How Kisspeptin, Stress, and Prolactin Disrupt Hormonal Balance in Functional Hypothalamic Amenorrhea (FHA)
Before we dive in, we want to give credit to the author. This was written by Cat, a graduate of our Holistic HA Practitioner (HHAP) Certification Program. Cat brings a deep understanding of the root causes of HA and is passionate about supporting women on the path to recovery through education, empowerment, and holistic strategies.
Understanding Kisspeptin, Stress, and Prolactin in Functional Hypothalamic Amenorrhea (FHA)
Kisspeptin is a small but mighty neuropeptide that plays a crucial role in regulating reproductive hormones. Often called the “master controller” of the reproductive system, kisspeptin activates gonadotropin-releasing hormone (GnRH)—the hormone that kickstarts the entire hypothalamic-pituitary-ovarian (HPO) axis (1).
When kisspeptin levels fall, GnRH slows down, and the reproductive system becomes suppressed—this is exactly what happens in functional hypothalamic amenorrhea (FHA), a condition driven by chronic stress and low energy availability (2).
How Low Energy Availability Suppresses Kisspeptin and Reproductive Hormones
In FHA, the body enters a state of conservation due to insufficient caloric intake, excessive exercise, or both. Appetite-regulating hormones like leptin and ghrelin become key players in this metabolic adaptation (3).
Leptin, produced by fat cells, signals energy sufficiency and activates kisspeptin neurons.
Ghrelin, produced in the stomach during fasting, has the opposite effect—it suppresses kisspeptin signaling.
In states of low energy, leptin drops and ghrelin rises. As a result, kisspeptin neurons receive weaker signals, leading to decreased GnRH pulses. Without consistent GnRH activity, ovulation and menstruation are halted (4).
The Impact of Chronic Stress and Cortisol on Kisspeptin in FHA
FHA is not just about energy balance—it’s also about stress perception. Emotional, physical, or metabolic stress elevates cortisol, which directly suppresses kisspeptin through glucocorticoid receptors on kisspeptin neurons. This action inhibits the KISS1 gene, the very gene responsible for kisspeptin production (5).
Even without extreme calorie restriction, high stress alone can suppress kisspeptin and disrupt the reproductive axis (5).
Kisspeptin, Dopamine, and Prolactin: A Hormonal Chain Reaction in FHA
Kisspeptin doesn’t just influence GnRH—it also affects dopamine production, which in turn regulates prolactin levels. If you want to understand how prolactin fits into this hormonal web, check out our article on How Prolactin Can Disrupt Hormone Balance in FHA.
In the hypothalamus, TIDA neurons (tuberoinfundibular dopaminergic neurons) are responsible for producing dopamine, and these neurons are activated by kisspeptin (6). When kisspeptin drops in FHA, dopamine also declines.
Compounding the issue, low estrogen—resulting from suppressed GnRH—further reduces dopamine. Estrogen supports dopamine synthesis and protects dopaminergic neurons (7). The outcome? Less dopamine means prolactin rises unchecked, further inhibiting GnRH and worsening the hormonal shutdown.
Understanding Hormonal Imbalance in FHA: A Soccer Team Analogy
Imagine your reproductive hormones as a soccer team:
Kisspeptin is your left-winger—responsible for setting plays, but benched during stress or low energy.
GnRH is your right-wing playmaker—relying on kisspeptin’s signal to stimulate luteinizing hormone (LH) and follicle stimulating hormone (FSH).
Dopamine is the goalie—blocking prolactin, the opposing team’s scorer.
In FHA, kisspeptin stays off the field. GnRH falters, dopamine weakens, and prolactin scores, shutting down the cycle (6).
The Vicious Hormonal Cycle in Functional Hypothalamic Amenorrhea
FHA isn’t just about skipped periods—it’s a protective brain response to perceived unsafety and energy deficiency.
Here’s how the hormonal cycle spirals:
Low kisspeptin → Low GnRH → Low estrogen → Low dopamine → High prolactin →Even lower GnRH → Amenorrhea continues.
How to Restore Hormonal Balance and Recover from FHA
Recovery from hypothalamic amenorrhea starts with sending safety signals back to your brain. This means focusing on energy availability, rest, and stress reduction—not just eating more or exercising less.
