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Review
. 2023 Sep;98(9):1376-1385.
doi: 10.1016/j.mayocp.2023.05.027.

Functional Hypothalamic Amenorrhea: Recognition and Management of a Challenging Diagnosis

Mariam Saadedine  1 , Ekta Kapoor  2 , Chrisandra Shufelt  3
Affiliations
Review

Functional Hypothalamic Amenorrhea: Recognition and Management of a Challenging Diagnosis

Mariam Saadedine et al. Mayo Clin Proc. 2023 Sep.

Abstract

Functional hypothalamic amenorrhea is responsible for approximately a third of the cases of secondary amenorrhea. The condition is a result of disturbances in gonadotropin-releasing hormone pulsatile secretion at the level of the hypothalamus, which in turn disrupts gonadotropin secretion. It is due to psychosocial stress, disordered eating, and/or excessive exercise. Often, however, it is a combination of more than one etiology, with a possible role for genetic or epigenetic predisposition. The dysfunctional gonadotropin-releasing hormone release leads to the cessation of ovarian function, resulting in amenorrhea, infertility, and a long-term impact on affected women's bone health, cardiovascular risk, cognition, and mental health. Functional hypothalamic amenorrhea is a diagnosis of exclusion, and treatment involves identifying and reversing the underlying cause(s). The aim of this concise review is to summarize the current knowledge of functional hypothalamic amenorrhea, review its pathophysiology and the adverse health consequences, and provide recommendations for diagnosis and management of this condition. Furthermore, this review will emphasize the gaps in research on this common condition impacting women of reproductive age all over the world.

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Conflict of interest statement

Conflicts of interest:

MS: None

EK: Dr. Kapoor has no conflicts of interest directly related to the subject of this manuscript. However, over the past 36 months she has been a consultant for Astellas and Mithra Pharmaceuticals, Scynexis and Womaness. She receives grant support form Mithra Pharmaceuticals. She has received payment for development of educational content from Med Learning Group and Academy of Continued Healthcare Learning. She has received honoraria for CME activity from CogniMed, PriMed and OBG Management

CS: None

Figures

Figure 1:
Figure 1:
Functional hypothalamic amenorrhea: the walking unwell
See this image and copyright information in PMC

References

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