New Guideline on Hypothalamic Amenorrhea Released

The Endocrine Society released a clinical practice guideline for the diagnosis and treatment of functional hypothalamic amenorrhea. The full guideline will be published in The Journal of Clinical Endocrinology & Metabolism.

Hypothalamic amenorrhea occurs when the hypothalamus slows or stops releasing GnRH, a hormone that controls the menstrual cycle. It can increase the risk of other health issues such as delayed puberty in adolescents and infertility in female adults. Catherine M. Gordon of Cincinnati Children’s Hospital Medical Center in Cincinnati, OH, and the chair of the guideline task force said, “Referring patients to a nutritionist for specialized dietary instructions is an extremely important part of their care. Menstrual cycles can often be restored with increased calorie consumption, improved nutrition or decreased exercise activity.”

The task force commissioned two systematic reviews and used the best available evidence from other systematic reviews and individual studies. Major recommendations from the clinical guideline include:

• Hypothalamic amenorrhea is a “diagnosis of exclusion,” which requires clinicians to rule out other conditions that could be interrupting the menstrual cycle.
• As part of their initial evaluation, women diagnosed with hypothalamic amenorrhea should have a series of lab tests to check levels of hormones including estrogen, thyroid hormones and prolactin. The workup can help identify factors preventing menstruation.
• Hypothalamic amenorrhea patients should be evaluated for inpatient treatment if they have an abnormally slow heart rate, low blood pressure, or an electrolyte imbalance. Careful monitoring is needed in these cases because there is a high mortality rate associated with hypothalamic amenorrhea in the setting of eating disorders, particularly anorexia nervosa.
• Select patients presumed to have hypothalamic amenorrhea should undergo a brain MRI to check for damage to or abnormalities of the pituitary gland or pituitary hormone deficiencies, if they exhibit select signs or symptoms, including a history of severe or persistent headaches; persistent vomiting that is not self-induced; changes in vision, thirst or urination not attributable to other causes; neurological signs suggesting a central nervous system abnormality; or other clinical signs or test results that suggest pituitary hormone deficiency or excess.

The task force concluded that functional hypothalamic amenorrhea is a type of chronic anovulation commonly associated with stress, weight loss, excessive exercise, or a combination thereof. Medical, dietary, and mental health support are necessary when treating this condition as appropriate treatment options are “under debate and investigation.”

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