The american society for reproductive medicine, the european society of endocrinology, and the pediatric endocrine society. Functional hypothalamic amenorrhea fha is a form of amenorrhea and chronic anovulation and is one of the most common types of secondary amenorrhea. Endocrine society experts issue clinical practice guideline. Outline the diagnostic workup, including blood testing, imaging, and functional studies 3. Simple discussions about increasing caloric intake and decreasing energy expenditure may be all that is necessary to treat amenorrhea, and consequently, ovulatory menses. Also commonly referred to as functional hypothalamic amenorrhea fha, ha is characterized by three main types according to the physiologic or psychological trigger. However, recent advances in our knowledge about the role of the central nervous system cns and. Functional hypothalamic amenorrhea should be, in each case, differentiated from other forms of primary or secondary amenorrhea. Differential diagnosis functional hypothalamic amenorrhea should be, in each case, differentiated from other forms of primary or secondary amenorrhea. The basic approach to this distinction is an assessment of the gonadotropins and identifying hypo. Bruni v, dei m, morelli c, schettino mt, balzi d, nuvolone d.
It is often seen in the setting of stress, weight loss, or excessive exercise. Functional hypothalamic amenorrhea is a reversible form of gonadotropinreleasing hormone gnrh deficiency commonly triggered by stressors such as excessive exercise, nutritional deficits, or. It was previously known as juvenile hypothalamosis syndrome, prior to the discovery that sexually mature females are equally affected. The physiology of gonadotropinreleasing hormone gnrh secretion in men and. Functional hypothalamic amenorrhea fha is a disorder of the hypothalamic pituitaryovarian axis in an otherwise anatomically and organically normal system and is characterized by a. Functional hypothalamic amenorrhea is a condition characterized by the absence of menses due to the suppression of the hypothalamicpituitaryovarian axis, in which no anatomical or organic disease is identified.
Hypothalamic amenorrhea isnt something you should self diagnose. This guideline was funded by the endocrine society. Nov 16, 2016 i have a hypothalamic amenorrhea update for you and as im sure youve gathered from the post title, its good news. Patients with primary or secondary amenorrhea should be evaluated for other causes of amenorrhea before a diagnosis of fha can be made. Diagnosis of hypothalamic amenorrhea involves first eliminating other causes of amenorrhea. Functional hypothalamic amenorrhea is a common form of secondary. First, reverse underlying causes of hypothalamic amenorrhea through behavior modification reduce stress levels, decrease intensity of exercise, and increasing weight and bmi. The article ends with the authors clinical recommendations. A comprehensive guide to hypothalamic amenorrhea recovery and much more, including fertility treatments, pregnancy and postpartum question, and life after recovery. The psychoneuroendocrinology of functional hypothalamic. Warren8 1cincinnati children s hospital medical center, cincinnati, ohio 45229. Mood disorders and sexual functioning in women with functional hypothalamic amenorrhea. Jan 31, 2007 indeed, the rationale for the use of sex steroid replacement is based on the erroneous assumption that functional forms of hypothalamic hypogonadism represent only or primarily an alteration in the hypothalamic. Use of cognitive behavior therapy for functional hypothalamic.
The basic approach to this distinction is an assessment of the gonadotropins and identifying hypogonadotrophic hypogonadism. If such a diagnosis has been made, the key diagnostic tool is a gnrh stimulation test, which. The role of antecedent stress as an explanation for both the neurochemical changes and the dysfunctional behavior of these women is examined by utilizing concepts provided by the animal model of inescapable shock and the human. An endocrine society clinical practice guideline catherine m. The 2017 endocrine society clinical practice guidelines on functional hypothalamic amenorrhea fha, cosponsored by. Pdf mood disorders and sexual functioning in women with. Pdf a genetic basis for functional hypothalamic amenorrhea.
