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
...y (ES) suggests that clinicians ma...
ES suggests diagnostic evaluation for FHA in...
...reening patients with FHA for psychological stress...
...ians establish the diagnosis of FHA, the E...
...tial Etiologies of Amenorrhea...
...Common Causes of Anovulation and Accompanying L...
Evaluation
...Evalua...
...h suspected FHA, ES recommends obtaini...
...tient with suspected FHA, ES recomm...
...ts and women with suspected FHA, ES recommends obt...
...t of an initial endocrine evaluation...
...xcluding pregnancy, ES suggests administe...
...S recommends a brain magnetic resonanc...
ES suggests that clinicians obtain a baselin...
...primary amenorrhea, ES suggests evaluat...
...ine BMD measurement by DXA in those with ≥6 mont...
...nitoring for hyperresponse in those treated wit...
Treatment
...Treatment...
...hat clinicians evaluate patients for inpatient tre...
...and women with FHA, ES recommends corre...
...and women with FHA, ES suggests psych...
...S suggests against patients with FHA using oral c...
...atients with FHA using OCPs for contraception...
...rt-term use of transdermal E2 therapy with cycl...
...against using bisphosphonates, denosumab, tes...
...A cases, ES suggests that short-ter...
...nt with pulsatile gonadotropin-relea...
cautious use of gonadotropin therapy. (2-VL)6...
...reatment with clomiphene citrate for ovula...
...e use of kisspeptin and leptin for treating infer...
...iven that there is only a single, small stu...
...ggests that clinicians should induce ovulation...