To support kisspeptin and hormonal recovery:
Increase caloric intake
Reduce physical and emotional stress
Prioritize rest and nervous system regulation
As energy availability rises, leptin increases, ghrelin decreases, kisspeptin reactivates, and the HPO axis begins to function again. Dopamine levels rise, prolactin drops, and menstrual function is restored.
Key Takeaway: Kisspeptin as the Hormonal Gatekeeper in FHA Recovery
Kisspeptin is the hormonal gatekeeper of your reproductive health. In FHA, it’s silenced by energy deficiency and stress—triggering a domino effect of hormonal disruptions. The good news? Your body can recover. With nourishment, rest, and resilience, the hormonal orchestra can play again—on time, in rhythm, and in balance.
Feeling like stress might be the missing link in your period recovery?
If you're dealing with high prolactin, missing periods, or feeling stuck in HA, you're not alone—and you don’t have to figure it out by yourself. Our 1:1 coaching and group coaching is designed to help you uncover the root causes, calm your nervous system, and restore your missing period with confidence.
At The HA Society, we provide education, community, and individualized support to help women move through the complexities of recovery—from stress-driven hormone disruptions to body image and behavior change. Whether you’re in the thick of healing or supporting others through it, we’re here to walk with you.
Curious to learn more about how stress affects your hormones—or want to become the kind of practitioner who can guide others through this healing process? Explore our Holistic HA Practitioner Certification Program, where graduates like Cat learn the science-backed tools to help clients recover their cycles, restore fertility, and heal holistically.
Keep Reading:
Stress and Amenorrhea: What Is the Connection?
Tips to Eat More Without The Stress + Meal Ideas for Hypothalamic Amenorrhea
References:
Harter, C. J. L., Kavanagh, G. S., & Smith, J. T. (2018). The role of kisspeptin neurons in reproduction and metabolism. The Journal of Endocrinology, 238(3), R173–R183. https://doi.org/10.1530/JOE-18-0108
2. Patel, A. H., Koysombat, K., Pierret, A., Young, M., Comninos, A. N., Dhillo, W. S., & Abbara, A. (2024). Kisspeptin in functional hypothalamic amenorrhea: Pathophysiology and therapeutic potential. Annals of the New York Academy of Sciences, 1540(1), 21 46. https://doi.org/10.1111/nyas.15220
3. Meczekalski, B., Katulski, K., Czyzyk, A., Podfigurna‐Stopa, A., & Maciejewska‐Jeske, M. (2014). Functional hypothalamic amenorrhea and its influence on women’s health. Journal of Endocrinological Investigation, 37(11), 1049 1056. https://doi.org/10.1007/s40618-014-0140-1
4. Ihalainen, J. K., Mikkonen, R. S., Ackerman, K. E., Heikura, I. A., Mjøsund, K., Valtonen, M., & Hackney, A. C. (2024). Beyond Menstrual Dysfunction: Does Altered Endocrine Function Caused by Problematic Low Energy Availability Impair Health and Sports Performance in Female Athletes? Sports Medicine, 54(9), 2267–2289. https://doi.org/10.1007/s40279-024-02065-6
5. Meczekalski, B., Niwczyk, O., Bala, G., & Szeliga, A. (2022). Stress, kisspeptin, and functional hypothalamic amenorrhea. Current Opinion in Pharmacology, 67, 102288. https://doi.org/10.1016/j.coph.2022.102288
6. Iwata, K., & Ozawa, H. (2020). The role of hypothalamic kisspeptin neurons in regulating reproductive function. Journal of Nippon Medical School, 16(2), 110–114. https://pmc.ncbi.nlm.nih.gov/articles/PMC8656200/
7. Del Río, J. P., Alliende, M. I., Molina, N., Serrano, F. G., Molina, S., & Vigil, P. (2018). Steroid hormones and their action in women's brains: The importance of hormonal balance. Frontiers in Public Health, 6, 141. https://doi.org/10.3389/fpubh.2018.00141
8. Dobranowska, K., Plińska, S., & Dobosz, A. (2024). Dietary and Lifestyle Management of Functional Hypothalamic Amenorrhea: A Comprehensive Review. Nutrients, 16(17), 2967. https://doi.org/10.3390/nu16172967
