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It's been several months, and you still haven't had a period -- and you're not pregnant. What could be going on? The issue could be amenorrhea -- a lack of a menstrual period for more than three cycles -- and while many things can trigger this condition, a thyroid disorder is one of the most common. Ahead, a look at the link between amenorrhea and your thyroid.
The Hypothalamus-Pituitary-Thyroid (HPT) Axis, the Hypothalamic-Pituitary-Adrenal (HPA) Axis, and the Hypothalamic Pituitary Gonadal (HPG) Axis are all intimately connected, and their functions affect the status of the others. For example, chronic stress (such as due to infection, toxins, or illness) can significantly impact the function of the thyroid gland.
Regulation of the reproductive system begins at the hypothalamus and interacts with the gonadal (sex) glands in both men and women. In women, the release of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) controls follicle ripening, stimulation, and release of eggs in the ovary, all parts of the menstrual cycle.
When hypothyroidism negatively affects gonadal function, reproductive hormones are frequently dysregulated, resulting in menstrual dysfunction. One of the most common symptoms is an irregular menstrual cycle, or even the loss of the menstrual period, known as amenorrhea, or absence of menses.
Discovered in 1840 by Van Basedow, amenorrhea describes when the loss of a menstrual period (also known as menses) for 3 consecutive cycles. It is generally classified into two types, primary and secondary. Primary amenorrhea is when menstruation does not happen at puberty (usually by age 15) and secondary amenorrhea is when a lack of menstrual bleeding occurs later, due to outside causes. Secondary amenorrhea can be related to symptoms of thyroid dysfunction. Overall, it's estimated that amenorrhea affects around 1% of women.
Other signs and symptoms that may accompany menstrual irregularity include a milky nipple discharge, hair loss, headaches, vision changes, excess facial hair, pelvic pain, and acne.
Because these symptoms also overlap with those of hypothyroidism, it can be hard to differentiate the two issues, and they are sometimes overlooked. This is why if you have amenorrhea or any menstrual disorder, testing your thyroid levels is so important.
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In addition to checking thyroid levels, evaluation of amenorrhea and menstrual dysfunction should also include testing your prolactin levels. Prolactin is a hormone that is responsible for lactation in pregnant women and breast development. Most prolactin production comes from the pituitary gland, the same gland that produces TSH (thyroid stimulating hormone). Abnormal thyroid hormone levels are a trigger for abnormal prolactin levels.
One study from the mid-1990s showed that among 127 women with secondary amenorrhea, just over 7% of them had abnormal prolactin levels and over 4% had abnormal Thyroid Stimulating Hormone (TSH) levels. In another study of 50 women with secondary amenorrhea, both prolactin and thyroid levels were evaluated. The study found that hyperprolactinemia (high prolactin levels) with thyroid dysfunction in women can be a contributory factor in those with amenorrhea. Another study of 16 women with both hypothyroidism and elevated TSH levels showed that 10 out of the 16 women also had high prolactin levels. When hypothyroidism was treated, it had a positive effect on normalizing prolactin levels as well.
Treating amenorrhea first begins with identifying and treating the risk factors and root issues. In patients with amenorrhea caused by hypothyroidism or thyroid dysfunction, treatment of the thyroid condition should restore normal menstrual cycles. Be advised, however, that it can take some time before a regular cycle begins and becomes consistent.
A usual course of treatment for hypothyroidism is the use of thyroid hormone replacement medication. Monitored treatment with medication as well as regularly checking thyroid hormone and thyroid levels can have a promising outcome for those with amenorrhea or other related thyroid symptoms.
If you suspect that you might have amenorrhea and have not had your thyroid checked, a good starting place is Paloma's convenient home Thyroid Test Kit. this test conveniently measures your TSH, Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPOAb). Getting an accurate diagnosis and effective hypothyroidism treatment is also convenient with Paloma's team of thyroid doctors. Our thyroid-savvy healthcare providers can guide you toward successful treatment options, and put you on the path to healthy living.
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