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Disclaimer
is Guideline attempts to define principles of practice that should produce high-quality patient care.
It is applicable to specialists, primary care, and providers at all levels. is Guideline should not be
considered exclusive of other methods of care reasonably directed at obtaining the same results. e
ultimate judgment concerning the propriety of any course of conduct must be made by the clinician
aer consideration of each individual patient situation. Neither IGC, the medical associations, nor
the authors endorse any product or service associated with the distributor of this clinical reference tool.
ESFHA1772
Î In patients with FHA wishing to conceive, after a complete fertility workup
ES suggests:
• treatment with pulsatile gonadotropin-releasing hormone (GnRH) as a first line,
followed by gonadatropin therapy and induction of ovulation when GnRH is not
available (2|⊕
);
• cautious use of gonadotropin therapy (2|⊕
);
• a trial of treatment with clomiphene citrate for ovulation induction if a woman has a
sufficient endogenous estrogen level (2|⊕
);
• against the use of kisspeptin and leptin for treating infertility (2|⊕
); and
• given that there is only a single, small study suggesting efficacy but minimal potential for
harm, clinicians can consider a trial of CBT in women with FHA who wish to conceive,
since this treatment has the potential to restore ovulatory cycles and fertility without the
need for medical intervention. (2|⊕⊕
)
Î ES suggests that clinicians should induce ovulation only in women with
FHA that have a body mass index (BMI) of at least 18.5 kg/m
2
and only
after attempts to normalize energy balance, due to the increased risk for
fetal loss, small-for-gestational-age babies, preterm labor, and delivery by
Cesarean section for extreme low weight. (2|⊕⊕
)
Treatment
Source
Gordon CM, Ackerman KE, Berga SL, Kaplan JR, Mastorakos G, Misra M, Murad MH, Santoro
NF, Warren MP. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice
Guideline. J Clin Endocrinol Metab. 2017 May 1;102(5):1413-1439.
Cosponsoring Associations: e American Society for Reproductive Medicine, the European
Society of Endocrinolog y, and the Pediatric Endocrine Society.
Abbreviations
17-OHP, 17-hydroxyprogesterone; AMH, anti-Müllerian hormone; BMD, bone mineral
density; BMI, body mass index; CAH, congenital adrenal hyperplasia; CBT, cognitive behavior
therapy; DHEA, dehydroepiandrosterone; DHEA-S, dehydroepiandrosterone sulfate; DXA,
dualenerg y X-ray absorptiometry; E2, estradiol; ES, Endocrine Society; FHA, functional
hypothalamic amenorrhea; FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing
hormone; HPA, hypothalamic–pituitary–adrenal; HPO, hypothalamic–pituitary–ovarian;
IGF, insulinlike growth factor; LH, luteinizing hormone; MRI, magnetic resonance imaging ;
nl, normal; OCP, oral contraceptive pill; P4, progesterone; PCOS, polycystic ovary syndrome;
PRL, prolactin; rPTH, recombinant parathyroid hormone 1-34; T, testosterone; T4, thyroxine;
TSH, thyroid-stimulating hormone
