Diagnostic and therapeutic approach to hypothalamic amenorrhea

Hypothalamic amenorrhea (HA) is a secondary amenorrheawith no evidence of endocrine/systemic causal factors, mainly related tovarious stressors affecting neuroendocrine control of the reproductiveaxis. In clinical practice, HA is mainly associated with metabolic, physical,or psychological stress. Stress is the adaptive response of our bodythrough all its homeostatic systems, to external and/or internal stimulithat activate specific and nonspecific physiological pathways. HA occursgenerally after severe stressant conditions/situations such as dieting,heavy training, or intense emotional events, all situations that caninduce amenorrhea with or without body weight loss and HA is a secondaryamenorrhea with a diagnosis of exclusion. In fact, the diagnosisis essentially based on a good anamnestic investigation. It has to be investigatedusing the clinical history of the patient: occurrence of menarche,menstrual cyclicity, time and modality of amenorrhea, and it has to beexclude any endocrine disease or any metabolic (i.e., diabetes) and systemicdisorders. It is necessary to identify any stressant situation inducedby loss, family or working problems, weight loss or eating disorders, orphysical training or agonist activity. Peculiar, though not specific, endocrineinvestigations might be proposed but no absolute parameter canbe proposed since HA is greatly dependent from individual response tostressors and/or the adaptive response to stress. This article tries to giveinsights into diagnosis and putative therapeutic strategies.