Functional hypothalamic and drug-induced amenorrhea: an overview

Lania, Andrea; Gianotti, Laura; Gagliardi, Irene; Bondanelli, Marta; Vena, Walter; Ambrosio, Maria Rosaria

doi:10.1007/s40618-019-01013-w

Cited by 22 publications

(19 citation statements)

References 71 publications

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“…In order to establish the diagnosis of functional amenorrhea, organic causes must be ruled out, requiring detailed physical examination and clinical history, associated with imaging and biochemical tests. 2,6,7 The correct amount of energy for the body is what allows the performance of metabolic processes such as thermoregulation, locomotion, reproduction, growth and general homeostasis; all of this is made possible by adequate hormonal secretion. 2 In response to the energy deficit resulting from low intake and high energy expenditure, there is a reduction in basal metabolism, in order to preserve energy.…”

Section: Discussionmentioning

confidence: 99%

“…2,6,7 The correct amount of energy for the body is what allows the performance of metabolic processes such as thermoregulation, locomotion, reproduction, growth and general homeostasis; all of this is made possible by adequate hormonal secretion. 2 In response to the energy deficit resulting from low intake and high energy expenditure, there is a reduction in basal metabolism, in order to preserve energy. A great part of this phenomenon is due to the described reduction in serum T3 and IGF-1, due to growth hormone resistance.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the various health benefits that physical activity has, when performed strenuously associated with a strict diet, the calorie deficit can negatively impact body functioning and hormonal balance. [1][2][3] Hypothalamic amenorrhea is a disorder that generates a state of chronic anovulation. This disorder is common in high-performance female athletes, as well as patients with anorexia nervosa, whose rigid diet and low weight maintenance affects the hypothalami-pituitary-ovary axis by suppressing GnRH pulses and decreasing LH and FSH secretion, generating a state of hypoestrogenism, menstrual cycle irregularities and infertility.…”

Section: Introductionmentioning

confidence: 99%

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Functional hypothalamic amenorrhea remission, with spontaneous pregnancy after behavioral modifications

Campagnolo¹,

Duarte²,

Santos³

2020

IPCB

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Functional Hypothalamic Amenorrhea (FHA) is a disorder that generates a state of chronic anovulation due to a low calorie intake and high energy expenditure through intense physical activity. This energy deficit induce several hormonal changes that lead to decreased secretion of gonadotrophin releasing-hormone (GnRH) and luteinizing hormone (LH), resulting in a chronic state of hypoestrogenism and infertility. Loss of bone mineral content and delayed puberty may also arise from such condition depending on patient´s age. Herein we present a case of a patient with HFA that was reversible through behavioral modifications, resulting in spontaneous pregnancy

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional hypothalamic amenorrhea remission, with spontaneous pregnancy after behavioral modifications

Campagnolo¹,

Duarte²,

Santos³

2020

IPCB

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“…As the existing literature on stress-induced CH appears orientated towards women, we focus our discussion on “Stress-Amenorrhoea” (SA). In women, SA is common and is thought to account for 15–48% of menstrual disorders [ 112 , 113 ]. Ultimately, SA ensues from activation of multiple neural, metabolic and hormonal pathways that culminate in a reduction of the pulsatile secretion of GnRH from hypothalamic neurons [ 111 , 112 ].…”

Section: Signals From the Outside: Morphine Anabolic-androgenic Steroids Physical Trauma And Stressmentioning

confidence: 99%

“…In women, SA is common and is thought to account for 15–48% of menstrual disorders [ 112 , 113 ]. Ultimately, SA ensues from activation of multiple neural, metabolic and hormonal pathways that culminate in a reduction of the pulsatile secretion of GnRH from hypothalamic neurons [ 111 , 112 ]. During acute and chronic stress, there is activation of the sympathetic adreno-medullary and HPA axes, respectively [ 114 ].…”

Section: Signals From the Outside: Morphine Anabolic-androgenic Steroids Physical Trauma And Stressmentioning

confidence: 99%

Mechanisms of Central Hypogonadism

Barber

Kyrou

Kaltsas

et al. 2021

IJMS

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Reproductive function depends upon an operational hypothalamo–pituitary–gonadal (HPG) axis. Due to its role in determining survival versus reproductive strategies, the HPG axis is vulnerable to a diverse plethora of signals that ultimately manifest with Central Hypogonadism (CH) in all its many guises. Acquired CH can result from any pituitary or hypothalamic lesion, including its treatment (such as surgical resection and/or radiotherapy). The HPG axis is particularly sensitive to the suppressive effects of hyperprolactinaemia that can occur for many reasons, including prolactinomas, and as a side effect of certain drug therapies. Physiologically, prolactin (combined with the suppressive effects of autonomic neural signals from suckling) plays a key role in suppressing the gonadal axis and establishing temporary CH during lactation. Leptin is a further key endocrine regulator of the HPG axis. During starvation, hypoleptinaemia (from diminished fat stores) results in activation of hypothalamic agouti-related peptide neurons that have a dual purpose to enhance appetite (important for survival) and concomitantly suppresses GnRH neurons via effects on neural kisspeptin release. Obesity is associated with hyperleptinaemia and leptin resistance that may also suppress the HPG axis. The suppressibility of the HPG axis also leaves it vulnerable to the effects of external signals that include morphine, anabolic-androgenic steroids, physical trauma and stress, all of which are relatively common causes of CH. Finally, the HPG axis is susceptible to congenital malformations, with reports of mutations within >50 genes that manifest with congenital CH, including Kallmann Syndrome associated with hyposmia or anosmia (reduction or loss of the sense of smell due to the closely associated migration of GnRH with olfactory neurons during embryogenesis). Analogous to the HPG axis itself, patients with CH are often vulnerable, and their clinical management requires both sensitivity and empathy.

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Effects of Environment and Lifestyle Factors on Anovulatory Disorder

Song

2021

Environment and Female Reproductive Health

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Functional hypothalamic and drug-induced amenorrhea: an overview

Cited by 22 publications

References 71 publications

Functional hypothalamic amenorrhea remission, with spontaneous pregnancy after behavioral modifications

Functional hypothalamic amenorrhea remission, with spontaneous pregnancy after behavioral modifications

Mechanisms of Central Hypogonadism

Effects of Environment and Lifestyle Factors on Anovulatory Disorder

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