3 (HYPERthyroidism) may result in anxiety, weight loss, insomnia, diarrhea, heavy periods, infertility, recurrent miscarriage, etc.. 
  • Low T4/T3 (HYPOthyroidism) may result in fatigue, depression, dry skin and hair, infrequent or no periods, infertility, recurrent miscarriage, and even permanent brain damage to a growing baby in the womb. 
  • For this reason, I will keep your thyroid gland functioning well. 

The Good news is...

Life Style Changes are Often Effective Treatment

  • Diet/ weight GAIN
  • DECREASE exercise
  • Adequate calcium intake for bone health, 600 mg 2x daily, 8 hrs apart
  • Adequate Vitamin D intake (lab value > 50 ng/ml) 
  • Note: If Vit D is low, your body will not be able to absorb the calcium you ingest, in order to be taken up by your bones to keep them healthy. 

recommended dietitian

What will a NaPro appointment with Sharon Best be like?

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. 

Fertility Care Practitioners webpage


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. 

Creighton Model Charting

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. 

recommended dietitian


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. 

Meet Dr. Naomi Whittaker

What type of laboratory tests may be done?

What type of laboratory tests may be done?

What type of laboratory tests may be done?

laboratory tests

What type of imaging tests may be done?

What type of laboratory tests may be done?

What type of laboratory tests may be done?

Imaging Tests

Treatments for Functional Hypothalamic Amenorrhea/ Oligomenorrhea

Urinary LH-monitor (ClearBlue) Why I would not recommend use

Urinary LH-monitor (ClearBlue) Why I would not recommend use

Treatments

Urinary LH-monitor (ClearBlue) Why I would not recommend use

Urinary LH-monitor (ClearBlue) Why I would not recommend use

Urinary LH-monitor (ClearBlue) Why I would not recommend use

LH-monitors

How can I make an appointment?

You can schedule an appointment to see Sharon at Natural Women's Health by calling the office at: 215-939-4251. If you would just like to chat to find our more information, please email stbest8@gmail.com and a phone appointment can can easily be scheduled. 

Copyright © 2022 Queen of Hearts Fertility Care  & Napro Technology - All Rights Reserved.

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