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Exercise induced amenorrhoea occurs in 5-25% of athletes and 1.8% of the general population. The incidence is higher in marathon runners and is more frequent in women who weigh less and were slightly younger. [2] Exercise amenorrhoea has also been reported in ballet dancers, cyclists, swimmers and those involved in non-weight bearing sports. [1]
In one study, 5.4% of athletes with eating disorders reported suicide attempts. Although 83% of anorexia nervosa patients partially recover, the rate of sustained recovery of weight, menstrual function and eating behavior Amenorrheic women can be infertile, due to the absence of ovarian follicular development, ovulation, and luteal function.
Both significant weight loss and weight gain can cause FHA through insulin. [12] Significant weight loss, as in eating disorders and chronic malnutrition, is characterized by low insulin levels. Significant weight gain can lead to obesity and insulin resistance, which mimics low insulin levels via functional hypoinsulinaemia. [12]
Physiologic amenorrhea is present before menarche, during pregnancy and breastfeeding, and after menopause. [3] Breastfeeding or lactational amenorrhea is also a common cause of secondary amenorrhoea. [26] Lactational amenorrhea is due to the presence of elevated prolactin and low levels of LH, which suppress ovarian hormone secretion. [27]
Since common causes of FHA include exercising too much, eating too little, or being under too much stress, diagnosis of FHA includes assessing for any changes in exercise, weight, and stress. In addition, evaluation of amenorrhea includes a history and physical examination, biochemical testing, imaging, and measuring estrogen level.
The National Institutes of Health has a body weight planner that you can use to calculate your target food intake based on your optimal weight, age, height and activity level.
In patients with functional hypothalamic amenorrhea due to physical or psychological stress, non-pharmacological options include weight gain, resolution of emotional issues, or decreased intensity of exercise. Patients experiencing amenorrhea due to hypothyroidism may be started with thyroid replacement therapy. Dopamine agonists such as ...
In women with hypogonadotropic hypogonadism suspicious for functional hypothalamic amenorrhea, treatment should be centered around weight gain, reducing intensity and frequency of exercise, and stress reduction with psychotherapy or counseling. [10]