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Functional hypothalamic amenorrhea is a state of reversible hypogonadism common in adolescents and young women that can be triggered by energy deficit or emotional stress or a combination of these factors. Energy deficit may be a consequence of (i) reduced caloric intake, as seen in patients with eating disorders, such as anorexia nervosa, or (ii)...
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... Психопатологические особенности пациенток с ФГА крайне важны в отношении развития, прогрессирования и общего прогноза заболевания [9]. Больные, страдающие функциональной аменореей, имеют значительно более высокие показатели депрессии и тревоги по сравнению с группой контроля, чаще проявляют дисфункциональные установки, такие как невротический перфекционизм с повышенной уязвимостью от мнения других людей, сообщают о внутреннем чувстве незащищенности и потребности контролировать малейшие изменения в жизни, им гораздо труднее адаптироваться к ежедневным событиям обыденной жизни по сравнению с женщинами без менструальных дисфункций [10,11]. ...
The article presents data on the relationship of pathogenetic mechanisms for the development of menstrual disorders of functional and organic origin in connection with mental disturbances from the point of view of the psychosomatic concept. According to the latter, functional disorders of the menstrual cycle are considered as psychosomatic, in which gynecological pathology develops as a result of psychopathological illness. A striking example of such a disorder is functional hypothalamic amenorrhea. At the same time, endocrinopathies, such as polycystic ovary syndrome and premature ovarian insufficiency, can also be considered in the paradigm of psychosomatic illnesses of ovarian function due to the high prevalence of anxiety and depressive disorders in this cohort of patients. This review highlights the importance of interdisciplinary collaboration between a gynecologist and a psychiatrist for the most effective reproductive rehabilitation of patients with amenorrhea. Literature search was carried out in national (eLibrary, CyberLeninka.ru) and international (PubMed, Cochrane Library) databases in Russian and English. The priority was free access to the full text of articles. The choice of sources was prioritized for the period from 2018 to 2023.However, taking into account the insufficient knowledge of the chosen topic, the choice of sources dates back to 1985.
... FHA is frequently associated with endocrine impairments involving the thyroid and/or adrenal glands. However, it is also characterized by neuroendocrine dysfunctions, as evidenced by altered synthesis and release of several neurotransmitters, including serotonin, acetylcholine, dopamine and norepinephrine [55,109,110]. ...
Functional hypothalamic amenorrhea (FHA) is one of the most common causes of both primary and secondary amenorrhea in women of reproductive age. It is characterized by chronic anovulation and the absence of menses that appear as a result of stressors such as eating disorders, excessive exercise, or psychological distress. FHA is presumed to be a functional disruption in the pulsatile secretion of hypothalamic gonadotropin-releasing hormone, which in turn impairs the release of gonadotropin. Hypoestrogenism is observed due to the absence of ovarian follicle recruitment. Numerous neurotransmitters have been identified which play an important role in the regulation of the hypothalamic-pituitary-ovarian axis and of which the impairment would contribute to developing FHA. In this review we summarize the most recent advances in the identification of contributing neuroendocrine disturbances and relevant contributors to the development of FHA.
... The diagnosis of functional hypothalamic amenorrhea (FHA) is carried out after having excluded all anatomic and organic causes of PA [12]. According to Gordon et al., 2017, FHA is often associated with stress, weight loss, excessive exercise, and their combination [13]. ...
Primary amenorrhea (PA) describes the complete absence of menses by the age of 15 years. It is a devastating diagnosis that can affect the adolescent’s view of her femininity, sexuality, fertility and self-image. A normal menstrual cycle can occur only in the presence of: a properly functioning hypothalamus–pituitary axis, well-developed and active ovaries, outflow tract without abnormalities. Any dysfunction in any of these players can result in amenorrhea. PA evaluation includes the patient’s medical history, physical examination, pelvic ultrasonography and initial hormone evaluation, limited to the serum-follicle-stimulating hormone (FSH) and luteinizing hormone, testosterone and prolactin. A karyotype should be obtained in all adolescents with high FSH serum levels. The main causes of PA, whether or not accompanied by secondary sexual characteristics, include endocrine defects of the hypothalamus–pituitary–ovarian axis, genetic defects of the ovary, metabolic diseases, autoimmune diseases, infections, iatrogenic causes (radiotherapy, chemotherapy), environmental factors and Müllerian tract defects. PA management depends on the underlying causes. Estrogen replacement therapy at puberty has mainly been based on personal experience. PA can be due to endocrine, genetic, metabolic, anatomical and environmental disorders that may have severe implications on reproductive health later in life. In some complex cases, a multidisciplinary team best manages the adolescent, including a pediatrician endocrinologist, gynecologist, geneticist, surgeon, radiologist, and psychologist.
... Alterations in menstrual status are a consequence of hypothalamic dysfunction, which in turn is a consequence of many hormonal changes resulting from low energy availability. 4 Menstrual irregularity is reported in up to 24% of high school athletes and in up to 66% of adult athletes. 5,6 The risk of developing FHA depends on the nature of athletic activity, the extent of training and the nutritional status of the athlete, and is more common in endurance athletes (including long distance runners, swimmers and rowers) and those engaged in sports that favor leanness (such as runners, gymnasts, figure skaters, cheerleaders and divers). ...
... 2,3,7 In young women, a major consequence of low energy availability and associated hormonal alternations (lower levels of gonadal hormones, insulin like growth factor-1, leptin and higher levels of cortisol and peptide YY) is low bone density and increased fracture risk. 4 Particularly, female athletes with amenorrhea tend to have a higher risk for stress fractures than normally menstruating athletes. 9 In addition, there is a concern that low energy availability and menstrual dysfunction may result in impaired bone accrual during the pubertal years of peak bone acquisition. ...
... There are also other consequences of low energy availability and hypogonadism in athletes, including possible cardiovascular and psychological consequences. 4,10 To prevent a long-lasting impact on bone health, timely diagnosis of the Triad is critical, such that nutritional, psychological and other interventions can be implemented in a timely fashion. A position statement from the Female and Male Athlete Coalition and the American College of Sports Medicine discusses the importance of asking questions related to the three components of the Triad during the pre-participation physical. ...
The Female Athlete Triad (Triad) refers to the triad of low energy availability, impaired menstrual function and low bone density. However each component of the Triad is, in fact, a spectrum with energy availability ranging from normal to low, menstrual function ranging from normal to luteal phase defects and anovulatory cycles to frank functional hypothalamic amenorrhea (FHA, absence of menses) and bone density ranging from normal to low. There is obviously a need to engage coaches in education efforts so they know about the Triad and its components, can pass on this information to their teams, be comfortable discussing dietetic and menstrual issues with female athletes, and recognize Triad symptoms early and bring these to medical attention in a timely fashion. Coaches are in a unique position to educate athletes and prevent the Triad from developing or worsening over time, and to advocate for optimal resources including for the services of a sports dietician and psychologist.
The results of many studies in recent years indicate a significant impact of pituitary function on bone health. The proper function of the pituitary gland has a significant impact on the growth of the skeleton and the appearance of sexual dimorphism. It is also responsible for achieving peak bone mass, which protects against the development of osteoporosis and fractures later in life. It is also liable for the proper remodeling of the skeleton, which is a physiological mechanism managing the proper mechanical resistance of bones and the possibility of its regeneration after injuries. Pituitary diseases causing hypofunction and deficiency of tropic hormones, and thus deficiency of key hormones of effector organs, have a negative impact on the skeleton, resulting in reduced bone mass and susceptibility to pathological fractures. The early appearance of pituitary dysfunction, i.e. in the pre-pubertal period, is responsible for failure to achieve peak bone mass, and thus the risk of developing osteoporosis in later years. This argues for the need for a thorough assessment of patients with hypopituitarism, not only in terms of metabolic disorders, but also in terms of bone disorders. Early and properly performed treatment may prevent patients from developing the bone complications that are so common in this pathology. The aim of this review is to discuss the physiological, pathophysiological, and clinical insights of bone involvement in pituitary disease.
Functional hypothalamic amenorrhea (FHA) is characterized by estrogen deficiency that significantly impacts on metabolic, bone, cardiovascular, mental, and reproductive health. Given the importance of environmental factors such as stress, and body composition, and particularly considering the importance of estrogens in regulating the gut microbiota, some changes in the intestinal microenvironment are expected when all of these factors occur simultaneously. We aimed to assess whether the gut microbiota composition is altered in FHA and to determine the potential impact of hormonal replacement therapy (HRT) on the gut microbiota. This prospective observational study included 33 patients aged 18-34 years with FHA and 10 age-matched healthy control women. Clinical, hormonal, and metabolic evaluations were performed at baseline for the FHA group only, while gut microbiota profile was assessed by 16S rRNA gene amplicon sequencing for both groups. All measurements were repeated in patients with FHA after receiving HRT for 6 months. Gut microbiota alpha diversity at baseline was significantly different between patients with FHA and healthy controls (p<0.01). At the phylum level, the relative abundance of Fusobacteria was higher in FHA patients after HRT (p<0.01), as was that of Ruminococcus and Eubacterium at the genus level (p<0.05), which correlated with a decrease in circulating proinflammatory cytokines. FHA is a multidimensional disorder which is interconnected with dysbiosis through various mechanisms, particularly involving the gut-brain axis. HRT appears to induce a favorable shift in the gut microbiota in patients with FHA, which is also associated with a reduction in the systemic inflammatory status.
Functional hypothalamic amenorrhea is responsible for approximately a third of the cases of secondary amenorrhea. The condition is a result of disturbances in gonadotropin-releasing hormone pulsatile secretion at the level of the hypothalamus, which in turn disrupts gonadotropin secretion. It is due to psychosocial stress, disordered eating, and/or excessive exercise. Often, however, it is a combination of more than one etiology, with a possible role for genetic or epigenetic predisposition. The dysfunctional gonadotropin-releasing hormone release leads to the cessation of ovarian function, resulting in amenorrhea, infertility, and a long-term impact on affected women's bone health, cardiovascular risk, cognition, and mental health. Functional hypothalamic amenorrhea is a diagnosis of exclusion, and treatment involves identifying and reversing the underlying cause(s). The aim of this concise review is to summarize the current knowledge of functional hypothalamic amenorrhea, review its pathophysiology and the adverse health consequences, and provide recommendations for diagnosis and management of this condition. Furthermore, this review will emphasize the gaps in research on this common condition impacting women of reproductive age all over the world.
Eating disorders (EDs) are characterized by severe disturbances in eating behaviors and can sometimes be fatal. Eating disorders are also associated with distressing thoughts and emotions. They can be severe conditions affecting physical, psychological, and social functions. Preoccupation with food, body weight, and shape may also play an important role in the regulation of eating disorders. Common eating disorders have three major types: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). In some cases, EDs can have serious consequences for an individual's physical and mental health. These disorders often develop during adolescence or early adulthood and affect both males and females, although they are more commonly diagnosed in young adult females. Treatment for EDs typically involves a combination of therapy, nutrition counseling, and medical care. In this narrative review, the authors summarized what is known of EDs and discussed the future directions that may be worth exploring in this emerging area.
