Functional hypothalamic amenorrhea: A call for global awareness and research

Functional hypothalamic amenorrhea (FHA) is a common yet under-recognized cause of secondary amenorrhea resulting from reversible suppression of the hypothalamic-pituitary-ovarian axis. Triggered by chronic stress, low energy availability, disordered eating, and/or excessive exercise, FHA leads not only to anovulation and hypoestrogenism but also to broader neuroendocrine disruption involving the hypothalamic-pituitary-adrenal and thyroid axes. Although historically associated with extreme trauma and the "female athlete triad," FHA occurs worldwide and remains significantly underdiagnosed across diverse cultural and socioeconomic settings. Beyond reproductive consequences, FHA has been associated with reduced bone density, endothelial dysfunction, adverse cardiometabolic profiles, sexual dysfunction, mood disorders, and cognitive symptoms, while potential effects on brain and gut physiology remain less established. Despite these multisystem concerns, evidence-based treatment strategies are limited, and diagnosis is often delayed due to stigma, normalization of menstrual irregularities, and lack of clinical awareness. There is a critical need for global education, standardized diagnostic and management guidelines, mechanistic research to define long-term risks, and development of targeted interventions that restore both ovarian function and underlying neuroendocrine health. In this clinical perspective, we highlight key gaps and priorities to improve recognition, management, and long-term outcomes. FHA should be recognized as an important marker of overall well-being and a call to advance scientific understanding and care for affected individuals worldwide.