Functional hypothalamic amenorrhea

Behaviors that activate the hypothalamic-pituitary-adrenal (HPA) axis or suppress the hypothalamic-pituitary-thyroidal (HPT) axis can disrupt the hypothalamic-pituitary-gonadal axis in women and men. Individuals with functional hypothalamic hypogonadism typically display a combination of behaviors that serve as psychogenic stressors or present metabolic challenges. Reproductive recovery depends on restoration of the HPA and HPT axes. Hormone replacement regimens have limited benefit because they do not fully restore endocrine and metabolic homeostasis and their use masks deficits that accrue from altered HPA and HPT function. Long-term deleterious consequences of stress-induced anovulation may include an increased risk of cardiovascular disease, osteoporosis, depression, and dementia. Although fertility can be restored with exogenous administration of gonadotropins or pulsatile GnRH, fertility management alone will not permit recovery of the HPA and HPT axes. HPA activation and HPT suppression are linked to poor obstetrical and fetal outcomes. In contrast, behavioral and psychologic interventions that address problematic behaviors and attitudes engender full endocrine recovery, thus offering better individual, maternal, and child health.