In a woman of reproductive age, the absence of menstruation for more than three months is never trivial: this is what we call amenorrhoea. It almost always reflects a hormonal or metabolic imbalance that needs to be identified quickly.
In the webinar hosted by Simplycure, naturopath and nutritional therapist Manon Borderie reviews the main pathological causes seen in clinic: hypothalamic amenorrhoea1, polycystic ovary syndrome (PCOS), hyperprolactinaemia and hypothyroidism.
In this article, find out how to identify the level of the imbalance and adapt care to the patient profile in front of you.
Hypothalamic amenorrhoea: when the body switches to economy mode
This is the most common picture in young, active women: intensive training, controlled eating, chronic stress or rapid weight loss. Faced with this energy deficit, the body shuts down GnRH secretion; FSH and LH fall, and ovulation is blocked.
Put simply, the body chooses survival over reproduction.
Reference work-up
ParameterClinical markerFSH, LH, oestradiolLowAMHNormal or highFasting insulinLowVitamin DOften < 45 ng/mlFerritinTarget: 60-100 ng/mlZinc, iodine, seleniumTo be checked if there are signs of thyroid slowdown
Action plan
Restore energy balance: +300-500 kcal/day, bring carbohydrates and fats back in.
Reduce intensive training, encourage yoga, walking and rest.
Support steroidogenesis: vit. D, gentle iron, zinc, cordyceps, raspberry bud extract.
Key point:
Too little body fat = reduced aromatase activity, so less oestrogen and no LH surge. Weight gain is often the key to the cycle returning.
PCOS: restoring ovulation by calming hyperandrogenism
When the cause is no longer energy related but metabolic, the diagnosis often turns towards PCOS. Polycystic ovary syndrome remains the leading cause of persistent anovulation.
Long cycles, localised acne, hirsutism, weight gain: the signs vary, but the mechanism is the same. Insulin resistance drives androgen production and disturbs the hormonal balance.
Reference work-up
ParameterClinical markerLH / FSHLH >= FSHAndrogens (testosterone, DHEA-S)RaisedSHBGLow where there is insulin resistanceBlood glucose, insulin, HOMA-IRHOMA > 1.9 = resistance possibleVitamin DTo be optimised > 45 ng/mlAndrostanediol glucuronideMarker of excess DHT
Action plan
Improve insulin sensitivity: myo-inositol, chromium, protein-rich breakfast, walking after meals.
Moderate DHT: zinc, nettle, saw palmetto, pumpkin seeds, green tea.
Support the thyroid and vit. D to stimulate aromatase.
Key point:
PCOS is not only an ovarian disorder: it is a whole-body metabolic imbalance. Treatment must target insulin as much as androgens.
Hyperprolactinaemia: releasing the dopaminergic brake
When stress takes hold, dopamine falls, prolactin rises and ovulation stops. Moderate hyperprolactinaemia is sometimes enough on its own to block the cycle.
Before considering heavier investigations, rule out a false positive linked to exertion, a recent meal or mental load.
If prolactin stays high, look at thyroid function; mild hypothyroidism can raise it2. Where values are very high, or where symptoms such as headaches or visual disturbance are present, a pituitary MRI is indicated.
Reference work-up
ParameterClinical markerProlactinRaised (25-100 ng/ml)TSHOften > 2 mIU/LFSH, LHNormal or low
Action plan
Repeat the test fasting and at rest (stress and exertion = false positive).
Support dopamine: L-tyrosine or rich food sources (eggs, almonds, soft cheeses).
Reduce mental load: magnesium bisglycinate, rhodiola, ashwagandha.
Investigate the pituitary (MRI) if prolactin is very high or headaches are present.
Key point:
Always rule out associated hypothyroidism before considering an adenoma.
Hypothyroidism: a link that is often overlooked
Finally, some cases of amenorrhoea conceal a slowed thyroid.
T3 plays a key role in follicular maturation, in the conversion of steroid hormones and in the regulation of prolactin.
Even mild dysfunction can block ovulation.
Reference work-up
ParameterClinical markerTSHSometimes "normal" < 4 mIU/L, but > 2 is often already too highFree T3, free T4LowFerritin, zinc, iodine, seleniumCofactors for T4 to T3 conversion
Action plan
Optimise the cofactors: iodine, selenium, zinc, iron.
Encourage a protein-rich breakfast high in L-tyrosine.
Support T3: vit. D, sleep, stress management.
Key point:
Even "mild" hypothyroidism can block ovulation; always check T3/T4 and not TSH alone.
Micronutrition: the "small gaps" that keep amenorrhoea going
Whatever the cause, correcting nutritional shortfalls remains an essential lever.
A simple vitamin D or iron deficiency can be enough to unbalance the ovarian axis.
The table below sets out the priorities to check in practice.
NutrientKey rolepractical sourcesVitamin DRegulates hormones and supports insulin sensitivitySun exposure, supplements if neededIronEssential to the synthesis of steroid hormonesMeat, pulses, gentle supplements if deficientZincInvolved in androgen metabolism and blood glucose balanceOysters, seeds, seafood, supplementsIodine and seleniumEssential to thyroid health and to healthy follicle developmentSeaweed, Brazil nuts, fishCholesterolPrecursor of all the sex hormonesEggs, oily fish, good-quality offal
Reading the situation at a glance: summary decision table
Faced with amenorrhoea lasting more than three months, this table helps you identify the most likely scenario and choose your first clinical steps.
Clinical contextBaseline work-upLikely pictureFirst leverLow energy intake, intense sporting activity or high stress, no periods for several monthsLow FSH, LH and oestradiol, normal or high AMH, low insulinHypothalamic amenorrhoeaIncrease calorie intake, cut back on sport, support recoveryIrregular or absent cycles, acne, hirsutism, sometimes weight gainLH higher than FSH, raised androgens, low SHBG where there is insulin resistancePCOSMyo-inositol, protein-rich breakfast, walking after meals, zincGalactorrhoea, headaches, stressful context before the blood drawRaised prolactin to be confirmed, TSH sometimes above 2 mIU/LHyperprolactinaemiaRepeat the test at rest, support dopamine, investigate the thyroidFatigue, feeling the cold, sluggish transit, low moodTSH above 2 mIU/L, low T3 and T4, possible iron, iodine or selenium deficiencyHypothyroidismOptimise thyroid cofactors, and consider a medical opinion
Amenorrhoea: identify the causes, restore the balance
Faced with amenorrhoea, the practitioner’s priority is to understand the underlying cause: energy deficit, metabolic imbalance, chronic stress or a thyroid brake.
Each of these scenarios reflects an adaptive response by the body, and that response has to be read before anything is corrected.
In practice, care rests on three pillars:
Explore the hormonal axis (FSH, LH, TSH, prolactin, androgens, T3/T4) to locate the blockage.
Correct the micronutrient deficiencies that keep the disorder going (vitamin D, iron, zinc, iodine, selenium).
Rebalance the underlying terrain through diet, sleep and stress management.
The aim is not simply to restart menstruation, but to restore stable, lasting hormonal function.
With Simplycure, you have a platform built to structure these protocols, select the right supplements and deliver personalised follow-up. Browse our catalogue or get in touch to find out more!
