Endocrine Abstracts

Functional hypothalamic amenorrhoea (FHA) is a disorder associated with functional inhibition of the hypothalamic-pituitary-ovarian axis due to deficiency of pulsatile GnRH. The incidence of FHA ranges from 15 to 48% of all secondary amenorrheas. The abnormal GnRH secretion leads to decreased pulses of gonadotropins, absent midcycle surges in luteinizing hormone (LH) secretion, absence of normal follicular development, anovulation, and low estradiol (E2). Causes of FHA can be classified into the three groups: i) stress-related factors ii) consequences of weight loss or underweight, and iii) extreme physical exercise. FHA is a ‘diagnosis of exclusion’ and requires multidisciplinary approach. Diagnosis of FHA is based upon the findings of amenorrhea, low gonadotropins and E2 with evidence of a precipitating factor (exercise, low weight, stress). Treatment of FHA should be aimed at elimination of the primary cause, i.e. a decrease in emotional strain, reduction of physical exercise, or optimisation of BMI. If periods do not return after a period of six months, hypoestrogenism may affect the bone metabolism. Hormone replacement is useful in both the treatment of menstrual disorders and normalisation of bone mineral density. Transdermal therapy is more appropriate. Clomiphene Citrate (CC) has also been used to restore periods in women with FHA. We report a series of 16 patients diagnosed with FHA who were treated with CC. An oral preparation (50 mg/day) was administered for 5 days. This was followed by a double dose (100 mg/day) for another 5 days a month later. If periods returned, treatment was continued for the two more months with 100 mg/day from day 3 to day 7 day of the cycle. 13 patients responded well periods retuned to normal, one patient became pregnant. The present data show that CC treatment can be useful to restore normal cycles in young women with FHA.