Should I take the progesterone-only pill (minipill) if I am suffering from hypothalmic amenorrhea?
This is a complex question. First off, birth control menstrual periods are drug induced so they are actually not true periods. If you have tissue build up in the uterus from estrogen production, then the minipill will induce bleeding. Menstrual bleeding is induced by a fall in progesterone and estrogen levels. However, birth control pills contain synthetic hormones, even the minipill ones which contain a synthetic progestin. Progestins are not progesterone as they are progesterone molecules that have been chemically altered. The real question is why you have hypothalamic amenorrhea. There is a work up involved to figure out what that means. The other name for this is functional amenorrhea. It is frequently found in women who are athletic and long distance runners. Although the pituitary gland is called the “Master Endocrine Gland”, it is really under the control of the hypothalamus.
Hypothalamic amenorrhea is a dysfunction of pulsatile release of gonadotropin releasing hormone from the hypothalamus. If the pituitary gland does not receive this pulsatile stimulation, it will down regulate production and release of FSH (follicle stimulating hormone) and LH (leutinizing hormone). This leads to lack of follicle (egg) development in the ovary with no ovulation and therefore no progesterone production from the corpus luteum which develops in the ovary after ovulation. Therefore, the Minipill replicates what your ovary is supposed to be doing and is not doing. Young women who start birth control pills in their early to mid teenaged years really have no idea if they have normal ovarian and menstrual cycles. Nevertheless, figuring out why you have hypothalamic amenorrhea is indicated so you should find a gynecologist well versed in reproductive endocrinology. There are significant health effects from this disorder including bone loss, osteopenia, osteoporosis and infertility issues.
