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Expert Q&A

	By Traci Kurtzer Obstetrician and Gynecologist

After having very erratic cycles (not ovulating or having a period for months, then having non-ovulatory bleeding -- only ovulating 2-3 times in one year, according to my detailed charting) my nurse practitioner did some hormone testing. I was told my troubles are probably caused by a hypothalamic disturbance. What causes a hypothalamic disturbance and can it be corrected? What is it specifically? What are the symptoms?

The hypothalamus is a small organ in the brain which sends hormonal signals to the pituitary gland. One of the signals is gonadotropin releasing hormone (GnRH) which promotes secretion of the hormones which regulate the menstrual cycle, follicle stimulating hormone (FSH) and leutininzing hormone (LH).

A "hypothalamic disturbance" likely refers to a deficiency in normal GnRH pulsatile secretion, but is a diagnosis only made by excluding other pituitary causes of not ovulating. The main symptom is irregular or absent periods. Sometimes FSH and LH levels will be low. It can be caused by high levels of stress, excessive exercise or weight loss (especially if severe in anorexic or bulemic women.) Stress reduction can be achieved through meditation, yoga and keeping consistent daily patterns. If a woman has lost 10-15 percent of her ideal body weight, weight gain will usually lead to regular menses. If no underlying cause can be corrected, it is important to be on birth control pills or another hormonal regimen to prevent osteoporosis. For women desiring pregnancy, assistance with ovulation induction would be necessary.

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