One of the things that I regularly hear normalised is missing periods, often being written off as suspected PCOS without further investigation. However, this dismissive approach can potentially lead to serious underlying health issues going undiagnosed. In this piece, we’ll dive into two conditions that can cause irregular or absent periods: Polycystic Ovary Syndrome (PCOS) and Hypothalamic Amenorrhea (HA). While they may present similarly on the surface, understanding their differences is crucial for proper diagnosis and treatment.
Before we get into the specifics of both PCOS and HA, let’s first touch on why regular periods are so important. Despite what we may have been taught as teenagers, periods are about so much more than fertility; they are a key indication of a person’s overall health. Now referred to as a fifth vital sign - alongside heart rate, respiratory rate, body temperature and blood pressure - the menstrual cycle can point to a multitude of things happening in the body. Irregular or missing cycles can indicate various underlying issues such as thyroid disorders, hormonal imbalances or chronic stress, amongst others. Which is why it’s so important to pay attention to your cycle and not dismiss any changes or irregularities as normal.
Regular periods signal that your body is functioning as it should, meaning your hormones are in balance and all systems are working together harmoniously (or Hormoniously, should I say). When periods become irregular or stop altogether (outside of pregnancy and menopause), it’s the body’s way of signalling that something is off. The long-term consequences of this can be significant, from decreased bone density to fertility problems, as well as everything from mood to skin health.
The good news is that there’s now much more information and support available about both of these conditions, and here I’ll help you understand what steps to take if you suspect you have either of them.
PCOS: More Than Just Irregular Periods
Let’s start with PCOS, which is a hormonal disorder that impacts ovarian function. It is characterised by irregular or anovulatory cycles (cycles without ovulation), high levels of male hormones (also known as androgens), and also polycystic ovaries, though it’s important to note that not all of those with PCOS have cysts. A diagnosis of PCOS typically requires the presence of at least two of these three aforementioned key characteristics.
Whilst the exact cause of PCOS remains unknown, there are some patterns amongst those who have it. Many people with PCOS struggle with insulin resistance, meaning their bodies have trouble using insulin effectively, which can lead to insulin building up in the bloodstream and potentially triggering higher levels of androgens. Weight gain is also something many PCOS sufferers struggle with, which becomes a frustrating cycle in that PCOS can make it harder to lose weight, yet carrying extra weight can make the symptoms more severe.
Symptoms of PCOS
The hormonal imbalances in PCOS can cause a range of symptoms, including:
Irregular or absent periods
Excessive hair growth, also known as hirsutism
Acne
Male-pattern baldness
Difficulty losing weight
Fertility issues
It's important to note that PCOS is a diagnosis of exclusion, meaning other potential causes of these symptoms should be ruled out before confirming a PCOS diagnosis. Also important to note is that a scanas a standalone is not enough to diagnose or rule out PCOS.
Hypothalamic Amenorrhea: When Your Body Says Stop
Now turning to Hypothalamic Amenorrhea (HA), which is a condition where the hypothalamus, a region of the brain that controls hormone production, essentially shuts down the reproductive system. This occurs when the body perceives too much stress, either physical or psychological, and when the body is exerting more energy than it is taking in.
Short periods of amenorrhea can be normal in response to acute stressors like an illness, trauma, or surgery. However, if periods are absent for more than three consecutive cycles, it shouldn’t be ignored and needs further investigation.
HA is often triggered by:
Chronic stress
Overexercise
Undereating or extreme dieting
Rapid weight loss
Low body fat percentage
The body is incredibly smart, and if it perceives that there is not enough energy available for essential functions such as the heart and lungs, then it will redirect energy away from non-essential functions such as ovulation and reproduction.
PCOS & HA: How They Interconnect
Here's where things can get complicated. Many women with PCOS, in an attempt to manage their weight gain, may drastically restrict their diets or start to over-exercise. This can unfortunately inadvertently push them from a state of PCOS into HA.
