AMH with Hypothalamic Amenorrhea

May 15, 2024 | Blog

Many of you have been there before. After months (or years!) of struggling with infertility, you stumble your way into the diagnosis of Hypothalamic Amenorrhea (HA).

You find yourself sifting through a whole set of new acronyms – HA, TTC, OPK, etc. Your infertility diagnosis that you once thought was irreversible is all of a sudden something that you can fix! You’re ready to accept that you have HA because even though the recovery process won’t be a cakewalk, you know you can do it.

So you set out to have your hormones tested and unsurprisingly, everything comes back on the low range of normal. You also have a message from your REI telling you that you should consider prepping for an IVF cycle as soon as possible if you want to be pregnant due to low ovarian reserve.

Being diagnosed with a low ovarian reserve can feel soul-crushing. Like you did something wrong and now you’ve permanently damaged your fertility. If you’ve been told you have low ovarian reserve or low AMH in addition to HA, I want you to understand that this value is not the best representation of fertility in women who aren’t ovulating regularly.

What is AMH?

Anti-Müllerian hormone (AMH) is a common abbreviation and frequently-tested marker when assessing a woman’s fertility. AMH is produced in the ovaries by the granulosa cells surrounding the growing and developing follicles. A quick Google search about this hormone can be very misleading, especially in the context of HA.  So what does it actually tell you about your future fertility? 

During a healthy menstrual cycle, small sacs called follicles grow on your ovaries.  These follicles produce and release a series of reproductive hormones until eventually, one dominates in size and releases an egg. This process, formally known as ovulation, leads to either your monthly period or, if the egg gets fertilized, a pregnancy. AMH is one of the hormones produced by these follicles. It is traditionally used to estimate the amount of eggs you have left compared to your age-matched peers. Normal values for Anti-Müllerian hormone vary because this hormone naturally declines with age. 

AMH gets a lot of attention because it can predict how well someone will respond to an IVF cycle. However, outside the context of IVF, AMH is a flawed representation of fertility, especially when you aren’t ovulating regularly.

HA and Low AMH Levels

Some women with HA can present with abnormally low AMH levels. This can tie back to the fact that those with HA do not grow follicles like one with a healthy menstrual cycle would. Since AMH is produced by growing follicles, it can appear falsely low if a woman’s follicles are not developing. Cases of low AMH are more typical in those with severe cases of HA. In these cases, hormone levels of FSH and LH are very low because there is little/no communication going on between the brain ovaries and therefor no follicular growth.

On the flipside, your body can be making multiple follicles but their development can stall out before a dominant follicle is picked and primed for ovulation. This means you will have several growing follicles that are all producing AMH. This is where we can see a falsely high AMH ( > 4.6 ng/mL). This presentation of multiple follicles (seen via ultrasound) and high AMH is a reason why some women with HA get incorrectly diagnosed with Polycystic Ovarian Syndrome (PCOS). HA needs to be ruled out first before a medical professional is able to accurately diagnose someone with PCOS. And when someone does have HA, the number of follicles and AMH levels will normalize once the body begins cycling naturally.

Can it be improved?

In short, yes!

Learning that you have abnormal AMH may feel like a massive roadblock to your hopes of growing a family. But the bottom line is that AMH is not stagnant and can change over time. Some research suggests AMH levels can appear falsely low due to Vitamin D deficiency. Interestingly enough, proper Vitamin D supplementation has shown to increase low AMH and bring high AMH back down into a more normal range for age.

For fertility, optimal blood Vitamin D levels are > 50 ng/dL. It’s important to note than many standard lab ranges don’t identify a deficiency unless your below 30 ng/dL, which leaves a lot of people in the dark about their Vitamin D deficiency. If you have concern for low AMH it’s worth having your Vitamin D tested and getting started on a quality supplement.

If you have both low AMH and Hypothalamic Amenorrhea, remember that AMH isn’t the best indicator of fertility when your cycle is still missing.  There are several strategies to improve it, and step one is getting your body ovulating again! Many women with HA have seen their low AMH improve with recovery.

Overcoming HA alone is far from easy, but the team at The Food Freedom Fertility Society is able to provide you with the expertise and support to restore your fertility in under 3 months. Ready to next the step step on restoring your fertility?

You Can Recover from HA and Restore Your Fertility

Apply to Join the Food Freedom Fertility Society.

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1 Comment

  1. Robin Friedman

    Such a great overview of AMH and it’s significance in HA. Thank you!


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I’m a fertility nutritionist and registered dietitian who specializes in hypothalamic amenorrhea. My passion is helping women trying to conceive find freedom with food and exercise, so they can recover their period, and get pregnant naturally.

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Jan 19, 2022

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