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
...Diagno...
...ndocrine Society (ES) suggests that clinicians...
...ts diagnostic evaluation for FHA in adol...
...S suggests screening patients with FHA for psychol...
...nicians establish the diagnosis of FHA, the...
Table 1. Potential Etiologies of Ameno...
...e 2. Common Causes of Anovulation and Ac...
Evaluation
...Evaluation...
...s with suspected FHA, ES recommends obtaining a...
...th suspected FHA, ES recommends exc...
...and women with suspected FHA, ES recommend...
...initial endocrine evaluation for patients with...
...excluding pregnancy, ES suggests administeri...
...brain magnetic resonance imaging (MRI...
...clinicians obtain a baseline bone...
...f primary amenorrhea, ES suggests ev...
...easurement by DXA in those with ≥6 mont...
...itoring for hyperresponse in those treated w...
Treatment
T...
...ecommends that clinicians evaluate patients f...
...dolescents and women with FHA, ES recommends c...
...nts and women with FHA, ES suggests psycho...
...ts against patients with FHA using oral contracep...
...patients with FHA using OCPs for contracep...
...sts short-term use of transdermal E2 therapy with...
...s against using bisphosphonates, denos...
...rare adult FHA cases, ES suggests that short-te...
...reatment with pulsatile gonadotropin-releasing h...
...tious use of gonadotropin therapy. (2-VL)...
...ial of treatment with clomiphene citrat...
...use of kisspeptin and leptin for treating...
...ven that there is only a single, small study sugge...
...suggests that clinicians should induce ovulation...