Hypothalamic amenorrhea: clinical perspectives, pathophysiology, and management

Article Abstract:

Gonadotropin (luteinizing hormone, LH) is a chemical secreted by the pituitary gland that stimulates the sex organs (gonads) to produce eggs or sperm; its own secretion is controlled by gonadotropin-releasing hormone (GnRH or LHRH), manufactured in the hypothalamus (a part of the brain). Part 2 of the November 1990 issue of the American Journal of Obstetrics and Gynecology presents papers from a symposium devoted to pulsatile GnRH, a method of hormone delivery that makes it possible to treat a variety of clinical disorders associated with ovarian dysfunction. A review is presented of the symptoms, physiological abnormalities, and treatment of hypothalamic amenorrhea, a lack of menstruation that occurs as a result of a deficiency of pulsatile GnRH. Women with this disorder have not menstruated for at least six months; they are usually highly motivated, intelligent, and involved in high-stress occupations. Such patients are rarely overweight; many have experienced a stressful event prior to the beginning of amenorrhea. The diagnosis of this condition should be made only after other causes of amenorrhea have been ruled out. The pulse frequencies of GnRH and its consequent hormone, LH, are slowed in women with hypothalamic amenorrhea. Since LH and FSH are produced in normal or more-than-normal amounts after GnRH administration in such women, the defect appears to be at the level of the hypothalamus. Endogenous opiates (naturally-occurring substances in the body with effects similar to opium or derivatives) suppress pulsatile GnRH and LH secretion; secretion increases in women with hypothalamic amenorrhea after treatment with opiate antagonists. Stress, too, suppresses reproductive function and has been linked to hypothalamic amenorrhea. Treatment begins with a thorough examination, to exclude other diseases and evaluate the patient's life style and psychological status. If amenorrheic patients want to become fertile, clomiphene citrate may be administrated. Pulsatile GnRH may be prescribed to induce ovulation if this is not successful. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Causes of, Gonadotropin releasing hormone, Gonadorelin

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Ten-year follow-up of patients with secondary amenorrhea and normal prolactin

Article Abstract:

Secondary amenorrhea refers to the abnormal cessation of the menstrual cycle in a patient who formerly menstruated. It can be caused by an over production of the hormone prolactin, but it also can occur in women with normal levels of prolactin. Four different types of secondary amenorrhea were identified among 46 women based on whether progesterone induced uterine bleeding and by blood levels of hormones. The women were followed for a 10-year period to determine if normal menstrual cycles were resumed and if they could become pregnant. The patients with low levels of estradiol in their blood (hypoestrogenic amenorrhea) had a greater rate of recovery and were more likely to have their menstrual cycles return (66 percent) than those with normal levels of estradiol (18 percent). The patients with high levels of male hormones in their blood (hyperandrogenic amenorrhea), such as testosterone, and those with polycystic ovary syndrome required treatment with a drug called clomiphene citrate to induce ovulation (the maturation and release of eggs from the ovaries). Four out of nine of these patients were able to become pregnant following treatment with clomiphene. It is concluded that women with secondary amenorrhea caused by low levels of gonadotropins (hypoestrogenic amenorrhea) have a good chance of recovery to normal menstrual cycles. None of the patients with hyperandrogenic amenorrhea or polycystic ovaries had their menstrual cycles return to normal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis

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Cerebrospinal fluid levels of corticotropin-releasing hormone in women with functional hypothalamic amenorrhea

Article Abstract:

Elevated levels of corticotropin-releasing hormone may not be responsible for causing amenorrhea. Amenorrhea is an absence of regular menstrual periods. In a study of 29 women, those with amenorrhea had similar amounts of corticotropin-releasing hormone as women with normal menstrual periods.

Corticotropin releasing hormone, Corticotropin-releasing hormone

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