Hypothalamic Amenorrhea: Causes, Complications, & Controversies

Hypothalamic amenorrhea (HA) is considered a reversible condition characterized by the absence of menses for 3 months or more, due to suppressed secretions of gonadotropin releasing hormone affecting the entire hypothalamic-pituitary-ovarian axis. HA can be triggered by excessive stress, weight loss or excessive exercise, however, the etiology is still largely unknown. Serious, long-term complications include severe hypoestrogenism and infertility, in addition to a variety of hormonal aberrations. Hypoestrogenism also leads to diminished bone health, cardiovascular problems, and mood changes that lead to a higher prevalence of depression and anxiety. It is important that HA is diagnosed in a timely manner in order to begin therapeutic strategies that aim to resume menses and return to normal levels of circulating reproductive hormones. When attempts to resume menstruation naturally through lifestyle changes are unsuccessful, other pharmaceutical options are available. Treatment options range from estrogen-replacement therapy to the administration of gonadotropin releasing hormone, depending on the reproductive goals of the woman. More research is needed on novel treatments in order to determine the most effective standard of care.