R B Perkins1, J E Hall, K A Martin. 1. Reproductive Endocrine Unit and National Center for Infertility Research, Massachusetts General Hospital, 55 Fruit Street BHX 5, Boston, MA 02114, USA.
Abstract
BACKGROUND: Hypothalamic amenorrhoea (HA) is a syndrome associated with infertility and osteopenia in reproductive-age women. METHODS: To understand better the natural history of this disorder, 28 women participated in a retrospective, questionnaire-based analysis to elucidate factors associated with spontaneous recovery. RESULTS: 54% of subjects developed HA related to an eating disorder, 21% related to stress +/- weight loss, and 25% without obvious contributing factors (idiopathic). HA associated with a clear precipitant had a better prognosis than idiopathic HA (71 versus 29% recovery; P < 0.05). Reversal of the inciting factor appeared necessary but not sufficient for recovery (83% recovery if factor reversed). Normal menarche occurred in 61% of subjects, oligomenorrhoea in 32%, and primary amenorrhoea in 7%. Oligomenorrhoea and normal menarche showed a trend toward better prognosis than primary amenorrhoea (NS). Compared with controls, 46% of HA patients had decreased frequency of LH pulses, 7% decreased amplitude, 18% decreases in both frequency and amplitude, 18% absent pulses, and 11% normal-appearing pulses. Pulse pattern at baseline did not predict recovery. CONCLUSIONS: The aetiology of HA at the time of presentation predicts subsequent recovery of menstrual function. In stress, weight loss, or eating disorder-related HA, rates of recovery exceeded 80% when precipitating factors were reversed. Idiopathic HA may represent a different disorder as recovery rates were <30%.
BACKGROUND:Hypothalamic amenorrhoea (HA) is a syndrome associated with infertility and osteopenia in reproductive-age women. METHODS: To understand better the natural history of this disorder, 28 women participated in a retrospective, questionnaire-based analysis to elucidate factors associated with spontaneous recovery. RESULTS: 54% of subjects developed HA related to an eating disorder, 21% related to stress +/- weight loss, and 25% without obvious contributing factors (idiopathic). HA associated with a clear precipitant had a better prognosis than idiopathic HA (71 versus 29% recovery; P < 0.05). Reversal of the inciting factor appeared necessary but not sufficient for recovery (83% recovery if factor reversed). Normal menarche occurred in 61% of subjects, oligomenorrhoea in 32%, and primary amenorrhoea in 7%. Oligomenorrhoea and normal menarche showed a trend toward better prognosis than primary amenorrhoea (NS). Compared with controls, 46% of HA patients had decreased frequency of LH pulses, 7% decreased amplitude, 18% decreases in both frequency and amplitude, 18% absent pulses, and 11% normal-appearing pulses. Pulse pattern at baseline did not predict recovery. CONCLUSIONS: The aetiology of HA at the time of presentation predicts subsequent recovery of menstrual function. In stress, weight loss, or eating disorder-related HA, rates of recovery exceeded 80% when precipitating factors were reversed. Idiopathic HA may represent a different disorder as recovery rates were <30%.
Authors: Lisa M Caronia; Cecilia Martin; Corrine K Welt; Gerasimos P Sykiotis; Richard Quinton; Apisadaporn Thambundit; Magdalena Avbelj; Sadhana Dhruvakumar; Lacey Plummer; Virginia A Hughes; Stephanie B Seminara; Paul A Boepple; Yisrael Sidis; William F Crowley; Kathryn A Martin; Janet E Hall; Nelly Pitteloud Journal: N Engl J Med Date: 2011-01-20 Impact factor: 91.245
Authors: Angela Delaney; Adam B Burkholder; Christopher A Lavender; Lacey Plummer; Veronica Mericq; Paulina M Merino; Richard Quinton; Katie L Lewis; Brooke N Meader; Alessandro Albano; Natalie D Shaw; Corrine K Welt; Kathryn A Martin; Stephanie B Seminara; Leslie G Biesecker; Joan E Bailey-Wilson; Janet E Hall Journal: J Clin Endocrinol Metab Date: 2021-03-08 Impact factor: 6.134