Functional Hypothalamic Amenorrhea
Key Points
Key Points
- Functional hypothalamic amenorrhea (FHA) is a form of chronic anovulation, not due to identifiable organic causes, but often associated with stress, weight loss, excessive exercise, or a combination thereof.
- Investigations should include assessment of systemic and endocrinologic etiologies, since FHA is a diagnosis of exclusion.
- A multidisciplinary treatment approach is necessary, including medical, dietary, and mental health support.
- Medical complications include, among others, bone loss and infertility.
- Appropriate therapies are under debate and investigation.
Diagnosis
...iagnosi...
...ocrine Society (ES) suggests that clinici...
...ests diagnostic evaluation for FHA in adolesce...
...ts screening patients with FHA for p...
Once clinicians establish the diagnosis of FHA, t...
...Potential Etiologies of AmenorrheaHaving tr...
...ble 2. Common Causes of Anovulation and Accomp...
Evaluation
Evaluatio...
...nts with suspected FHA, ES recommends o...
...tient with suspected FHA, ES recommend...
...ts and women with suspected FHA, ES recommends...
...part of an initial endocrine evaluatio...
...excluding pregnancy, ES suggests adm...
...nds a brain magnetic resonance imaging (MRI) (wit...
...ests that clinicians obtain a baseline bone m...
...of primary amenorrhea, ES suggests evaluat...
...BMD measurement by DXA in those with â...
...l monitoring for hyperresponse in those treated...
Treatment
...atment
...ecommends that clinicians evaluate patients f...
...and women with FHA, ES recommends correcti...
In adolescents and women with FHA, ES...
...ainst patients with FHA using oral...
...atients with FHA using OCPs for contrace...
...ort-term use of transdermal E2 therapy...
...ts against using bisphosphonates, deno...
...A cases, ES suggests that short-term use of recom...
...ent with pulsatile gonadotropin-releasi...
...use of gonadotropin therapy. (2-VL)699...
...of treatment with clomiphene citrate for ovulat...
...use of kisspeptin and leptin for treating i...
...t there is only a single, small study...
...ests that clinicians should induce ovul...