FUNCTIONAL HYPOTHALAMIC AMENORRHEA: CURRENT INSIGHTS INTO PATHOGENESIS, DIAGNOSIS, AND THERAPY
Keywords:
functional hypothalamic amenorrhea, kisspeptin, GnRH, stress, energy deficiency, hypoestrogenism, fertilityAbstract
Functional hypothalamic amenorrhea (FHA) is a common cause of secondary amenorrhea in women of reproductive age, resulting from suppression of gonadotropin-releasing hormone (GnRH) secretion due to stress, energy deficiency, and psychosocial factors. This review summarizes current concepts of FHA pathogenesis, emphasizing the central role of kisspeptin and metabolic hormones in hypothalamic-pituitary-gonadal axis regulation. Clinical manifestations, diagnostic principles, and modern therapeutic strategies are discussed. Particular attention is paid to multidisciplinary approaches aimed at restoring energy balance, reducing stress, and implementing cognitive-behavioral therapy. Emerging treatments, including kisspeptin receptor agonists and leptin-based interventions, show promise for restoring ovulatory function and reproductive health.
References
Shufelt C. L. et al. Functional hypothalamic amenorrhea and preclinical cardiovascular disease //The Journal of Clinical Endocrinology & Metabolism. – 2024. – Т. 109. – №. 1. – С. e51-e57.
Behary P., Comninos A. N. Bone perspectives in functional hypothalamic amenorrhoea: an update and future avenues //Frontiers in Endocrinology. – 2022. – Т. 13. – С. 923791.
Meczekalski B. et al. Stress, kisspeptin, and functional hypothalamic amenorrhea //Current Opinion in Pharmacology. – 2022. – Т. 67. – С. 102288.
Męczekalski B. et al. Neuroendocrine disturbances in women with functional hypothalamic amenorrhea: an update and future directions //Endocrine. – 2024. – Т. 84. – №. 3. – С. 769-785.
Podfigurna A. et al. Kisspeptin and LH pulsatility in patients with functional hypothalamic amenorrhea //Endocrine. – 2020. – Т. 70. – №. 3. – С. 635-643.
Podfigurna A., Szeliga A., Meczekalski B. Serum kisspeptin and corticotropin-releasing hormone levels in patients with functional hypothalamic amenorrhea //Gynecol Reprod Endocrinol Metab. – 2020. – Т. 1. – №. 1. – С. 37-42.
Bonazza F. et al. Psychological factors in functional hypothalamic amenorrhea: A systematic review and meta-analysis //Frontiers in endocrinology. – 2023. – Т. 14. – С. 981491.
Пуршаева Э. Ш. и др. Дефицит массы тела и гинекологические заболевания молодых женщин //Вестник Российского университета дружбы народов. Серия: Медицина. – 2013. – №. 5. – С. 120-129.
Кузнецова И. В. и др. Психогенные стресс-зависимые нарушения менструального цикла: роль негормональной коррекции //Медицинский алфавит. – 2017. – Т. 2. – №. 10. – С. 54-61.
Marshall L. A. Clinical evaluation of amenorrhea in active and athletic women //Clinics in sports medicine. – 1994. – Т. 13. – №. 2. – С. 371-387.
Gordon C. M. et al. Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline //The Journal of Clinical Endocrinology & Metabolism. – 2017. – Т. 102. – №. 5. – С. 1413-1439.
Smetnik A. A. et al. Non-instrumental screening for low bone mineral density in women with secondary amenorrhea //Akusherstvo i Ginekologiya/Obstetrics and Gynecology. – 2014. – Т. 8. – С. 59-64.
