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Functional Hypothalamic Amenorrhea

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Î 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. Î Investigations should include assessment of systemic and endocrinologic etiologies, since FHA is a diagnosis of exclusion. Î A multidisciplinary treatment approach is necessary, including medical, dietary, and mental health support. Î Medical complications include, among others, bone loss and infertility. Î Appropriate therapies are under debate and investigation. Î Endocrine Society (ES) suggests that clinicians make the diagnosis of functional hypothalamic amenorrhea (FHA) only after excluding the anatomic or organic pathology of amenorrhea. (U) Î ES suggests diagnostic evaluation for FHA in adolescents and women whose menstrual cycle interval persistently exceeds 45 days and/or those who present with amenorrhea for ≥3 months. (2|⊕⊕ ) Î ES suggests screening patients with FHA for psychological stressors (patients with FHA may be coping with stressors, and stress sensitivity has multiple determinants). (2|⊕⊕⊕ ) Î Once clinicians establish the diagnosis of FHA, the ES suggests they provide patient education about various menstrual patterns occurring during the recovery phase. ES suggests clinicians inform patients that irregular menses do not require immediate evaluation and that menstrual irregularity does not preclude conception. (U) Diagnosis Key Points Grading System Strength of Recommendation 1 = strong 2 = weak U = ungraded Quality of Evidence ⊕⊕⊕⊕ = high ⊕⊕⊕ = moderate ⊕⊕ = low ⊕ = very low

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