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Functional Hypothalamic Amenorrhea
Functional hypothalamic amenorrhea is the most common cause of secondary amenorrhea in women of childbearing age. It is a reversible disorder caused by stress related to weight loss, excessive exercise and/or traumatic mental experiences. The basis of functional hypothalamic amenorrhea is hormonal, based on impaired pulsatile GnRH secretion in the hypothalamus, then decreased secretion of gonadotropins, and, consequently, impaired hormonal function of the ovaries. This disorder leads to hypoestrogenism, manifested by a disturbance of the menstrual cycle in the form of amenorrhea, leading to anovulation. Prolonged state of hypoestrogenism can be very detrimental to general health, leading to many harmful short- and long-term consequences.
The origin of FHA is believed to rely on impaired pulsatile gonadotropin releasing hormone (GnRH) secretion. Abnormal GnRH secretion causes a reduction in the pulses of both the luteinizing hormone (LH) and follicle stimulating hormone (FSH). As a consequence, there is no increase in LH secretion in the middle of the menstrual cycle, a lack of proper follicular development, successive anovulation and a low serum estradiol (E2) concentration . It is said that FHA may have a genetic predisposition, such as heterozygosity for congenital hypogonadotropic hypogonadism . Hypoestrogenism that results from the inhibition of the hypothalamus-pituitary- ovarian (HPO) axis has profound effects on many systems throughout the body, including reproductive, cardiac, skeletal and psychological. That is why it is so important to apply appropriate treatment as soon as possible to prevent numerous short- and long-term health consequences .
Initial management should focus on treating the underlying cause, that is, trying to gain weight, limiting exercise, or avoiding emotional stress. In situations where such treatment is not effective, hormone replacement therapy should be used to maintain normal estrogen levels, or if the patient wishes to become pregnant, treatment focused on ovulation induction or in vitro fertilization (IVF) .
3. Diagnosis of FHA
4. Consequences of FHA
Women with FHA are exposed to numerous health consequences of hypoestrogenism. They have a greater risk of developing complications in the reproductive, cardiovascular, skeletal system and psychiatric comorbidities, including anxiety and mood disorders. All consequences are contained in Figure 1 .
The entry is from 10.3390/endocrines2030020
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