Do I have RED-S, HA, or PCOS? —Lauren from FL
The best way we can attack this question is by explaining what each one is.
RED-S used to be known as the female athlete triad. It is now used to diagnose both men and women who are having hormonal problems. RED-S stands for Relative Energy Deficiency in Sport. This condition occurs because of low energy availability or LEA. More simply put, athletes see a decline in bone health, performance, and hormones because they don’t have enough food and rest to help them fuel appropriately for their workload in daily life. It’s important to note that you don’t have to be a professional athlete for this to apply to you! You can absolutely be a regular Joe exercising too much on fasted calories.
HA, or Hypothalamic Amenorrhea, is a symptom of RED-S. Amenorrhea is the absence of a period. The hypothalamic part refers to the brain functioning (the hypothalamus) that is being impaired from chronic stress. There is a difference between primary and secondary amenorrhea. I know that you didn’t specifically ask about that difference, but without your paperwork, it's best to cover all the bases! Primary Amenorrhea refers to someone who has never had their first period while Secondary Amenorrhea refers to a woman who has stopped ovulating for more than three months and therefore has stopped bleeding; the difference is that the secondary woman has had periods before. Hypothalamic Amenorrhea is therefore considered secondary amenorrhea.
PCOS is short for Polycystic Ovarian Syndrome. Hypothalamic Amenorrhea clients are often misdiagnosed with PCOS because PCOS women also miss periods. It is possible to have both PCOS and HA at the same time. But to keep things simple, PCOS can be seen in blood work. With PCOS, the GnRH pulse continues to be high. In HA, that pulse is low or not functioning at all. The GnRH then makes an excess of LH which again, is low or absent in HA women. Because the LH is high from constant GnRH pulses, FSH is low as a result. Let’s simplify! When I work with clients, I look to see the ratio between LH and FSH. HA clients are low in everything for blood work because the body is shutting down functions due to stress.
A common thread between all three of these is stress to the body. Your body works best when the physical, nutritional, and mental stress is managed appropriately.
