Estriol administration modulates luteinizing hormone secretion in women with functional hypothalamic amenorrhea

Genazzani, Alessandro D.; Męczekalski, Błażej; Podfigurna-Stopa, Agnieszka; Santagni, Susanna; Rattighieri, Erica; Ricchieri, Federica; Chierchia, Elisa; Simoncini, Tommaso

doi:10.1016/j.fertnstert.2011.11.004

Cited by 17 publications

(13 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…or ran at least 30 miles per week [ 17 ]. History of emotionally stressful events preceding the onset of amenorrhea included problems within the family, at school, at work or of psychosocial stress (psychiatric diseases were excluded using DSM IV criteria) [ 18 ]. None of the women had hirsutism or acne.…”

Section: Methodsmentioning

confidence: 99%

Basal and dynamic relationships between serum anti-Müllerian hormone and gonadotropins in patients with functional hypothalamic amenorrhea, with or without polycystic ovarian morphology

Hager

Ott

Marschalek

et al. 2022

Reprod Biol Endocrinol

View full text Add to dashboard Cite

Background To evaluate in women with functional hypothalamic amenorrhea (FHA), whether there is a difference between patients with and without polycystic ovarian morphology (PCOM) concerning the response to a gonadotropin releasing hormone (GnRH) stimulation test and to pulsatile GnRH treatment. Methods In a retrospective observational study, 64 women with FHA who underwent a GnRH stimulation test and 32 age-matched controls without PCOM were included. Pulsatile GnRH treatment was provided to 31 FHA patients and three-month follow-up data were available for 19 of these. Results Serum levels of gonadotropins and estradiol were lower in FHA women than in controls (p < 0.05). FHA patients revealed PCOM in 27/64 cases (42.2%). FHA patients without PCOM revealed lower anti-Müllerian hormone (AMH) levels than controls (median 2.03 ng/mL, IQR 1.40–2.50, versus 3.08 ng/mL, IQR 2.24–4.10, respectively, p < 0.001). Comparing FHA patients with and without PCOM, the latter revealed lower AMH levels, a lower median LH increase after the GnRH stimulation test (240.0%, IQR 186.4–370.0, versus 604.9%, IQR 360.0–1122.0; p < 0.001) as well as, contrary to patients with PCOM, a significant increase in AMH after three months of successful pulsatile GnRH treatment (median 1.69 ng/mL at baseline versus 2.02 ng/mL after three months of treatment; p = 0.002). Conclusions In women with FHA without PCOM, the phenomenon of low AMH levels seems to be based on relative gonadotropin deficiency rather than diminished ovarian reserve. AMH tended to rise after three months of pulsatile GnRH treatment. The differences found between patients with and without PCOM suggest the former the existence of some PCOS-specific systemic and/or intra-ovarian abnormalities.

show abstract

Section: Methodsmentioning

confidence: 99%

Basal and dynamic relationships between serum anti-Müllerian hormone and gonadotropins in patients with functional hypothalamic amenorrhea, with or without polycystic ovarian morphology

Hager

Ott

Marschalek

et al. 2022

Reprod Biol Endocrinol

View full text Add to dashboard Cite

show abstract

“…Medical treatment options for facilitating the recovery of menses include gonadal hormonal therapy (Falsetti et al 2002;Genazzani et al 2012;Shen, Xu, and Lin 2013), recombinant human leptin (metreleptin) (Chou et al 2011;Welt et al 2004) or opioid receptor blockers (naltrexone) . Altogether, six prospective studies are available (3 of low, 1 of middle and 2 of high quality).…”

Section: Treatment Options Trailed For Re-onset and Maintenance Of Menstruationmentioning

confidence: 99%

“…This has generated the hypothesis that the pituitary response to GnRH and the ovarian response to gonadotropin could be reinforced with estrogen. However, studies evaluating this hypothesis failed to show any effect on the likelihood of recovery of menses (Falsetti et al 2002;Genazzani et al 2012;Shen, Xu, and Lin 2013).…”

Section: Medicationmentioning

confidence: 99%

Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

Pape

Herbison

Leeners

2020

Human Reproduction Update

View full text Add to dashboard Cite

BACKGROUND Prolonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fat and hormonal parameters are known to be involved in the initiation of the menstrual cycle, their role in the physiology of return of menses is currently poorly understood. We summarise here the current knowledge on the epidemiology and physiology of return of menses. OBJECTIVE AND RATIONALE The aim of this review was to provide an overview of (i) factors determining the recovery of menses and its timing, (ii) how such factors may exert their physiological effects and (iii) whether there are useful therapeutic options to induce recovery. SEARCH METHODS We searched articles published in English, French or German language containing keywords related to return of menses after FHA published in PubMed between 1966 and February 2020. Manuscripts reporting data on either the epidemiology or the physiology of recovery of menses were included and bibliographies were reviewed for further relevant literature. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria served to assess quality of observational studies. OUTCOMES Few studies investigate return of menses and most of them have serious qualitative and methodological limitations. These include (i) the lack of precise definitions for FHA or resumption of menses, (ii) the use of short observation periods with unsatisfactory descriptions and (iii) the inclusion of poorly characterised small study groups. The comparison of studies is further hampered by very inhomogeneous study designs. Consequently, the exact prevalence of resumption of menses after FHA is unknown. Also, the timepoint of return of menses varies strongly and reliable prediction models are lacking. While weight, body fat and energy availability are associated with the return of menses, psychological factors also have a strong impact on the menstrual cycle and on behaviour known to increase the risk of FHA. Drug therapies with metreleptin or naltrexone might represent further opportunities to increase the chances of return of menses, but these require further evaluation. WIDER IMPLICATIONS Although knowledge on the physiology of return of menses is presently rudimentary, the available data indicate the importance of BMI/weight (gain), energy balance and mental health. The physiological processes and genetics underlying the impact of these factors on the return of menses require further research. Larger prospective studies are necessary to identify clinical parameters for accurate prediction of return of menses as well as reliable therapeutic options.

show abstract

“…The recovery of pulsatile GnRH secretion with normal frequency and altitude is the critical mechanism for rebuilding ovulation. Other studies have shown that estrogen administration improves the function of the HPO axis, BMD, eating attitudes, and body shape perceptions (68)(69)(70)(71).…”

Section: Hormonal Replacement Therapymentioning

confidence: 94%

The effects of weight loss-related amenorrhea on women’s health and the therapeutic approaches: a narrative review

Chen¹,

Lu²,

Zhou³

et al. 2023

Ann Transl Med

View full text Add to dashboard Cite

Background and Objective Weight loss-related amenorrhea is defined as the reversible functional inhibition of the hypothalamic-pituitary-ovarian (HPO) axis associated with weight loss or low body weight, which occurs mostly in adolescents and women of reproductive age. The specific pathological mechanisms of this disease have not yet been elucidated, and the optimal evidence-based guidelines for its clinical assessment and management are limited. This review summarizes its adverse effects on female health, and the individualized, emerging, and multidisciplinary therapeutic approaches used to treat it. Methods We searched the PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases for Chinese and English literature on functional hypothalamic amenorrhea (FHA), and retrieved original articles (on basic and clinical research) and reviews published up to December 2022. Key Content and Findings We reviewed the findings on the unfavorable effects of weight loss-related amenorrhea with a focus on reproduction, the skeletal and cardiovascular system, other endocrine effects, and mental health. Lifestyle changes and hormonal replacement have been shown to alleviate the underlying causes and lead to the recovery of menstruation. However, the efficacy of treatments is affected by many factors, such as psychological stress and heterogeneity. Conclusions Weight loss-related amenorrhea, which is an important type of FHA, is manifested by anovulation and hypoestrogenism, and has both short- and long-term adverse effects on women’s overall health. It is difficult to alleviate its underlying causes. Individualized treatments need to be optimized and emerging or multidisciplinary therapeutic approaches need to be explored that aim to recover normal menstruation and ovulation, eliminate the undesirable effects of prolonged hypoestrogenism and alleviate psychological disorders.

show abstract

Estriol administration modulates luteinizing hormone secretion in women with functional hypothalamic amenorrhea

Cited by 17 publications

References 30 publications

Basal and dynamic relationships between serum anti-Müllerian hormone and gonadotropins in patients with functional hypothalamic amenorrhea, with or without polycystic ovarian morphology

Basal and dynamic relationships between serum anti-Müllerian hormone and gonadotropins in patients with functional hypothalamic amenorrhea, with or without polycystic ovarian morphology

Recovery of menses after functional hypothalamic amenorrhoea: if, when and why

The effects of weight loss-related amenorrhea on women’s health and the therapeutic approaches: a narrative review

Contact Info

Product

Resources

About