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Journal of Endocrinological... Sep 2019Functional hypothalamic amenorrhea (FHA) is a form of chronic anovulation not due to identifiable organic causes and with adverse health consequences. The identification... (Review)
Review
BACKGROUND
Functional hypothalamic amenorrhea (FHA) is a form of chronic anovulation not due to identifiable organic causes and with adverse health consequences. The identification of women with this disorder or the precocious identification of women at risk is based on the knowledge of lifestyle risk factors or behaviors such as stress, weight loss, and excessive physical exercise that are known to negatively impact gonadal axis activity.
METHODS
In this overview, we described the most common forms of FHA, in particular stress-induced amenorrhea and overtraining-induced amenorrhea. In addition, although its mechanisms can differ from those involved in FHA, we reviewed the available literature on drug-induced amenorrhea, highlighting the clear connection between this condition and psychoactive drugs such as antipsychotics, antidepressants and anti-epilectics thus raising concern about the role that the abuse of substances such as opioids or alcohol can possibly have on the growing unexplained infertility of the female population.
Topics: Amenorrhea; Female; Humans; Hypothalamic Diseases; Prognosis; Psychotropic Drugs
PubMed: 30742257
DOI: 10.1007/s40618-019-01013-w -
The Lancet. Child & Adolescent Health Sep 2018Female athletes often experience amenorrhoea at various times during training, but this should not be considered normal. Low energy availability is a common cause of... (Review)
Review
Female athletes often experience amenorrhoea at various times during training, but this should not be considered normal. Low energy availability is a common cause of menstrual dysfunction, and amenorrhoea can serve as a warning sign of some of the health and performance consequences associated with inadequate energy, including poor bone accrual and low bone mineral density. Adolescence is an important time for bone accrual, growth, and development, making delayed menarche and secondary amenorrhoea particularly concerning in young athletes. The development of disordered eating and eating disorder behaviours also peaks during adolescence. Thus, screening for low energy availability, establishing the various causes of amenorrhoea, and treating amenorrhoea and low energy availability with an interdisciplinary team is most effective.
Topics: Adolescent; Algorithms; Amenorrhea; Female; Hormones; Humans; Sports
PubMed: 30119761
DOI: 10.1016/S2352-4642(18)30145-7 -
Clinical Chemistry Aug 2014
Topics: Adrenocorticotropic Hormone; Adult; Amenorrhea; Cushing Syndrome; Diagnosis, Differential; Female; Hirsutism; Humans; Hydrocortisone; Weight Gain
PubMed: 25070974
DOI: 10.1373/clinchem.2013.217059 -
Best Practice & Research. Clinical... Jun 2019With the onset of puberty a range of problems may be encountered by the young girl. Some of these include a range of gynaecological issues relating to delayed onset of... (Review)
Review
With the onset of puberty a range of problems may be encountered by the young girl. Some of these include a range of gynaecological issues relating to delayed onset of puberty, delayed menarche, atypical pubertal changes and the identification of anomalies of the genital tract. The distinction between physiological events and pathological problems is important to avoid unnecessary distress and anxiety. The onset of cyclic hormonal changes also provokes a number of "non-gynaecological" problems - where the link to cyclic hormonal events is often overlooked and an important opportunity to potentially intervene and assist is missed. From a global perspective there are a range of problems that are particularly encountered with the onset of puberty including the risks of sexual violence, which in the setting of having achieved the age of reproductive potential result in unplanned pregnancies, unsafe abortions and adolescent pregnancy all of which pose life threatening risks. Sex education in its broadest sense is important for all young people. Access to contraception for adolescents is vital, such that clinicians across all streams of health care who are involved in the care of young people should take the opportunity to educate and provide this care.
Topics: Adenomyosis; Adolescent; Amenorrhea; Contraception; Female; Humans; Menstruation Disturbances; Ovarian Diseases; Pregnancy; Puberty; Uterine Hemorrhage
PubMed: 31278062
DOI: 10.1016/j.beem.2019.06.002 -
Vnitrni Lekarstvi Oct 2015Functional hypothalamic amenorrhea (FHA) besides pregnancy and syndrome of polycystic ovary is one of the most common causes of secondary amenorrhea. FHA results from... (Review)
Review
Functional hypothalamic amenorrhea (FHA) besides pregnancy and syndrome of polycystic ovary is one of the most common causes of secondary amenorrhea. FHA results from the aberrations in pulsatile gonadotropin-releasing hormone (GnRH) secretion, which in turn causes impairment of the gonadotropins (follicle-stimulating hormone and luteinizing hormone). FHA is a form of the defence of organism in situations where life functions are more important than reproductive function. FHA is reversible; it can be normalized after ceasing the stress situation. There are three types of FHA: weight loss related, stress-related, and exercise-related amenorrhea. The final consequences are complex hormonal changes manifested by profound hypoestrogenism. Additionally, these patients present mild hypercortisolemia, low serum insulin levels, low insulin-like growth factor 1 (IGF-1) and low total triiodothyronine. Women health in this disorder is disturbed in several aspects including the skeletal system, cardiovascular system, and mental problems. Patients manifest a decrease in bone mass density, which is related to an increase in fracture risk. Therefore, osteopenia and osteoporosis are the main long-term complications of FHA. Cardiovascular complications include endothelial dysfunction and abnormal changes in the lipid profile. FHA patients present significantly higher depression and anxiety and also sexual problems compared to healthy subjects.
