PCOS VS HA: Part 2
This is part 2 of my PCOS VS HA series, if you haven’t yet already please read part 1 here.
Polycystic ovarian syndrome (PCOS) and hypothalamic amenorrhea (HA) are two conditions that share many commonalities and it can feel tricky to differentiate between HA and PCOS. This blog post is to be used as an educational resource and summarises the key ways to identify whether it is PCOS or HA.
What are some ways to know if I have HA or PCOS?
Menstrual cycle
Women with PCOS are more likely to have irregular periods (oligomenorrhoea), with 4-9 cycles per year with long cycles that range from 30, 45 or even 90 days. Additionally, women with PCOS are more likely to have heavy periods (menorrhagia) when they have a menstrual period. This is because their estrogen levels are normal to high, and estrogen causes the uterine lining to thicken. Hence, typically there’s a very heavy uterine lining being shed with irregular periods.
Women with HA will not have a period at all. They may initially notice their periods become more irregular and then disappear altogether. Their uterine lining will often be thin as estrogen levels are low. Hence, amenorrhea is more likely to be associated with women with HA and oligomenorrhoea in women with PCOS.
2. Lab testing
Lab tests such as blood work can help aid to identify whether a woman has PCOS and HA, with the most obvious differentiating marker being the ratio between the two gonadotrophin hormones (luteinising hormone (LH) and follicle-stimulating hormone (FSH)). Ideally, you’ll be testing these on day 2 of your cycle (if the cycle is irregular or absent, any day is fine). In PCOS, the LH: FSH ratio is high in PCOS and low in HA. Other lab markers that help to differentiate between PCOS and HA include estrogen, progesterone, androgens, fasting insulin and cortisol.
Women with HA have a lower bone mineral density (BMD) due to insufficient oestrogen levels, increased cortisol levels and inadequate nutrient intake. If an individual has not had her period for 6 months, it’s recommended that she evaluates her bone mineral density (BMD) using a dual-energy x-ray absorptiometry (DXA) scan.
3. BMI of the individual
An individual can develop HA regardless of their body weight but is more common in women with a BMI that is on the lower end of normal or underweight as HA is caused by an energy deficit (from overexercising or under-eating or a combination of the two).
In contrast, an estimated 80% of individuals with PCOS are insulin resistant, which increases the likelihood of increased body weight. Women with PCOS are more likely to be at a normal or higher end of the BMI, and studies have estimated that 30-60% of women with PCOS as overweight or obese. Additionally, both with lean and obese PCOS, women are more likely to have central obesity and increased fat distribution in their upper body compared to women without PCOS.
4. Client history
Lastly, comprehensive case-taking and understanding the client’s history will help to differentiate between the two conditions. Some important questions to ask include
When did the menstrual cycle become missing?
Was the period regular previously or had gone missing after dieting, a stressful event or a fitness challenge?
Has the individual’s weight changed recently?
What is their exercise routine like?
Are they engaging in high-intensity exercise most days of the week? Does missing exercise make them uncomfortable?Are they restricting their diet?
This includes restriction of macronutrients (e.g., low-fat diet or keto diet), food groups (e.g., dairy-free, gluten-free) and/or overall energy intake
Do they have a “type A” or perfectionist type personality?
As nutritionists, we cannot diagnose any medical conditions, as we are not medical doctors. We provide you with nutritional and lifestyle support based on the diagnosis once you receive a diagnosis from your doctor, please reach out via my booking link if you would like more support. If you found this post helpful, please see Parts 1 and Part 3 of my PCOS VS HA series.
