Chapter 4
Irregular or No Ovulation
IN ORDER TO GET PREGNANT, you need sperm, egg, and a uterus, so fertility challenges certainly arise when ovulation is irregular or not happening at all.
Some women do not ovulate regularly, often leading to a halt in menstrual periods, a condition called amenorrhea. In this section, we will discuss one cause: hypothalamic amenorrhea (HA), but amenorrhea can also be caused by hyperprolactinemia (high levels of prolactin), ovulatory disorders, including PCOS, and other, rare causes.
What the West Says 
The hypothalamus sits at the base of your brain and effectively serves as the command center for just about all of your body’s functions. It serves as the mediator between the nervous system and the endocrine system, by telling the pituitary (an almond-shaped gland behind the center of your forehead) which hormones to secrete. The hypothalamic-pituitary-ovarian axis (HPO axis) refers to the interactive relationship between the hypothalamus, pituitary, and the reproductive system.
Sometimes the hypothalamus doesn’t function properly. There are several reasons why this can happen:
Poor nutrition and severe calorie restriction, as often seen in women with eating disorders
Sudden extreme weight loss
Overexercise or extreme athleticism (i.e., young competitive gymnasts)
Extreme stress, often prolonged
Unknown (idiopathic) causes
Because the hypothalamus controls reproductive hormones, amenorrhea, anovulation, and infertility can arise when it doesn’t function properly.
Hypothalamic amenorrhea (HA) ranges from poor function to complete ovarian shutdown and cessation of menstruation. HA differs from advanced maternal age or premature ovarian failure because in this case the brain is the reason for the diminished action, not the ovaries themselves.
For younger women, this can be good news. Because both Chinese and Western medicine can assist in getting the hypothalamus back online, once things are up and running there’s a good chance that the eggs are still healthy enough to make a healthy baby. Depending on the severity, women with this condition may require hormone support throughout much of their pregnancy.
Diagnosis of Hypothalamic Amenorrhea
Lab work for patients with HA will often show very low FSH, estradiol, and LH levels. This is because in women with HA, the HPO-axis is not working properly and the end result is that the ovaries don’t get the signal to ovulate via the hypothalamus and pituitary gland.
Another diagnostic tool is called a “progesterone challenge.” If a woman isn’t getting her period and is given progesterone, her period should start shortly after she stops taking it (the same way you get your period a day or two into the placebo pills in birth control packs). In the case of women with hypothalamic amenorrhea, progesterone alone won’t induce a period because her lining is too thin to shed. Consequently, a woman with HA will need estrogen to build her lining followed by progesterone to make her period start.
Medical Treatment of Hypothalamic Amenorrhea
Lifestyle changes are the best treatment for hypothalamic amenorrhea. Learning to manage stress, seeking treatment for eating disorders, gaining sufficient weight, and reducing exercise to appropriate levels goes a long way in giving the hypothalamus a kick start.
Fertility drugs for promoting ovulation and menstruation are the most common form of treatment offered by Western medicine, and IVF is often recommended.
Women with this condition should seek regular medical care and work hard to maintain a healthy diet, as there is an increased risk of osteoporosis and heart disease associated with this condition.
The Importance of Diet and Lifestyle for Hypothalamic Amenorrhea
A woman with hypothalamic amenorrhea should first determine if her condition is due to insufficient food intake, and if so, she must take action to increase her calorie consumption because restricting food is simply incompatible with a healthy pregnancy. For women with a history of calorie restricting or other eating disorders, appropriate mental and emotional support should be sought, in addition to nutritional changes.
Once eating is restored to normal quantities and frequency, focusing on digestion is the next, most important step. Balancing intestinal bacteria with cultured foods, probiotic supplements, and digestive enzymes (if necessary) will help to restore the body’s ability to assimilate nutrition, allowing it to heal. Consuming lots of bone broth is key to healing the digestive tract and improving nutrient assimilation, so soups and broths are perfect foods to focus on, especially at the beginning.
Once digestion is working well, the main focus should be on foods to nourish Jing and to build Qi and Blood. It is vital to eat enough healthy saturated fat, in order that the body has enough building blocks to make hormones.
While we hope that any imbalances that have arisen as a result of a dysfunctional hypothalamus can be corrected through natural means alone, this may not always be possible. Some women’s reproductive systems have been shut down for so long that a jump start of hormone therapy is required to get things moving again. The need for this depends on age and how much time you’re willing to dedicate to reversing your condition. In some cases, even after some hormonal supplementation, follicle counts remain very low due to having your ovaries in a resting state for too long. In this case, medications that stimulate the ovaries may be helpful, either in conjunction with IUI or IVF.
What the East Says
In terms of stimulating the hypothalamus, two acupuncture channels—the Ren Mai and the Du Mai—have the greatest influence. Part of the Eight Extraordinary Meridian system, these two channels form a closed loop called the Microcosmic Orbit, which can be superimposed right over the HPO axis, and thereby have direct impact on its function. By stimulating the HPO axis, hormone function will begin to restore, along with better Qi and Blood flow to the uterus.
Suppressed hypothalamic function can also cause the nervous system to be out of balance, generating anxiety, fear, and stress, even when the situation at hand doesn’t warrant it. Acupuncture is also one of the best methods for addressing this imbalance.
Herbal medicine for hypothalamic amenorrhea focuses on the phasic treatments we have discussed in previous sections, with special attention paid to Jing herbs because the brain is governed by the Kidney system in Chinese medicine, which is made of Jing.
KATIE’S STORY