Functional hypothalamic amenorrhea and its influence on. Functional hypothalamic amenorrhea fha is the term used to describe amenorrhea that results from such causes and is diagnosed after excluding other etiologies of amenorrhea. Adolescents or young women with this condition typically present with amenorrhea of 6 months duration or. Hypothalamic amenorrhea fertility centers of illinois. The most common form of secondary amenorrhea is hypothalamic amenorrhea, where the female body reverts to. Investigations should include assessment of systemic and endocrinologic etiologies, since fha is a diagnosis of exclusion.
Fha is presumed to be a functional disruption of pulsatile hypothalamic gonadotropin. Hypothalamic amenorrhea is a condition when the menstrual cycle and ovulation is disrupted due to the hypothalamus not working properly. Understand the pathophysiology underlying fha and the evidence base for the new es guideline on this topic 2. Functional hypothalamic amenorrhea guidelines pocket guide. Women with functional hypothalamic amenorrhea but not other forms of anovulation display amplified cortisol concentrations. Hypothalamic amenorrhea commonly occurs in women who have eating disorders anorexia nervosa or women who have very low body fat, such as seen in athletes. Identify a management plan for adolescents and women with fha 5. Functional hypothalamic amenorrhea and its influence on women. Functional hypothalamic amenorrhea new england journal. A genetic basis for functional hypothalamic amenorrhea nejm. The terms functional hypothalamic amenorrhea and hypothalamic amenorrhea ha are often used interchangeably. I got my period back cue the confetti, girl dancing in the red dress emoji.
Mar 22, 2017 the guideline, titled functional hypothalamic amenorrhea. Treatments to prevent bone loss in functional hypothalamic. Hypothalamic amenorrhea as a possible cause of a missed period. Acupuncture and moxibustion for functional hypothalamic. Hypothalamic amenorrhea and the longterm health consequences. Functional hypothalamic amenorrhea is a reversible form of gonadotropinreleasing hormone gnrh deficiency commonly triggered by stressors such as excessive exer cise, nutritional deficits, or psychological distress. Feb 06, 2020 functional hypothalamic amenorrhea fha is a common cause of amenorrhea in adolescent girls. Hypothalamic amenorrhea can also occur due to stress and poor nutrition. It is potentially reversible, and is often seen in the setting of stress, weight loss, or excessive exercise 1,2,3. Recovery of ovarian activity in women with functional. Jan 25, 2019 hypothalamic amenorrhea is a condition in which the periods or the menstrual cycle in a female stops due to a problem in the hypothalamus gland.
Hypothalamic amenorrhea develops when poor nutrition or stress alters your signaling to the brain to regulate the menstrual cycle. The diagnosis and management of fha, as well as the overall approach to the woman with primary and secondary amenorrhea, is presented separately. Stressinduced anovulation functional hypothalamic amenorrhea 34 hyperandrogenismpcos 29 hyperprolactinemia premature menopause 12 ashermans syndrome 5 other 7 abased on data presented in reindollar, r. Apr 23, 2020 hypothalamic amenorrhea is cessation of menses caused by disorders that interfere with normal hypothalamic pituitaryovarian axis activation. Treatment of functional hypothalamic amenorrhea with. Secondary amenorrhea is when a woman who previously menstruated on a regular basis misses her periods for six months, or when a woman who previously experienced irregular periods skips her periods for 12 months. Functional hypothalamic amenorrhea fha is defined as the absence of menses, caused by a suppression of the hypothalamicpituitaryovarian hpo axis, in which no anatomic or organic cause is found. Women with this condition may be severely restricting their caloric intake, exercising more than two to three hours a day, or under major psychological stress. Fha is characterized by the absence of menses and profound hypoestrogenemia due to suppression of the hypothalamic pituitaryovarian axis 12. Fha was defined by a history of amenorrhea of at least 6 months duration, a negative urinary pregnancy test, serum lh, fsh, tsh, prl, and androgen levels within the normal range, and an lh. The participants include an endocrine societyappointed task force of eight experts, a methodologist, and a medical writer. Studies also show that this condition may be related to infertility and anovulation. Body composition variables and leptin levels in functional hypothalamic amenorrhea and amenorrhea related to eating disorders.
