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
...iagnosis
...rine Society (ES) suggests that clinicians make t...
...ests diagnostic evaluation for FHA i...
...ests screening patients with FHA for psycholog...
...inicians establish the diagnosis of FHA, the ES su...
...e 1. Potential Etiologies of Ameno...
...2. Common Causes of Anovulation and Accompanying...
Evaluation
Evaluatio...
...patients with suspected FHA, ES recommends ob...
...with suspected FHA, ES recommends excludin...
...cents and women with suspected FHA, ES r...
...art of an initial endocrine evaluatio...
...cluding pregnancy, ES suggests admin...
...recommends a brain magnetic resona...
...s that clinicians obtain a baseline b...
...primary amenorrhea, ES suggests eva...
...aseline BMD measurement by DXA in those with...
clinical monitoring for hyperresponse in those...
Treatment
...eatmen...
...recommends that clinicians evaluate pa...
...escents and women with FHA, ES recommends co...
In adolescents and women with FHA, ES suggests p...
...against patients with FHA using oral contracep...
...nts with FHA using OCPs for contraception, ES sug...
...suggests short-term use of transdermal E2 the...
...sts against using bisphosphonates, denosuma...
...ult FHA cases, ES suggests that short-term use of...
...with pulsatile gonadotropin-releasing hormone...
...gonadotropin therapy. (2-VL)699...
...trial of treatment with clomiphene citrate for o...
...st the use of kisspeptin and leptin...
...ere is only a single, small study sugge...
...at clinicians should induce ovulat...