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