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Endocrine Society Issues Hypothalamic Amenorrhea Guideline

Female athletes and women who have eating disorders are prone to developing a condition called hypothalamic amenorrhea that causes them to stop menstruating. The Endocrine Society today issued a Clinical Practice Guideline advising healthcare providers on ways to diagnose and treat this condition.

The guideline, titled “Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the May 2017 print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM).

Hypothalamic amenorrhea occurs when the hypothalamus in the brain slows or stops releasing GnRH, the hormone that controls the menstrual cycle. It often affects adolescent girls or women with low body weight, a low percentage of body fat, a very low calorie or fat intake, and emotional stress. Ballet dancers, figure skaters, runners, and others who burn more calories through exercise than they consume in their diet can be at risk for developing hypothalamic amenorrhea.

“This energy imbalance needs to be addressed to effectively treat hypothalamic amenorrhea and typically requires behavioral modifications,” says Catherine M. Gordon of Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio, and the chair of the task force that authored the guideline. “Referring patients to a nutritionist for specialized dietary instructions is an extremely important part of their care. Menstrual cycles can often be restored with increased calorie consumption, improved nutrition or decreased exercise activity.”

Hypothalamic amenorrhea raises the risk of other health problems, such as delayed puberty in adolescents and infertility in adult women. Chronic hypothalamic amenorrhea can contribute to bone loss, and some patients develop stress fractures and are at high risk to develop osteoporosis.

To diagnose hypothalamic amenorrhea, healthcare providers must rule out other conditions that can halt menstruation, including benign tumors in the pituitary gland and adrenal gland disorders. The guideline recommends that providers first exclude pregnancy as a cause and then perform a full physical exam to evaluate for other potential causes. General laboratory tests, including a complete blood count and electrolytes, also are part of the recommended screening process.

The Society’s public education arm, the Hormone Health Network, offers more information on hypothalamic amenorrhea and women’s reproductive health.

Other members of the Endocrine Society task force that developed this guideline include: Kathryn E. Ackerman of Boston Children’s Hospital and Massachusetts General Hospital in Boston, Mass.; Sarah L. Berga and Jay R. Kaplan of Wake Forest School of Medicine in Winston-Salem, N.C.; George Mastorakos of Areteio Hospital in Athens, Greece; Madhusmita Misra of Massachusetts General Hospital in Boston, Mass.; M. Hassan Murad of The Mayo Clinic in Rochester, Minn.; Nanette F. Santoro of the University of Colorado School of Medicine in Aurora, Colo.; and Michelle P. Warren of Columbia University Medical Center in New York, N.Y.

The Society established the Clinical Practice Guideline Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis, treatment, and management of endocrine-related conditions. Each guideline is created by a task force of topic-related experts in the field. Task forces rely on evidence-based reviews of the literature in the development of guideline recommendations. The Endocrine Society does not solicit or accept corporate support for its guidelines. All Clinical Practice Guidelines are supported entirely by Society funds.

The Clinical Practice Guideline was co-sponsored by the American Society for Reproductive Medicine, European Society of Endocrinology, and the Pediatric Endocrine Society.

The guideline will be published online.

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