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

J Clin Res Pediatr Endocrinol. 2020 Feb 6;12(Suppl 1):18-27. doi: 10.4274/jcrpe.galenos.2019.2019.S0178.


Functional hypothalamic amenorrhea (FHA) is a common cause of amenorrhea in adolescent girls. It is often seen in the setting of stress, weight loss, or excessive exercise. FHA is a diagnosis of exclusion. Patients with primary or secondary amenorrhea should be evaluated for other causes of amenorrhea before a diagnosis of FHA can be made. The evaluation typically consists of a thorough history and physical examination as well as endocrinological and radiological investigations. FHA, if prolonged, can have significant impacts on metabolic, bone, cardiovascular, mental, and reproductive health. Management often involves a multidisciplinary approach, with a focus on lifestyle modification. Depending on the severity, pharmacologic therapy may also be considered. The aim of this paper is to present a review on the pathophysiology, clinical findings, diagnosis, and management approaches of FHA in adolescent girls.

Keywords: Adolescent; diagnosis; functional; hypothalamic amenorrhea; treatment.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Amenorrhea / diagnosis
  • Amenorrhea / etiology
  • Amenorrhea / physiopathology
  • Amenorrhea / therapy*
  • Female
  • Fertility
  • Humans
  • Hypothalamic Diseases / complications*
  • Life Style
  • Physical Examination
  • Psychotherapy