What is Functional Hypothalamic Amenorrhea?

Functional hypothalamic amenorrhea is an endocrine disorder that causes menstrual irregularity or cessation. The disorder is localised at the level of the hypothalamus and leads to Hypogonadotrophic Hypogonadism (HP).

It is characterised by reduced frequency and intensity of GnRH signal transmission from the hypothalamus resulting in lower levels of LH and FSH from the pituitary gland and thus reduced ovarian function. The latter leads to lower estrogen levels and inability to ovulate (anovulation), which will eventually lead to amenorrhea or oligomenorrhea (a cycle longer than 35 days).


How common is it?

Hypothalamic functional amenorrhea is one of the most common causes of menstrual disorders, especially in young women, accounting for 15%-35% of cases.


What are the symptoms and signs?

  • amenorrhea or oligomenorrhea
  • infertility
  • significant weight loss
  • intense psychological stress

What are the causes?

Psychological and metabolic stress are the most important causes. Stress and weight loss act synergistically in this case.


How is hypothalamic amenorrhea diagnosed?

History, physical examination and hormone tests establish the diagnosis, while blood tests and imaging tests rule out other causes of amenorrhea.


How is it treated?

The treatment of functional hypothalamic amenorrhea is hormone replacement therapy with an estrogen-progesterone combination. At the same time, it is recommended to treat psychological and/or metabolic stress with a team of specialists.