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Functional Hypothalamic Amenorrhea

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Functional Hypothalamic Amenorrhea, Functional Amenorrhea

  • See Also
  1. Amenorrhea
  2. Female Athlete Triad
  • Definitions
  1. Functional Hypothalamic Amenorrhea
    1. Chronic Anovulation due to hypothalamic-pituitary axis suppression from functional causes
  • Causes
  1. Weight loss (e.g. Eating Disorder such as Anorexia)
  2. Excessive Exercise (including Female Athlete Triad)
  3. Excessive emotional stress
  • Associated Conditions
  1. Female Athlete Triad
  • History
  1. See Amenorrhea
  • Exam
  1. See Amenorrhea
  • Labs
  1. See Amenorrhea
  2. Serum LH and Serum FSH
    1. Low to low normal levels
  3. Serum Estradiol
    1. Low
  4. Exclude other causes
    1. Pregnancy Test (all patients!)
    2. Thyroid Stimulating Hormone (TSH)
    3. Serum Prolactin
  • Imaging
  1. Pelvic Ultrasound (part of evaluation for Secondary Amenorrhea)
    1. See Amenorrhea
  2. Bone Density (DEXA Scan) Indications
    1. Amenorrhea (6 months or more)
    2. Nutritional deficit
    3. Stress Fracture history
  • Evaluation
  1. See Amenorrhea
  2. Functional Hypothalamic Amenorrhea is a diagnosis of exclusion (evaluate for other causes)
  • Management
  1. See Female Athlete Triad
  2. Treat underlying cause (multidisciplinary approach)
    1. Eating Disorder or other weight loss cause
    2. Stress Reduction
    3. Female Athlete Triad
  3. Contraception as needed
    1. Patients are still at risk for pregnancy (Ovulation without Menstruation may occur)
  • Complications
  1. Decreased Bone Mineral Density (Osteopenia, Osteoporosis)
    1. Bisphosphonates are not recommended in Female Athlete Triad
    2. Combined Oral Contraceptives do not improve bone density
    3. Consider short-term Estradiol if nonpharmacologic management fails after 6-12 months
      1. Transdermal 17B-Estradiol (100 mcg patch for Bone Age >15 years old) AND
      2. Medroxyprogesterone 2.5 mg daily for 10 days each month
  • References
  1. Klein (2019) Am Fam Physician 100(1): 39-48 [PubMed]