(4,5,9,14) The latter is common in female athletes and can be termed functional hypothalamic amenorrhea
Some theoretical and disease-based research suggests a possible role for oral contraceptives to prevent bone loss in pre- and postmenopausal women, (6) but little research has investigated younger women with hypothalamic amenorrhea
. A recent open-label study that did examine bone mineral density (BMD) in women with hypothalamic amenorrhea
before and after 13 cycles of oral contraceptives found a significant increase in BMD in the spine, but not at the hip.
The mean body mass index (BMI), percent ideal body weight, percent fat, total fat mass, and fat-free mass were all lower in the anorexia nervosa groups, compared with women who had hypothalamic amenorrhea
and healthy controls.
All of those with hypothalamic amenorrhea
were 90%-110% of ideal body weight; had been amenorrheic for at least 3 months; had normal FSH, prolactin, testosterone, and free testosterone levels; an LH-to-FSH ratio of less than 2.5; absence of hirsutism; and no history of an eating disorder.
Results of a "proof of concept" study of eight women with hypothalamic amenorrhea
and six controls suggest that leptin--a hormone secreted by adipocytes that regulates energy homeostasis--might help in a range of neuroendocrine disorders, such as anorexia nervosa, infertility, and exercise-induced bone loss, said Dr.
Ringham and her colleagues had previously demonstrated that women with functional hypothalamic amenorrhea
are distinguishable from women having as organic cause for their amenorrhea as well as from normally menstruating women on the basis of their high levels of subthreshold symptoms of disordered eating, with dysfunctional attitudes, mild undernutrition, and/or excessive energy output.
Ahima said that the decrease in levels of leptin--which mediates the suppression of reproductive, growth, and thyroid hormones: increases glucocorticoids; and stimulates food retake--may have evolved as a defense against starvation, which hypothalamic amenorrhea
This psychological intervention also reduced the elevated cortisol secretion characteristic of functional hypothalamic amenorrhea
, a common disorder also known as stress-induced anovulation.
Clomiphene is ineffective for women with hypothalamic amenorrhea
and by perprolactinemia.
Functional hypothalamic amenorrhea
is anovulation that's not attributable to a discernible orgarnic cause.
Ahima said that the decrease in leptin levels during fasting--which mediates the suppression of reproductive, growth, and thyroid hormones, increases glucocorticoids, and stimulates food intake--may have evolved as a defense against starvation, which hypothalamic amenorrhea
Preclinical studies in monkeys had demonstrated that psychological stress and mild metabolic imbalances act synergistically in inducing functional hypothalamic amenorrhea