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...
...e Society (ES) suggests that clinicians make the...
...ests diagnostic evaluation for FHA in adole...
...ts screening patients with FHA for psych...
...linicians establish the diagnosis of FHA...
...1. Potential Etiologies of AmenorrheaHaving t...
...n Causes of Anovulation and Accompa...
Evaluation
Evaluation
...ts with suspected FHA, ES recommends ob...
...with suspected FHA, ES recommends e...
...nd women with suspected FHA, ES recommends obtain...
...of an initial endocrine evaluation for p...
...g pregnancy, ES suggests administering...
...recommends a brain magnetic resonance im...
...S suggests that clinicians obtain a baseline bone...
...ses of primary amenorrhea, ES suggests evaluat...
...measurement by DXA in those with ≥6...
...monitoring for hyperresponse in thos...
Treatment
...reatme...
...recommends that clinicians evaluate...
...escents and women with FHA, ES rec...
...olescents and women with FHA, ES suggests psycho...
...ggests against patients with FHA using oral co...
...nts with FHA using OCPs for contraception,...
...ts short-term use of transdermal E2 the...
...gainst using bisphosphonates, denosumab, t...
In rare adult FHA cases, ES suggests that shor...
...h pulsatile gonadotropin-releasing hormone (G...
...tious use of gonadotropin therapy. (2-VL)...
...reatment with clomiphene citrate for ovulation ind...
...he use of kisspeptin and leptin for treating infer...
...ere is only a single, small study suggesting...
...ts that clinicians should induce ovulation...