The "move more, eat less" mantra, can be particularly dangerous for women with PCOS, because by potentially overdoing it, they may find themselves dealing with a whole new set of health issues related to HA, including:
Loss of menstrual cycle
Decreased bone density
Increased risk of stress fractures
Mood disturbances
Cardiovascular issues
It’s also worth mentioning that that extreme carbohydrate restriction, which is something that many people turn to as a result of PCOS weight gain, can actually signal the hypothalamus to shut down ovulation. This is because adequate carbohydrate intake is crucial for proper hormonal function. A normal question that follows here is - what is the right amount of carbohydrate to eat? If you know me, you might know what I’m going to say. This is really personal and depends on your unique biochemistry - your level of activity, your genetics, your levels of stress, your age, how well you’re sleeping all come into it.
The Importance of Proper Diagnosis
Given the potential for misdiagnosis and the serious health implications of both PCOS and HA, it's crucial to work with healthcare providers who are well-versed in these conditions. A proper diagnosis typically involves:
A detailed medical history
Blood tests to check hormone levels
Pelvic ultrasound (particularly for PCOS diagnosis)
Evaluation of stress levels, exercise habits, and dietary patterns
Treatment approaches for PCOS and HA differ significantly, which is why accurate diagnosis is so important.
Managing PCOS & HA: A Holistic Approach
The management of both PCOS and HA will be an incredibly unique journey, because each individual’s physiology will require a different approach. That said, there are a few blanket recommendations that I would universally suggest.
If you suspect you have PCOS, these are some lifestyle factors that you can look to implement:
At meals, fill your plate with nutritious, whole foods, and focus on getting a good amount of fibre from whole grains and vegetables (aiming for half your plate to be greens can be a good visual guideline)
Incorporate strength training into your week, as this can help the body to use insulin more efficiently
High levels of stress can worsen PCOS symptoms, so try a yoga or meditation app when possible to find some moments of calm
With PCOS putting the body in a state of low-grade inflammation, sleep is an essential tool to try and minimise the inflammatory response. With sleep deprivation contributing to inflammation, it’s essential to prioritise getting as much sleep as possible, ideally 8 hours per night - if you’re finding sleep difficult, we do see a correlation with PCOS and sleep issues, consider working with a holistic practitioner who can support you
Other inflammation culprits are the toxins in our everyday home and beauty products. The endocrine disruptors in a lot of products can interfere with our body’s hormonal systems - have a read of this recent article about some simple changes you can make today
If you suspect you have HA, there are two words I want you to consider: nourish and rest. The path to recovery and returning to a regular menstrual cycle typically involves nourishing and resting your body, and you can do this in a few ways:
Reducing high-intensity exercise, and instead focusing on gentle steady-state movement such as walking or yoga
Make sure you are resting your body. Rest takes a backseat to being busy, but is essential for those with HA. Read more about the seven types of rest (yes, seven) here and how they can help you
Try stress management techniques such as therapy, if it’s accessible to you, or a meditation app. I really like Insight Timer - my friend Jenny (www.breathbodysoul.co.uk) also has some fab breathwork and meditations on Spotify - check one out here
Consume enough energy to match your energy output. This will vary from person to person, and remember that anything you Google about this will generate super generic responses, so it’s worth speaking to a professional to ensure that you’re taking in enough fuel to support hormone function
Build carbohydrates into your diet, if you aren’t already. Carbohydrates are the body’s main source of energy, which as per the point above, is essential for regaining a healthy hormone cycle
Practise patience. This is one of the hardest things to do as recovery can take time, but it’s worth it for the long-term health outcomes
The Bigger Picture: Listening to Your Body
Whether dealing with PCOS, HA, or any other menstrual irregularity, the key takeaway is this: your period is a vital sign. It's your body's way of communicating with you about your overall health and wellbeing. Missing periods should never be dismissed as normal or automatically attributed to PCOS without proper investigation. By understanding the differences between conditions like PCOS and HA, you are in a better position to seek appropriate care and take the path best suited to your own, individual health journey.