Amenorrhea Guidelines

Updated: Oct 14, 2019
  • Author: Kristi A Tough DeSapri, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Guidelines Summary

Hypothalamic Amenorrhea.

The Endocrine Society has issued guidelines on diagnosing and treating hypothalamic amenorrhea.

Guideline recommendations include the following [75, 76] :

  • A diagnostic evaluation for hypothalamic amenorrhea should be considered in adolescents and women who persistently exceed 45 days between menstrual cycles and/or those who present with amenorrhea for 3 months or more after the healthcare provider has excluded other conditions that could be causing amenorrhea.
  • Exclude pregnancy in patients with suspected hypothalamic amenorrhea and then perform a full physical examination including tests of estrogen, thyroid hormones, and prolactin.
  • Refer patients to a nutritionist
  • Brain MRI is recommended in patients with a history of headaches; persistent vomiting, change in vision, thirst, urination not linked to other causes, lateralizing neurologic signs, and/or tests that suggest pituitary hormone level abnormalities.  
  • Inpatient treatment is recommended for hypothalamic amenorrhea patients who have severe bradycardia, hypotension, orthostasis, and/or electrolyte imbalance. Because of the high mortality rate associated with eating disorders, and especially anorexia nervosa, careful monitoring is recommended in extremely low weight patients.