Hypothalamic Amenorrhea vs. PCOS

In my last blogpost, I talked about how eating more and lowering the amount and intensity of my exercise helped me overcome Hypothalamic Amenorrhea (HA), which helped increase my fertility. However, I didn’t JUST have HA. My doctors also discovered I had PCOS, too. It’s actually not common for women to have both, but I was in that rare category. However, neither HA nor PCOS are death sentences for fertility. In other words, you can recover enough from both to go on to get pregnant and have healthy babies.

I received an email from a reader asking me to further clarify and delineate the differences between PCOS and HA. Therefore, that’s what I’m doing in this post:


PCOS is a complicated condition with varied symptoms, making diagnosis difficult. There are three common manifestations of the syndrome; experiencing two or more leads to a diagnosis of PCOS.


The criteria are:

  1. Absent or irregular menstrual cycles
  2. Hyper-androgenism
  3. Polycystic ovaries (contain multiple small follicles)

Hyper-androgenism is an excess of “male” hormones like testosterone. In some women this manifests biochemically, in measured blood levels. In others, physical symptoms such as excess hairiness, acne resistant to standard treatments, and possibly insulin resistance are evident.


An ultrasound machine that allows for visualization of internal organs is used to look at ovaries. With recent technology, more than 25 follicles or an ovarian volume of more than 10 cc must be seen in order to classify ovaries as truly polycystic. This is important as many women with HA also have multiple small follicles in their ovaries.

Hypothalamic Amenorrhea

It is easy to understand why HA and PCOS are confused. Women with HA seem to meet two of the criteria for diagnosing PCOS: absent periods and “polycystic ovaries.” However, it is important first to make sure that the description of the ovaries as polycystic is by the criteria given above—more than 25 follicles between 2-9 mm or a volume greater than 10 cc. Around 30% of the population has multi-cystic ovaries that are often mislabeled as “polycystic.”


Correctly diagnosing HA over PCOS is important as the lifestyle changes to treat each condition are essentially opposite. If HA seems the more appropriate diagnosis based on your lifestyle, it probably is correct.


Diagnosing HA over PCOS

Experts in the field of PCOS maintain that a diagnosis can only be made after other possible conditions, including HA, have been ruled out.

Therefore, in a woman who fulfills one or more of the following criteria, HA should be suspected and ruled out before a PCOS diagnosis is made:

  1. Low BMI and/or weight loss of more than 10 lb
  2. Stress fracture or low bone density measured by DXA
  3. Restrictive eating habits, either amount or variety.
  4. Regular (often excessive but not always) exercise
  5. Chronic or acute stress, or perfectionism

A diagnosis of HA over PCOS can be corroborated by blood work. Physical symptoms can also aid in distinguishing between the two.


Why Diagnosis Matters

While treatments to encourage ovulation to allow for pregnancy are similar whether the diagnosis is HA or PCOS, many women with HA have difficulty getting pregnant until undereating, over-exercising, and stress are addressed. Following a lifestyle designed to combat PCOS will have a negative effect.

*Information from this post gathered from the free PCOS vs HA chapter by the authors of “No Period. Now What?” Dr. Nicola Rinaldi, Stephanie Buckler and Lisa Waddel. Learn more at http://www.noperiodnowwhat.com

* * * * * * * *

Do you struggle with either HA or PCOS? Do you have symptoms that mimic either? If you have never been diagnosed, will you seek out a medical professional to help you figure it out?


2 thoughts on “Hypothalamic Amenorrhea vs. PCOS

  1. I just came across this post – you did an excellent job of summarizing and I love the illustrations you found. I also really appreciate your giving NPNW credit 🙂


    1. Thank you Nico! I’m sorry I JUST now responded to your comment. I found a “hidden” comments part in my blog that I’m just now getting to. Yes, I loved “No Period, Now What.” That book really helped me. I’m very grateful that you wrote it!


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