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
...gnosis
...ociety (ES) suggests that clinicians m...
...S suggests diagnostic evaluation for FHA in adole...
...s screening patients with FHA for psychologic...
...linicians establish the diagnosis...
...Potential Etiologies of AmenorrheaHavi...
...ble 2. Common Causes of Anovulation and...
Evaluation
...luation...
...n patients with suspected FHA, ES recommends obtai...
...ent with suspected FHA, ES recommends excluding pr...
...and women with suspected FHA, ES recommen...
...itial endocrine evaluation for patients wit...
...r excluding pregnancy, ES suggests administ...
...a brain magnetic resonance imaging (MRI) (with...
...suggests that clinicians obtain a baseline bone...
...of primary amenorrhea, ES suggests evaluating M...
...ine BMD measurement by DXA in those with ≥6...
...cal monitoring for hyperresponse in those tr...
Treatment
Treatment
...recommends that clinicians evaluate patien...
...n adolescents and women with FHA, ES reco...
...ts and women with FHA, ES suggests psycho...
...against patients with FHA using oral contracepti...
...h FHA using OCPs for contraception, ES sug...
...sts short-term use of transdermal E2 therapy wit...
...ggests against using bisphosphonates, de...
...e adult FHA cases, ES suggests that short-...
...with pulsatile gonadotropin-releasin...
...autious use of gonadotropin therapy....
...trial of treatment with clomiphene citrate f...
...nst the use of kisspeptin and leptin for t...
...en that there is only a single, sma...
...suggests that clinicians should induce ovula...