Hypothalamic amenorrhea: clinical perspectives, pathophysiology, and management.
The development of functional hypothalamic amenorrhea reflects an individual's response to environmental stressors and life-style variables. In this disorder there are no detectable anatomic abnormalities with respect to the hypothalamic-pituitary-ovarian-endometrial axis. Current evidence suggests that the common underlying defect is a decrease in the activity of the hypothalamic gonadotropin-releasing hormone pulse generator. Of the neuroendocrine factors that appear to regulate gonadotropin-releasing hormone activity, the opiate and dopamine neuronal systems have been implicated as factors that are responsible in part for the decreased secretion of gonadotropin-releasing hormone. Because of the functional nature of this disorder, reactivation of the hypothalamic-pituitary unit would be expected to take place in most women after accommodation to environmental stressors or modification in life-style. For women with persistent anovulation, treatment with estrogen-replacement therapy should be offered. In those desiring fertility, ovulation induction with pulsatile gonadotropin-releasing hormone would be the most effective modality.
Liu
J H
JH
Department of Obstetrics and Gynecology, University of Cincinnati, OH 45267-0526.
D000568:Amenorrhea / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000858:Anovulation / Q000209:etiology / Q000628:therapy; D004298:Dopamine / Q000502:physiology; D004723:Endorphins / Q000502:physiology; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000378:metabolism*; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008019:Life Style; D007986:Luteinizing Hormone / Q000097:blood / Q000378:metabolism; D008787:Metoclopramide / Q000494:pharmacology; D010062:Ovulation Induction; D011247:Pregnancy; D011374:Progesterone / Q000097:blood; D011954:Receptors, Dopamine / Q000187:drug effects; D013315:Stress, Psychological / Q000150:complications
D004723:Endorphins; D011954:Receptors, Dopamine; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D008787:Metoclopramide; D004298:Dopamine