Functional hypothalamic amenorrhea

Functional hypothalamic amenorrhea (FHA) is a reversible form of anovulation due to behavioral and psychological factors that elicit hypothalamic hypercortisolism and a cascade of neuroendocrine adaptations including hypothalamic hypothyroidism. The neuroendocrine constellation conserves and diverts energy to perceived challenges. Behavioral interventions such as cognitive behavior therapy that address problematic attitudes and behaviors reduce hypothalamic hypercortisolism and restore ovulatory eumenorrhea. Hormonal therapies offer less promise but contraception should be provided if needed. Infertility treatment should be undertaken with caution. The role of psychotropics has not been appropriately studied. The many health consequences of chronic stress and hypoestrogenism necessitate ongoing care.