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Functional hypothalamic amenorrhea: Pathophysiology and clinical manifestations

Authors
Kathryn E Ackerman, MD, MPH
Madhusmita Misra, MD, MPH
Section Editors
Robert L Barbieri, MD
William F Crowley, Jr, MD
Deputy Editor
Kathryn A Martin, MD

INTRODUCTION

Low energy availability (from decreased caloric intake, excessive energy expenditure, or both) and stress are common causes of hypogonadotropic hypogonadism in women. Functional hypothalamic amenorrhea (FHA) is the term used to describe amenorrhea that results from such causes and is diagnosed after ruling out other etiologies of amenorrhea. The terms functional hypothalamic amenorrhea and hypothalamic amenorrhea (HA) are often used interchangeably.

This topic will review the pathophysiology and clinical manifestations of FHA. The diagnosis and management of FHA, as well as the overall approach to the woman with primary and secondary amenorrhea, is presented separately. (See "Functional hypothalamic amenorrhea: Evaluation and management" and "Evaluation and management of primary amenorrhea" and "Evaluation and management of secondary amenorrhea".)

EPIDEMIOLOGY

One of the most common types of secondary amenorrhea is FHA, which by definition excludes organic disease. Risk factors for FHA include eating disorders (in particular anorexia nervosa [AN]), excessive exercise, and stress. FHA is responsible for approximately 25 to 35 percent and 3 percent of secondary and primary amenorrhea cases, respectively. (See "Epidemiology and causes of secondary amenorrhea" and "Causes of primary amenorrhea".)

Low-weight eating disorders are reported in 0.2 to 4 percent of adolescents and young adult women [1]. Although amenorrhea is no longer a diagnostic criterion for AN per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [2], FHA is commonly seen in this condition. (See "Eating disorders: Overview of epidemiology, clinical features, and diagnosis".).

Many, if not most, women of reproductive age engage in some form of exercise. Most obtain health benefits, but some can also develop menstrual dysfunction [3]. In addition, excessive exercise and/or inadequate caloric intake leading to relative energy deficiency at a critical time in development may delay puberty [4].

                       

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Literature review current through: Jul 2017. | This topic last updated: Apr 21, 2017.
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