Nav: Home

Endocrine Society experts issue Clinical Practice Guideline on hypothalamic amenorrhea

March 22, 2017

WASHINGTON -- 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), a publication of the Endocrine Society.

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," said 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.

Recommendations from the guideline include:
  • Hypothalamic amenorrhea is a "diagnosis of exclusion," which requires healthcare providers to rule out other conditions that could be interrupting the menstrual cycle.

  • As part of their initial evaluation, women diagnosed with hypothalamic amenorrhea should have a series of laboratory tests to check levels of hormones including estrogen, thyroid hormones and prolactin. The workup can help identify factors preventing menstruation.

  • Hypothalamic amenorrhea patients should be evaluated for inpatient treatment if they have an abnormally slow heart rate, low blood pressure, or an electrolyte imbalance. Careful monitoring is needed in these cases because there is a high mortality rate associated with hypothalamic amenorrhea in the setting of eating disorders, particularly anorexia nervosa.

  • Select patients presumed to have hypothalamic amenorrhea should undergo a brain MRI to check for damage to or abnormalities of the pituitary gland or pituitary hormone deficiencies, if they exhibit select signs or symptoms, including a history of severe or persistent headaches; persistent vomiting that is not self-induced; changes in vision, thirst or urination not attributable to other causes; neurological signs suggesting a central nervous system abnormality; or other clinical signs or test results that suggest pituitary hormone deficiency or excess.
-end-
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 at https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2017-00131.

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world's oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

The Endocrine Society

Related Eating Disorders Articles:

Pregnant women with eating disorders and their children run higher risk of complications
Pregnant women with eating disorders should undergo extended pregnancy screenings considering their increased risk of complications.
Dementia and eating disorders: it is a problem of (semantic) memory
Eating disorders shown by patients with dementia are characterised by a vast range of behaviours that span from preference for sugary foods, binges, increase in appetite, to changes in table manners or in food preferences.
Prior eating disorders linked to long-term depression risk for mothers
A history of eating disorders and body image concerns before or during pregnancy are associated with future depressive symptoms among mothers, finds a new UCL-led study published in the British Journal of Psychiatry.
Men's porn habits could fuel partners' eating disorders, study suggests
A woman whose boyfriend or husband regularly watches pornography is more likely to report symptoms of an eating disorder, new research suggests.
How common are eating disorders in young children?
The frequency of eating disorder diagnoses was low among US children ages 9 to 10 in an analysis of data from another study.
Prevalence of eating disorders taken from largest sample in the United States
Biological Psychiatry has published a new study revising the outdated estimates of the prevalence of eating disorders in the United States.
Study points to path for better diagnosis of eating disorders, the deadliest of mental illnesses
A 'radical' new method for diagnosing eating disorders predicts 68 percent of people's problems in psychological and social functioning due to eating-disorder features.
New, ultra-rare gene mutations implicated in eating disorders
A combination of whole exome sequencing, machine learning, and network analysis, has identified new, ultra-rare gene mutations within specific biological pathways that may contribute to eating disorders, according to a study by researchers at the University of Iowa Carver College of Medicine and the Eating Recovery Center in Dallas, Texas.
Eating disorders linked to increased risk of theft and other criminal behavior
In an analysis of nearly 960,000 females, individuals with eating disorders were more likely to be convicted of theft and other crimes.
Mice exposed to prenatal stress are predisposed to eating disorders later in life
Scientists at the Weizmann Institute prevented the onset of eating disorders through dietary intervention.
More Eating Disorders News and Eating Disorders Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab