[Functional hypothalamic amenorrhea]

Vnitr Lek. 2015 Oct;61(10):882-5.
[Article in Czech]


Functional hypothalamic amenorrhea (FHA) besides pregnancy and syndrome of polycystic ovary is one of the most common causes of secondary amenorrhea. FHA results from the aberrations in pulsatile gonadotropin-releasing hormone (GnRH) secretion, which in turn causes impairment of the gonadotropins (follicle-stimulating hormone and luteinizing hormone). FHA is a form of the defence of organism in situations where life functions are more important than reproductive function. FHA is reversible; it can be normalized after ceasing the stress situation. There are three types of FHA: weight loss related, stress-related, and exercise-related amenorrhea. The final consequences are complex hormonal changes manifested by profound hypoestrogenism. Additionally, these patients present mild hypercortisolemia, low serum insulin levels, low insulin-like growth factor 1 (IGF-1) and low total triiodothyronine. Women health in this disorder is disturbed in several aspects including the skeletal system, cardiovascular system, and mental problems. Patients manifest a decrease in bone mass density, which is related to an increase in fracture risk. Therefore, osteopenia and osteoporosis are the main long-term complications of FHA. Cardiovascular complications include endothelial dysfunction and abnormal changes in the lipid profile. FHA patients present significantly higher depression and anxiety and also sexual problems compared to healthy subjects.

Publication types

  • Review

MeSH terms

  • Adult
  • Amenorrhea / blood
  • Amenorrhea / diagnosis*
  • Amenorrhea / etiology
  • Exercise / physiology
  • Female
  • Follicle Stimulating Hormone / blood*
  • Gonadotropin-Releasing Hormone / blood*
  • Humans
  • Hypothalamic Diseases / blood
  • Hypothalamic Diseases / diagnosis*
  • Hypothalamic Diseases / etiology
  • Luteinizing Hormone / blood*
  • Risk Factors
  • Stress, Physiological / physiology
  • Weight Loss / physiology


  • Gonadotropin-Releasing Hormone
  • Luteinizing Hormone
  • Follicle Stimulating Hormone