Hypothalamic amenorrhea: from diagnosis to therapeutical approach.

Among secondary amenorrheas, hypothaIamic amenorrhea (HA) is the ODe with 00 evidence of endocrine/systemic causai factors. HA is maioly related to various stressors affectiog neuroendocrine cootrol of the reproductive axis. In clinicaI practice, HA is maioly associated with metabolic,physical, or psychological stress. Stress is the adaptive respoose of our body through ali its homeostatic systems, to extemal and/or internai stimuli that activate specific and ooospecific physiological pathways. HA occurs generally after severe stressed conditions/situations such as dieting, heavytraining, or intense emotional events, ali situatioos that cao induce amenorrhea with or without body weight loss and HA is a secondary amenorrhea with a diagnosis of exclusion. In faci, the diagnosis is essentialIy based on a good aoamnestic investigatioo. It has to be investigated using the clinicaIhistory of the patient: occurrence of meoarche, menstrual cyclicity, time and modality of amenorrhea, aod it has to be excluded aoy enOOcrine disease or aoy metabolic (i.e., diabetes) aod systemic disorders. It is necessary to identify any stressed situation induced by 10ss, famity or working problems, weight loss or eatiog disorders, or physical training or agonist activity. Peculiar, though not specific, endocrine investigations might be proposed bui 00 absolute parameter cao be proposed since HA is greatly dependent from individuai response to stressors and/or the adaptive response to stress. This chapter aims to give iusights into diagnosis and putative therapeutic strategies.