FHA vs PCOS. Which is which?
Are your periods unmanageable or irregular in their timing or length? This could be a sign that something is going on somewhere else in your body as well. Although there are several reasons why your menstrual cycle might not fall between 21-35 days long, this article will explain two of the more complex causes.
Polycystic Ovary Syndrome (PCOS) and Functional Hypothalamic Amenorrhea (FHA) are two distinct yet commonly misunderstood conditions affecting women's reproductive health, that sometimes can be confused for each other. While both can lead to irregular menstruation, they differ significantly in their underlying causes, symptoms, and treatment options, therefore it’s really important to get the correct diagnosis. PCOS and FHA both need a diagnosis of exclusion which means that other conditions should be ruled out before making a final diagnosis of either.
So what is the difference between the two conditions?
PCOS is a hormonal and metabolic syndrome which means it involves changes in hormone levels and how they interact with biological processes such as energy metabolism and the menstrual cycle, and can impact our mental wellbeing. PCOS is a very complex condition that can be managed and treated with nutrition, herbal medicine, other lifestyle changes, and medications.
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Polycystic ovaries: Multiple small follicles in the ovaries that can be viewed on an ultrasound.
Irregular menstrual cycles: Infrequent, prolonged, or absent periods due to irregular ovulation related to hormone imbalance.
Fertility issues: Irregular ovulation decreases the number of times an egg can be fertilised, decreasing the chances of getting pregnant through natural conception.
Elevated levels of androgen (sex hormones): Symptoms include acne, hirsutism (excessive unwanted hair growth), and androgenic alopecia.
Insulin resistance: Often accompanied by weight gain, difficulty losing weight, and an increased risk of Type 2 Diabetes.
Mental Health: PCOS is associated with worsening outcomes from mental health conditions such as depression and anxiety.
Endometrial Hyperplasia: Absent periods can result in a thickening of the lining of the uterus which is known as endometrial hyperplasia. If not treated it can possibly lead to endometrial cancer.
FHA however, is the absence of menstruation, caused by disturbances in hormone production in the hypothalamus (a part of the brain) which in turn affects hormone levels in other parts of the body. This condition is known as a ‘functional disorder’ which means that it can be reversed by changing lifestyle factors including the amount of exercise you do, your eating behaviours, and the amount of stress you experience.
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Absence of menstruation: Those with FHA experience the absence of menstrual cycles for three or more consecutive months.
Low estrogen levels: This can cause vaginal dryness, decreased libido, and hot flashes.
Decreased mental well-being: Anxiety, depression, and mood swings are common with FHA.
Fatigue and low energy: Hormonal disturbances can cause fatigue and lethargy.
Bone health: Low mineral bone density, and increased risk of fractures.
Been diagnosed with PCOS or FHA? What’s next?
Nutritional therapy
Seeking help from a qualified nutritionist is very important when it comes to managing health conditions such as FHA or PCOS. While treatment of both of these conditions may involve changes to eating behaviours, these changes will be very unique to the individual and their specific requirements. These requirements may be considered based on a series of blood tests, body composition assessments and recommendations based on your age and life stage.
Changes to your exercise routine
Because FHA can stem from a pattern of under-fuelling with nutrition and overexercising, your health professional may suggest reducing the amount or intensity of the physical activity that you do each week, and balancing this with your food intake. Restoring energy balance is the main goal for treating FHA using a lifestyle modification approach.
Finding an exercise routine that works for you and your PCOS can seem daunting. However, a few small changes to your overall lifestyle can contribute to a movement and exercise plan that works for your body, and enjoyment and may even include prioritising walking over cardio. Check out our article on how to exercise with PCOS.
Mental wellbeing techniques
Chronic or prolonged stress can be part of an individual's experience with either FHA or PCOS. High stress levels can be a contributing factor for the development of FHA, while stress and other mental health challenges can be an outcome of developing PCOS. Learning how to manage stress effectively can be beneficial for your journey to recovery of FHA or your management of PCOS symptoms. Techniques such as deep breathing, meditation, and connecting with loved ones are all ways to reduce stress naturally.
While Polycystic Ovary Syndrome and Functional Hypothalamic Amenorrhea share irregular menstruation as a common symptom, they have distinct underlying causes and management strategies. Accurate diagnosis by a healthcare professional is essential for tailoring treatment to address the specific needs of each condition and the individual. Seeking advice from a qualified nutritionist or naturopath could be the first step you’re looking for to kickstart your journey to overall wellness.
Want to learn more about PCOS? Check out our blog for more articles on PCOS and other menstrual health conditions.
Need help with your periods?
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