[Functional hypothalamic amenorrhea]

Area of Science:

• Reproductive Endocrinology
• Neuroendocrinology

Background:

• Functional hypothalamic amenorrhea (FHA) is a prevalent cause of secondary amenorrhea, distinct from pregnancy and polycystic ovary syndrome.
• FHA arises from disrupted pulsatile gonadotropin-releasing hormone (GnRH) secretion, leading to impaired follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release.
• It represents a physiological defense mechanism prioritizing survival over reproduction, characterized by reversibility upon removal of stressors.

Purpose of the Study:

• To review the pathophysiology, types, hormonal changes, and health consequences of functional hypothalamic amenorrhea.
• To highlight the long-term skeletal, cardiovascular, and psychological impacts of FHA.

Main Methods:

• Literature review of functional hypothalamic amenorrhea.
• Analysis of hormonal profiles and health outcomes in FHA patients.

Main Results:

• FHA encompasses weight loss, stress, and exercise-related subtypes, all leading to profound hypoestrogenism.
• Associated hormonal disturbances include mild hypercortisolemia, low insulin, low IGF-1, and low triiodothyronine.
• Significant health consequences include decreased bone mineral density (osteopenia, osteoporosis), endothelial dysfunction, dyslipidemia, increased depression, anxiety, and sexual dysfunction.

Conclusions:

• Functional hypothalamic amenorrhea results in significant hypoestrogenism and diverse hormonal imbalances.
• Long-term complications of FHA severely affect women's health, particularly bone density and cardiovascular function.
• Addressing the underlying stressors is crucial for restoring reproductive function and mitigating long-term health risks.