Abstract
The aim of the study is to present the problem of functional hypothalamic amenorrhea, taking into account any disease and treatment, diagnosis, and consequences of this disease. We searched PubMed (MEDLINE) and included 38 original and review articles concerning functional hypothalamic amenorrhea. Functional hypothalamic amenorrhea is the most common cause of secondary amenorrhea in women of childbearing age. It is a reversible disorder caused by stress related to weight loss, excessive exercise and/or traumatic mental experiences. The basis of functional hypothalamic amenorrhea is hormonal, based on impaired pulsatile GnRH secretion in the hypothalamus, then decreased secretion of gonadotropins, and, consequently, impaired hormonal function of the ovaries. This disorder leads to hypoestrogenism, manifested by a disturbance of the menstrual cycle in the form of amenorrhea, leading to anovulation. Prolonged state of hypoestrogenism can be very detrimental to general health, leading to many harmful short- and long-term consequences. Treatment of functional hypothalamic amenorrhea should be started as soon as possible, and it should primarily involve lifestyle modification. Only then should pharmacological treatment be applied. Importantly, treatment is most often long-term, but it results in recovery for the majority of patients. Effective therapy, based on multidirectional action, can protect patients from numerous negative impacts on fertility, cardiovascular system and bone health, as well as reducing mental morbidity.
Highlights
Nowadays, more and more physicians, including gynecologists, are becoming aware of the tremendous impact of various types of stress has on women’s health, on the reproductive system
Functional hypothalamic amenorrhea (FHA) is the term used to describe lack of menstruation resulting from various kinds of stress, diagnosed after excluding other etiologies of amenorrhea
Abnormal gonadotropin releasing hormone (GnRH) secretion causes a reduction in the pulses of both the luteinizing hormone (LH) and follicle stimulating hormone (FSH)
Summary
More and more physicians, including gynecologists, are becoming aware of the tremendous impact of various types of stress has on women’s health, on the reproductive system. Functional hypothalamic amenorrhea (FHA) is the term used to describe lack of menstruation resulting from various kinds of stress, diagnosed after excluding other etiologies of amenorrhea. It is a common cause of hypogonadotropic hypogonadism in women, occurring in the absence of structural lesion. Initial management should focus on treating the underlying cause, that is, trying to gain weight, limiting exercise, or avoiding emotional stress In situations where such treatment is not effective, hormone replacement therapy should be used to maintain normal estrogen levels, or if the patient wishes to become pregnant, treatment focused on ovulation induction or in vitro fertilization (IVF) [6]
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