Metabolic and Endocrine Alterations in Underweight and Normal-Weight Women with Functional Hypothalamic Amenorrhea

Background: Functional hypothalamic amenorrhea (FHA) is a form of chronic anovulation associated with hypoestrogenism. Weight loss, excessive exercise, stress and long-lasting hypoestrogenism lead to infertility and bone loss. FHA also leads to metabolic changes that increase cardiovascular risk in women who otherwise appear metabolically healthy. Methods: This was a case-control study assessing metabolic and endocrine alterations in patients with FHA, stratified by BMI into underweight (BMI < 18.5) and normal-weight (BMI 18.5-24.99) categories. Results: Women diagnosed with FHA had significantly higher levels of total (193 ± 41.96 vs. 181 ± 28.23 mg/dL; p = 0.037) and LDL cholesterol (67 ± 34.89 vs. 63 ± 24.78 mg/dL; p = 0.018) compared with healthy controls. HDL cholesterol levels did not differ between groups; however, normal-weight participants in the study group had higher HDL cholesterol than underweight participants (p = 0.007). FHA patients had significantly lower HOMA-IR (p = 0.001), lower prolactin (p < 0.001), and higher cortisol levels (p = 0.036). Conclusions: Metabolic and endocrine alterations in FHA patients are modulated both by the condition per se and by BMI. FHA influences total and LDL cholesterol, prolactin, and cortisol levels, while BMI primarily affects HDL cholesterol. Both FHA and BMI have a statistically significant impact on HOMA-IR, but neither influences triglycerides or TSH levels. Our findings indicate that the recovery and prevention of metabolic complications require psychological support and consistent weight management.