The Cycle of Life: Menstruation and Women's Health
Functional hypothalamic amenorrhea (FHA) is a term used to describe the absence of menstruation resulting from various types of stress. Although women may miss their period due to pregnancy or irregular cycles, what differentiates FHA is the total absence of menstruation for at least three months. The types of stressors that contribute to the development of FHA can include rapid weight loss, inadequate nutrition, excessive and strenuous exercise, traumatic physiological experiences, or even genetic predispositions.
The basis of FHA is hormonal, specifically decreased secretion of both the luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are the female hormones that are essential for female reproductive health. The impaired hormonal function eventually leads to estrogen deficiency and manifests itself in the form of FHA.
Although the absence of a menstrual cycle may seem convenient, menstruation is one of the main indicators of health for women of childbearing age. It is imperative to understand the short-term and long-term effects of prolonged estrogen deficiency, also known as hypoestrogenism. Women suffering from FHA are at a greater risk of developing problems in their reproductive, cardiovascular, and skeletal systems. They are also at greater risk of developing mood disorders such as anxiety and depression.
In regards to the effects of FHA on the cardiovascular system, estrogen plays an integral role in regulating blood vessel function, and FHA-related estrogen deficiency harms cardiovascular health. Research from the Nurses’ Health Study noted irregular menstrual cycles could be correlated to an up to 50% increase in cardiovascular disease. Another study investigating coronary artery disease in premenopausal women found that 69% of young women with coronary artery disease have low estrogen levels. This is because estrogen is a vasodilator, meaning it allows blood vessels to dilate properly for healthy blood flow. So women who are estrogen-deficient due to FHA are at a higher risk of developing problems such as hypertension and heart failure at an earlier age.
The basis of FHA is hormonal, specifically decreased secretion of both the luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are the female hormones that are essential for female reproductive health. The impaired hormonal function eventually leads to estrogen deficiency and manifests itself in the form of FHA.
Although the absence of a menstrual cycle may seem convenient, menstruation is one of the main indicators of health for women of childbearing age. It is imperative to understand the short-term and long-term effects of prolonged estrogen deficiency, also known as hypoestrogenism. Women suffering from FHA are at a greater risk of developing problems in their reproductive, cardiovascular, and skeletal systems. They are also at greater risk of developing mood disorders such as anxiety and depression.
In regards to the effects of FHA on the cardiovascular system, estrogen plays an integral role in regulating blood vessel function, and FHA-related estrogen deficiency harms cardiovascular health. Research from the Nurses’ Health Study noted irregular menstrual cycles could be correlated to an up to 50% increase in cardiovascular disease. Another study investigating coronary artery disease in premenopausal women found that 69% of young women with coronary artery disease have low estrogen levels. This is because estrogen is a vasodilator, meaning it allows blood vessels to dilate properly for healthy blood flow. So women who are estrogen-deficient due to FHA are at a higher risk of developing problems such as hypertension and heart failure at an earlier age.
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Additionally, estrogen directly affects the structure and function of musculoskeletal tissues like muscles, tendons, and ligaments. Estrogen normally stimulates the activity of osteoblasts, which are cells that produce new bone. Women with FHA who exercise excessively in adolescence have been observed to have lower bone mineral density in the spine when compared to women with regular menstruation cycles and normal levels of estrogen. The resulting decrease in bone strength means that women with FHA are at higher risk of developing osteoporosis and bone fractures.
Finally, estrogens communicate with neurotransmitters, chemical messengers synthesized in the brain, like serotonin and dopamine that regulate mood. As such, it has been shown that women with FHA experience more anxiety, depression, and difficulty coping with daily stress when compared to healthy women who don’t have FHA.
As supported by the data from various studies, the menstrual cycle is essential to female health, illustrating the integral relationship between the endocrine system and the entire body. On a more positive note, FHA is reversible and hormonal imbalances can be resolved over time by normalizing energy availability and making lifestyle adjustments to minimize physical and psychological stress.
Initial management of FHA can focus on (but is not limited to) proper nutrition, reducing exercise, and avoiding psychological stress. Although seeking professional treatment is not necessary, women with FHA can benefit from working alongside a gynecologist, endocrinologist, and/or dietician to accurately pinpoint the underlying cause of their FHA and take steps towards a healthier lifestyle and future.
Finally, estrogens communicate with neurotransmitters, chemical messengers synthesized in the brain, like serotonin and dopamine that regulate mood. As such, it has been shown that women with FHA experience more anxiety, depression, and difficulty coping with daily stress when compared to healthy women who don’t have FHA.
As supported by the data from various studies, the menstrual cycle is essential to female health, illustrating the integral relationship between the endocrine system and the entire body. On a more positive note, FHA is reversible and hormonal imbalances can be resolved over time by normalizing energy availability and making lifestyle adjustments to minimize physical and psychological stress.
Initial management of FHA can focus on (but is not limited to) proper nutrition, reducing exercise, and avoiding psychological stress. Although seeking professional treatment is not necessary, women with FHA can benefit from working alongside a gynecologist, endocrinologist, and/or dietician to accurately pinpoint the underlying cause of their FHA and take steps towards a healthier lifestyle and future.
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