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Is it PCOS or Hypothalamic Amenorrhea?

Could your PCOS be Hypothalamic amenorrhea?

While you may be familiar with PCOS or heard about it, Hypothalamic amenorrhea isn’t talked about as often but can cause problems with a women’s hormones.

What is PCOS?

PCOS is an endocrine condition that impacts our female sex hormones. It includes symptoms such as;

  • Androgen excess. On blood work or via signs such as facial and body hair, acne or hair loss
  • Absent or irregular periods
  • Anovulation

PCOS symptoms can differ between women. You can read more on PCOS on the health conditions PCOS page

What is Hypothalamic amenorrhea (HA)?

Hypothalamic amenorrhea is when a women losses her periods as a result of undereating, over-exercising or stress. It can have similar symptoms as PCOS as women can also experience acne or facial hair. 


Which is it? PCOS or HA?

While a lot of the symptoms of PCOS and Hypothalmic amenorrhea can look similar the simplest way to know is;

  • In PCOS luteinizing hormone is high
  • Hypothalamic amenorrhea causes low luteinizing hormone


  • Irregular, absent periods
  • polycystic ovaries
  • hair growth increased androgens
  • normal/high fasting insulin
  • mild risk of bone loss
  • periods come back once stopping the pill
  • can occur at any age, but women under 25 can outgrow it
  • thickened uterine lining 
  • high LH to FSH


Hypothalamic amenorrhea

  • Irregular, absent periods
  • polycystic ovaries
  • possible mild hair growth 
  • low fasting insulin
  • significant bone loss
  • periods do not come back once stopping the pill
  • more likely under 30yo
  • thin uterine lining 
  • low LH to FSH

Why a correct diagnosis matters

With both conditions displaying polycystic ovaries, you can see how women are commonly diagnosed with PCOS when that may not be the case, paying special attention to the LH to FSH ratio can differentiate the two.

PCOS women are commonly told to eat less and promote weight loss, however in HA, women need to increase their calorie intake.

It is best to measure LH and FSH on day two of the menstrual cycle. If you are unable to track your cycle due to it being absent or irregular, you can test at day. There is no magic number of LH, and it does increase with age. What matters is the ratio in relation to FSH. 


What to do to test PCOS or HA

Remember PCOS can not be diagnosed by ultrasound alone.

  • test LH and FSH, and check the ratio. They should be in a 1:1 ratio and both under 10. If they aren’t I suggest making time to talk to me to understand these results clearly..
  • Are androgens excessive? Via a blood test or signs and symptoms? Signs of high androgens include acne, and hair growth on the body, such as the chin, jaw, and around the nipples, abdomen and chest. Also hair loss around the crown. You can also experience a deepening of the voice in severe cases.

What next?

If you have had a read of the above and tested the above and you are still confused as to what is going on with your periods and your hormones and are not sure if it is PCOS or Hypothalamic amenorrhea. I suggest making time to work together to understand what your hormones are doing. Some women can experience PCOS and HA, with often opposing treatment goals it is crucial to know what’s going on. You can understand your options to work with me.

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