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
