Date of Award
Spring 2025
Degree Name
Master of Medical Science (Physician Assistant)
Department
Physician Assistant; College of Health Sciences
First Advisor
Kimberly Erikson
Abstract
Hypothalamic amenorrhea (HA) accounts for approximately 30% of total cases of secondary amenorrhea in women of reproductive age. HA is defined as the absence of menses due to inadequate secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus leading to lack of secretion of gonadotropins from the anterior pituitary gland and steroid hormones from the ovaries. This feedback loop, called the hypothalamic-pituitary-gonadal (HPG) axis, regulates reproductive activity in animals and humans. When this system is disrupted in females due to a hormonal imbalance, menstrual abnormalities may emerge. Functional hypothalamic amenorrhea (FHA) is defined as the absence of menses in which anatomic or organic causes have been ruled out. It is primarily caused by psychological stress, low energy availability resulting from excessive exercise or inadequate energy intake, or a combination of these factors. FHA is also a catalyst for other health concerns, including osteoporosis and infertility.
Due to the multifactorial pathophysiology of FHA, a multidisciplinary approach to diagnosis and treatment should be implemented. Official guidelines on FHA were published by Endocrine Society in March 2017, nearly 8 years ago. According to these guidelines, recommendations for the most appropriate therapies remain under debate. This essay aims to synthesize current evidence-based research and create a clear roadmap for optimal patient care in patients with FHA, from initial assessment to treatment.
Recommended Citation
Foster, Monica, "Recommendations for Diagnosis and Treatment of Functional Hypothalamic Amenorrhea in Females of Reproductive Age" (2025). Capstone Showcase. 2.
https://scholarworks.arcadia.edu/showcase/2025/pa/2
Recommendations for Diagnosis and Treatment of Functional Hypothalamic Amenorrhea in Females of Reproductive Age
Hypothalamic amenorrhea (HA) accounts for approximately 30% of total cases of secondary amenorrhea in women of reproductive age. HA is defined as the absence of menses due to inadequate secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus leading to lack of secretion of gonadotropins from the anterior pituitary gland and steroid hormones from the ovaries. This feedback loop, called the hypothalamic-pituitary-gonadal (HPG) axis, regulates reproductive activity in animals and humans. When this system is disrupted in females due to a hormonal imbalance, menstrual abnormalities may emerge. Functional hypothalamic amenorrhea (FHA) is defined as the absence of menses in which anatomic or organic causes have been ruled out. It is primarily caused by psychological stress, low energy availability resulting from excessive exercise or inadequate energy intake, or a combination of these factors. FHA is also a catalyst for other health concerns, including osteoporosis and infertility.
Due to the multifactorial pathophysiology of FHA, a multidisciplinary approach to diagnosis and treatment should be implemented. Official guidelines on FHA were published by Endocrine Society in March 2017, nearly 8 years ago. According to these guidelines, recommendations for the most appropriate therapies remain under debate. This essay aims to synthesize current evidence-based research and create a clear roadmap for optimal patient care in patients with FHA, from initial assessment to treatment.