Do I have Lactational Amenorrhea or Hypothalamic Amenorrhea?
You have delivered your baby and now have a full-time job feeding your baby. If you exclusively breastfeed your little one it is normal to not have a period. But for how long? When can you expect your period to return? How can you know if it is Lactational Amenorrhea or Hypothalamic Amenorrhea that is causing your period to be missing?
What is Hypothalamic Amenorrhea?
Hypothalamic Amenorrhea is when your pulsatile release of gonadotropin-releasing hormone (GnRH) from the hypothalamus is interrupted by stress in form of under-eating and over-exercising. This will in turn prevent both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from being produced in sufficient amounts for ovulation.
What is Lactational Amenorrhea?
Lactational Amenorrhea is when your pulsatile release of gonadotropin-releasing hormone (GnRH) from the hypothalamus is interrupted by a hormone called pro-lactin, which is produced in high amounts when you baby is sucking on your breast. This will in turn prevent both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from being produced in sufficient amounts for ovulation. Lactational Amenorrhea is normal as long as you exclusivity breastfeed your baby. As soon as you
introduce solid food
your baby is skipping breastfeed meals
is sleeping through the night
is older than six months
your level of prolactin is not sufficient to prevent GnRH-pulses anymore and you should expect to resume ovulation within the next 4-6 weeks (and thereby the resumption of your period within about 6-8 weeks).
If you find yourself in the situation of thinning out your breastfeeding session, or even completely weaned your child, and still see no sign of ovulation, the probability is quite high that you have relapsed back into Hypothalamic Amenorrhea.
Risk factors for Hypothalamic Amenorrhea post-partum
You could get a blood work done by looking and look at your serum prolactin level to confirm that you are not having Lactational Amenorrhea. In my experience this is not really necessary, just as efficient is to look at the following risk factors in order to determine if you have Lactational Amenorrhea or Hypothalamic Amenorrhea:
Having Hypothalamic Amenorrhea before pregnancy
If you have suffered from Hypothalamic Amenorrhea in the past, you are more sensible to stress compared to someone who has had a regular cycle throughout adulthood. Being a mum of a newborn is wonderful but it can also wiled a tremendous amount of stress (you are sleep-deprived, tired, worried).
Little weight gain during pregnancy
If you did not gain a quite decent amount of weight during your pregnancy it means that you actually lost weight. So what is enough? You should at least mount for 10-12 kilos:
Larger breasts: 0.5 to 1.4 kilogram
Larger uterus: 1 kilogram
Placenta: 0.5 kilogram
Amniotic fluid: 1 kilogram
Increased blood volume: 1.5 to 2 kilograms
Increased fluid volume: 1 to 1.5 kilograms
Fat stores: 2.5 to 3.5 kilograms
If you fail to gain this amount you actually lost weight during your pregnancy, and this weight loss might be enough to induce your Hypothalamic Amenorrhea again.
Raid weight loss after delivery
Again, if you loose a lot of weight soon after delivery, it might be a sign that you did not manage to store in enough fat reserves during the pregnancy or even lost weight during pregnancy. This built up energy deficiency might lead to that your hypothalamus is detecting scarcity and hard times, and as a consequence it decides to shut down reproduction again.
You might notice a rapid weight loss right after delivery. this weight loss will however soon slow down and eventually stop. In this case this is NOT a sign of that you are eating enough. Rather it is a sign of your metabolism slowing down, and your body entering survival mode (and by that it shuts down reproduction).
Failure to meet breastfeeding energy needs
Producing breast milk to feed your child is a very energy intense process. You need to properly fuel up to support your body in this process. Your energy needs during breastfeeding are actually higher than they were during pregnancy. If you fail to meet these needs - intentionally or unintentionally - you will put your body back into a state of relative energy deficiency and by that Hypothalamic Amenorrhea.
Prior to recovery you might have been motivated by regaining your period to become pregnant. After pregnancy, you have accomplished this goal. It might therefore be tempting to fall back into old habits. This could mean not prioritizing meals or using exercise for stress-relief. Which is per-se not wrong; but if exercise is your only coping mechanism it´s an alarm signal. As a new mum you are already under a lot of stress. To add to this stress by engaging in restrictive eating, HIT-workouts, compulsive walking or a strict training routine might just be too much stress for your body to handle. It will response by shutting down reproduction.
Does this mean you have to start your Hypothalamic Amenorrhea recovery journey from scratch? No! You went through the tough process of Hypothalamic Amenorrhea Recovery once before! You know have all the tools, knowledge, skills and experiences you need in order to recover. I believe in you!