Key Differences Between Hypothalamic Amenorrhea (HA) and Polycystic Ovarian Syndrome (PCOS)
Both Hypothalamic Amenorrhea (HA) and Polycystic Ovarian Syndrome (PCOS) can cause irregular or absent periods, but they have different underlying causes, clinical presentations, and hormone profiles, making correct diagnosis essential for proper treatment.
So what exactly is going on for each syndrome?
When looking at the difference, HA is caused by stress, excessive exercise, under-eating, or low body fat. This leads to a suppression of the hypothalamic-pituitary-ovarian (HPO) axis. PCOS, on the other hand, is a hormonal and metabolic condition associated with insulin resistance, high androgens (male hormones), and ovarian dysfunction.
Hormone Pathology
HA typically presents with low hormonal markers. Generally all LH (luteinising hormone), FSH (follicle-stimulating hormone), oestrogen and AMH (anti-Müllerian hormone) can be low, as the brain signals to the ovaries are reduced. Results associated with PCOS are often characterised by elevated markers, being high LH and AMH, and elevated androgens (testosterone, DHEA-S), contributing to symptoms like acne and excess hair growth.
If you’re thinking you may have either condition but are not really sure, it is often an ultrasound that is completed in conjunction with blood work. The ovarian appearance on ultrasound is also very different between HA and PCOS. Women with HA usually have small or normal-sized ovaries with little to no follicular activity, whereas PCOS is associated with enlarged ovaries with multiple small follicles (often called “polycystic” ovaries), but no ovulation.
Does this resonate with you? What are some of the symptoms?
When looking at common symptoms we often see in clinic women with lean or athletic bodies, associated with low body fat mass, high stress response, excessive exercise and disordered eating patterns that have HA. Women with PCOS present with weight gain, insulin resistance, acne, excess hair growth (called hirsutism) and irregular ovulation.
What About Fertility? Why Does This Matter? Treatment for each condition is very different.
Both conditions often need support around reducing stress, with HA requiring an increased calorie intake diet (especially carbs and healthy fats), and decreasing excessive exercise to restore the production of hormones. In PCOS we look heavily into diet and how to reduce insulin resistance to blood sugar management, lowering androgens through herbs, lifestyle modifications, and acupuncture.
PCOS we often we suggest low GI foods, good fats and regular exercise, but for HA the opposite advice is given.
HA can often happen to women who have low body weight or calorie deficiency, and or over exercise. Often HA recommend to eat more protein, good fats, and more calories in gerneral, as well as reduce intense exercise.
When looking into primary and secondary forms of amenorrhea it’s important to note that thyroid function, certain meditations, diabetes, physical stress and premature ovarian insufficiency (POI – which we also can treat!) can also be part of the picture with HA. Anything that affects our hypothalamus in the brain and then switches off our menstruation hormonal casades. However all of these red flags can be treated and do not need to be a road block towards a healthy menstrual cycle.
If you’ve read this far and still feeling unsure on which condition you may have, we recommend working with a fertility acupuncturist at the clinic to help guide you toward the right diagnosis and treatment approach as each person is treated holistically and tailored support is given. Taking control of your hormones and starting your journey towards better health doesn’t have to be hard, we are your biggest cheerleaders in balancing your hormones naturally and creating a better longevity.
Book in with our fertility acupuncturists.
The Acupuncture Pregnancy Clinic offers supportive and collaborative care through acupuncture and Chinese medicine for fertility, IVF, pregnancy, and women’s health. You can find us in Westmead, Sydney CBD, Alexandria, Gosford, Melbourne, and Mornington.
