Where Have the Periods Gone? The Evaluation and Management of Functional Hypothalamic Amenorrhea

The document reviewed Functional Hypothalamic Amenorrhea (FHA), a condition causing amenorrhea due to suppression of the hypothalamic-pituitary-ovarian axis, often triggered by stress, weight loss, or excessive exercise. It emphasized that FHA is a diagnosis of exclusion, requiring other causes to be ruled out through a thorough history, physical examination, and various investigations, including hormone measurements and imaging. Prolonged FHA can have adverse effects on metabolic, bone, cardiovascular, mental, and reproductive health. Management strategies include lifestyle modifications, psychological therapy, and pharmacological therapy to promote bone health and prevent osteoporosis, with a preference for transdermal estrogen and cyclic oral progestin over combined oral contraceptives. The document also noted the potential cardiovascular risks associated with FHA and mentioned novel therapies like recombinant human leptin and kisspeptin, although more research is needed for these treatments. The importance of a multidisciplinary approach and further research into FHA treatments was highlighted.