Topics: Adult; Amenorrhea; Exercise; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypothalamic Diseases; Luteinizing Hormone; Risk Factors; Stress, Physiological; Weight Loss
PubMed: 26486482
DOI: No ID Found -
Endocrine Jun 2024Functional hypothalamic amenorrhea (FHA) is one of the most common causes of both primary and secondary amenorrhea in women of reproductive age. It is characterized by... (Review)
Review
Functional hypothalamic amenorrhea (FHA) is one of the most common causes of both primary and secondary amenorrhea in women of reproductive age. It is characterized by chronic anovulation and the absence of menses that appear as a result of stressors such as eating disorders, excessive exercise, or psychological distress. FHA is presumed to be a functional disruption in the pulsatile secretion of hypothalamic gonadotropin-releasing hormone, which in turn impairs the release of gonadotropin. Hypoestrogenism is observed due to the absence of ovarian follicle recruitment. Numerous neurotransmitters have been identified which play an important role in the regulation of the hypothalamic-pituitary-ovarian axis and of which the impairment would contribute to developing FHA. In this review we summarize the most recent advances in the identification of contributing neuroendocrine disturbances and relevant contributors to the development of FHA.
Topics: Humans; Female; Amenorrhea; Hypothalamic Diseases; Hypothalamo-Hypophyseal System; Neurosecretory Systems; Gonadotropin-Releasing Hormone
PubMed: 38062345
DOI: 10.1007/s12020-023-03619-w -
AIDS (London, England) Mar 2019There is conflicting literature to support a link between HIV and amenorrhea. Here, we conduct a meta-analysis to summarize the results from landmark studies in this... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
There is conflicting literature to support a link between HIV and amenorrhea. Here, we conduct a meta-analysis to summarize the results from landmark studies in this area and shed light on this important clinical association.
METHODS
Using a search of Ovid Medline and Embase, a total of 322 articles were screened for controlled matched observational studies of amenorrhea in premenopausal women living with HIV (WLWH). For inclusion, amenorrhea was defined as absence of menses for 3 months or longer. The meta-analysis used a random-effects model with an I2 calculated to assess heterogeneity.
RESULTS
Six studies from 1996 to 2010 were included in our analysis for a total of 8925 women (6570 WLWH). There was a significant association between HIV status and amenorrhea (OR 1.68, P value 0.0001) without evidence of heterogeneity (I2: 0.0%). In the majority of studies, there was no significant difference in substance use, smoking, or socioeconomic status between WLWH and controls. Additionally, in the majority of studies, amenorrhea in the setting of low BMI was significantly more frequent in WLWH than controls.
CONCLUSION
This meta-analysis provides a large population assessment of amenorrhea in HIV to suggest increased prevalence of menstrual disturbances in WLWH. It lends evidence suggestive that this relation is independent of substance use and socioeconomic status, but may be related to low BMI. Our findings reinforce the importance of routine assessment of reproductive health and time of last menstrual period as part of the health assessment of women, especially those living with HIV.
Topics: Adolescent; Adult; Amenorrhea; Female; HIV Infections; Humans; Middle Aged; Premenopause; Prevalence; Young Adult
PubMed: 30531313
DOI: 10.1097/QAD.0000000000002084 -
Seminars in Nephrology Mar 2021Sexual and reproductive function are impacted negatively in individuals with chronic kidney disease and end-stage renal disease. Disruption of the... (Review)
Review
Sexual and reproductive function are impacted negatively in individuals with chronic kidney disease and end-stage renal disease. Disruption of the hypothalamic-pituitary-gonadal axis plays a pivotal role in contributing to these manifestations as a result of decreasing kidney function and the development of uremia. Early menopause is encountered commonly in women with reduced kidney function, and treatment is problematic as a result of reduced kidney function changing the half-life of medications. Kidney transplantation corrects some of these abnormalities, but medications required after transplantation as well as the persistence of other comorbidities are barriers to normal restoration of gonadal dysfunction.
Topics: Amenorrhea; Estrogens; Female; Humans; Kidney Failure, Chronic; Renal Insufficiency, Chronic; Uremia
PubMed: 34140091
DOI: 10.1016/j.semnephrol.2021.03.007 -
Obstetrics and Gynecology Clinics of... Mar 2015Before initiating ovulation induction, it is important to evaluate the underlying cause of a patient's anovulation and to make lifestyle modifications or treat... (Review)
Review
Before initiating ovulation induction, it is important to evaluate the underlying cause of a patient's anovulation and to make lifestyle modifications or treat underlying medical conditions, as appropriate. Here, ovulation induction agents are discussed with attention to their pharmacology, indications for use, therapy regimens, and efficacy. Adjuvant therapies and appropriate monitoring are also reviewed.
Topics: Amenorrhea; Anovulation; Clomiphene; Estrogens; Female; Fertility Agents, Female; Gonadotropins; Humans; Hypogonadism; Infertility, Female; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Progestins
PubMed: 25681838
DOI: 10.1016/j.ogc.2014.09.007 -
La Revue de Medecine Interne Oct 2020
Topics: Adolescent; Amenorrhea; Diagnosis, Differential; Female; Hematocolpos; Humans; Pelvic Pain
PubMed: 32624261
DOI: 10.1016/j.revmed.2020.03.014