Treatment of FHA

Clinicians should evaluate patients with FHA and severe bradycardia, hypotension, orthostasis, or electrolyte imbalance for inpatient treatment.
The Endocrine Society recommends correcting the energy imbalance to improve hypothalamic-pituitary-ovarian axis function, which often requires behavioral change. Options for improving energy balance include increased caloric consumption, improved nutrition, or decreased exercise.
Adolescents and women with FHA should receive psychological support, such as cognitive behavior therapy.
Patients with FHA should avoid oral contraceptive pills for the sole purpose of regaining menses or improving bone mineral density.
Patients with FHA who are taking oral contraceptive pills should be informed that this medication could mask the return of spontaneous menses and that bone loss may continue, particularly if patients maintain an energy deficit.
Adolescents and women who have not had a return of menses after a reasonable trial of nutritional, psychological, or exercise intervention should receive short-term transdermal E2 therapy with cyclic oral progestin.
Adolescents and women with FHA should avoid using bisphosphonates, denosumab, testosterone, and leptin to improve bone mineral density.
In rare adult cases, the Endocrine Society suggests that short-term use of recombinant parathyroid hormone 1-34 is an option in the setting of delayed fracture healing and very low bone mineral density.
In patients with FHA wishing to conceive, after a complete fertility workup, the Endocrine Society suggests: treatment with pulsatile gonadotropin-releasing hormone (GnRH) as a first line, followed by gonadotropin therapy and introduction of ovulation when GnRH is not available; cautious use of gonadotropin therapy; a trial of treatment with clompiphene citrate for ovulation induction if a woman has a sufficient endogenous estrogen level; and against the use of kisspeptin and leptin for treating infertility. Clinicians can consider a trial of cognitive behavioral therapy, as the treatment has the potential to restore ovulatory cycles and fertility without medical intervention.

Reference

  1. Gordon CM, Ackerman KE, Berga SL, et al. Functional hypothalamic amenorrhea: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2017;102(5):1-27. doi:10.1210/jc.2017-00131


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