Potential health consequences of functional hypothalamic amenorrhea, often termed stress. The proximate cause of fha is reduced gnrh drive, which manifests in the circulation as decreased lh pulse frequency 1 x 1 crowley, w. Moreover, women with fha display subclinical hypercortisolism and hypothalamic hypothyroidism 4 x 4 berga, s. Mar 09, 2018 hypothalamic amenorrhea is a medical condition in which there is cessation of menstruation cycle for many months due to a problem in the hypothalamus. Functional hypothalamic amenorrhea is a condition that develops due to poor nutrition, stress, or too much exercise. Women with functional hypothalamic amenorrhea display multiple neuroendocrine aberrations suggestive of altered central neurotransmission.
Functional hypothalamic amenorrhea fha is a common and theoretically reversible form of anovulation. Functional hypothalamic amenorrhea dysmorphic features webbed neck, short stature, low hairline turner syndrome male pattern baldness, increased facial hair, acne hyperandrogenism, pcos. Approach your primary care provider and find a good functional practitioner experienced in ha like me t to work with you to diagnose the cause of your lack of period. Identify gaps in knowledge for fha that will move forward. She typically runs 10 km 6 mi per day, at least five times per week. Functional hypothalamic amenorrhea is a condition characterized by the absence of menses due to the suppression of the hypothalamic pituitaryovarian axis, in which no anatomical or organic disease is identified. The role of antecedent stress as an explanation for both the neurochemical changes and the dysfunctional behavior of these women is examined by utilizing concepts provided by the animal model of inescapable shock and the human condition of post traumatic. 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. Amenorrhea complementary and alternative medicine st. When your brain doesnt get proper nutrients, your brain to pulse the hormones that govern follicle ripening and release of eggs. Functional hypothalamic amenorrhea is associated with stress, weight loss, or exercise or a combination but the diagnosis requires ruling out organic or anatomic causes of anovulation. A genetic basis for functional hypothalamic amenorrhea. A 16yearold girl presents for evaluation of secondary amenorrhea. Main causes of hypothalamic amenorrhea are stress, poor nutrition and extreme exercise.
Hypothalamic amenorrhea is also seen in athletes and other women low body mass index bmi. Functional hypothalamic amenorrhea fha is a form of anovulation, due to the suppression of hypothalamicpituitaryovarian axis, not related to identifiable organic causes. The hypothalamus is responsible for producing the hormone that triggers the start of the menstrual cycle. Hypothalamic amenorrhea is cessation of menses caused by disorders that interfere with normal hypothalamic pituitaryovarian axis activation. Pdf functional hypothalamic amenorrhea researchgate. Jun 01, 20 functional hypothalamic amenorrhea occurs when the hypothalamic pituitaryovarian axis is suppressed due to an energy deficit stemming from stress, weight loss independent of original weight.
A new endocrine society guideline recommends a multidisciplinary approach to treatment of fha, including medical, dietary, and mental health support. Three main types of functional hypothalamic amenorrhea have been recog nized, associated with stress, weight loss, or exercise. Hypothalamic amenorrhea definition of hypothalamic. Functional hypothalamic amenorrhea fha is a form of anovulation, due to the suppression of hypothalamic pituitaryovarian axis, not related to identifiable organic causes. Functional hypothalamic amenorrhea treatment guidelines. I have a hypothalamic amenorrhea update for you and as im sure youve gathered from the post title, its good news. To formulate clinical practice guidelines for the diagnosis and treatment of functional hypothalamic amenorrhea fha. Clinical practice guideline functional hypothalamic amenorrhea. Functional hypothalamic amenorrhea symptoms ccrm fertility. Functional hypothalamic amenorrhea fha is an important cause of reversible nonorganic ovarian disruption. The terms fha and hypothalamic amenorrhea ha are often used interchangeably.
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