In this podcast episode, Sarah Liz King discusses the differences between lactation amenorrhea and hypothalamic amenorrhea. Lactation amenorrhea occurs when a woman is exclusively breastfeeding and high levels of prolactin suppress the production of sex hormones, preventing the menstrual cycle. Hypothalamic amenorrhea, on the other hand, is caused by a suppression of the hypothalamus, resulting in low estrogen levels and amenorrhea. Factors such as low energy availability, overtraining, or psychological stress can cause hypothalamic amenorrhea. To determine the cause, factors like feeding frequency, signs of the menstrual cycle returning, cervical mucus, and lifestyle factors should be considered.
Sarah Liz King (00:00:02) – Hi everyone, and welcome back to Holistic Health Radio. I’m your host, Sarah Liz King. I’m an exercise physiologist and health coach, empowering you to find your healthy balance with food, fitness and your body Through my 1 to 1 and group coaching programs, both myself and my team help women regain their periods, find food freedom, and have a healthier relationship with exercise, all while gaining body confidence. Today I am answering another listener question, which is what is the difference between lactation or amenorrhea and hypothalamic amenorrhea? So lactation or amenorrhea happens when a woman is exclusively breastfeeding postpartum. And what happens is your body kind of goes into this state where prolactin or an increase in prolactin, which is another hormone down, regulates the production of sex hormones. So you don’t have a period now this is a very natural process to occur. And while some women could be exclusively breastfeeding and regain their menstrual cycles, for a lot of women, it takes a decrease in the number or the frequency of times that you are feeding to basically have your menstrual cycle restart.
Sarah Liz King (00:01:22) – Now this is different from hypothalamic amenorrhea where basically the hypothalamus is suppressed and that is what’s leading to a reduction in Canada and releasing hormone that reduction in FSH and LH, obviously low estrogen which is causing you to have amenorrhea or no periods. So I guess from from a hormonal point of view, lactation or amenorrhea is caused by high prolactin levels, whereas hypothalamic amenorrhea is a suppression of the hypothalamus due to that low energy availability from under eating and overtraining and or too much psychological stress. So. How do you know if you’re in that postpartum period, whether you are really just having lactation or amenorrhea or whether maybe there’s a little bit of like hypothalamic amenorrhea that’s coming into play. This is particularly important to pay attention to. If you’ve had hypothalamic amenorrhea in the past. So some kind of key factors to look at is if you have decreased the frequency of how many feeds you’re having during the day and at night as well. And there’s still no signs and symptoms that your cycle might be returning. So no cervical mucus.
Sarah Liz King (00:02:47) – You’re not getting any of the kind of like maybe PMS symptoms you used to have before and you know that maybe some of your behaviors around nourishing your body enough, getting enough rest. Obviously that’s going to be a really difficult thing with a newborn as well. Um, and maybe too much exercise could be coming into play then. It could be that maybe it’s not just lactation or amenorrhea, but maybe there are a few factors in terms of the hypothalamic amenorrhea like story that are creating a little bit of a crossover effect for you. And I see this so much in the clients that come to me postpartum to regain their periods. They might have had a history of or disordered eating in the past. Maybe they’ve used fertility treatments to fall pregnant. They’ve had a very healthy pregnancy, they’ve given birth, they’ve gone through their breastfeeding journey and they might still be breastfeeding a little bit, but they’re a little bit curious about why their periods are still Mia. And it could be a few different reasons. One of the things that often talk about with clients who are newly pregnant after I guess, recovering from Ha, is that one of the most important things is adequate weight gain during pregnancy is a really important factor in ensuring that we get enough energy stored in our body so that we get healthier periods postpartum.
Sarah Liz King (00:04:11) – So making sure that you gain adequate amounts of weight during your pregnancy is actually really, really important. And obviously during that postpartum period, creating breast milk is actually a really taxing process on the body and it takes more energy to create breast milk than it does to kind of sometimes sustain your pregnancy, especially if you’ve had something like twins where you’re feeding two babies and not just one. So making sure that you gain enough weight during your pregnancy is really important. Making sure that you’re fueling enough while you’re breastfeeding is also really, really important and can be one of the factors that leads to you either gaining regaining your periods quicker when you reduce your breastfeeding or then still being. Am I a. So there’s no kind of clear cut picture as to whether it might be lactation or hypothalamic amenorrhea causing your missing periods? Postpartum. One of the things that I would recommend getting checked is having a blood test with your doctor so they can check your prolactin levels and see if there’s still really high and might be the things that are suppressing your hormones.
Sarah Liz King (00:05:20) – Obviously, if that’s happening, your estrogen levels are going to be really, really low. However, if you’ve ceased breastfeeding and you’re also still struggling with a missing period and you’ve had in the past, that’s when it’s really important to look at your lifestyle factors. Am I eating enough? Because especially as a new mom, you’re going to be moving incidentally a lot. You’re going to be rocking your baby. You’re going to be pushing their pram. You are rarely going to be sitting down. And that uses a lot of energy that sometimes we just don’t account for. Other things are not just your incidental activity, but any formal exercise you start re-engaging in and also making sure that you’re getting enough energy in to cover over the costs of breastfeeding and all of the incidental and structured exercise that you are engaging in. So if you have, I guess, a little bit of an inkling that maybe it’s the lifestyle factors, maybe you didn’t gain enough weight, maybe you lost weight really, really quickly postpartum then that hypothalamic amenorrhea story might be one of the reasons why your period is still missing.
Sarah Liz King (00:06:22) – And it might not just be that lactation amenorrhea, because once you reduce down your breastfeeding, your periods should naturally return because those prolactin levels will no longer be the things suppressing your. Ovulation. So then we have to look at the lifestyle factor things and make some adjustments so that your periods can return. And so many of the postpartum women I see, that’s what we have to do. We have to go through those lifestyle changes and sometimes it can take a little bit longer if we’re still kind of making sure that we are doing some breastfeeding and mixed feeding. So some breastfeeding, maybe some bottle feeding as well as solids as the newborn ages and gets a little bit older and then making sure that we give the mamas body the support that she needs so that her periods can restart again because it’s likely that the hypothalamic amenorrhea story coming into play. So hopefully that gives you a little bit more clarity around the differentiation between lactation and hypothalamic amenorrhea and what to do if you think maybe, oh, my periods have been missing for a little bit longer than they should have been postpartum and what to do about them.
Sarah Liz King (00:07:31) – So if you need any help or support, feel free to reach out and inquire about some of our coaching programs that can definitely help you support. They can definitely help support you through this process. Otherwise, keep looking after yourself and we’ll be back next week with a fresh new episode you can wrap your ears around.
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