Functional hypothalamic amenorrhea with or without polycystic ovarian morphology: a retrospective cohort study about insulin resistance

Mayrhofer, Daniel; Dewailly, Didier; Hager, Marlene; Marculescu, Rodrig; Beitl, Klara; Ott, Johannes

doi:10.1016/j.fertnstert.2022.09.029

Cited by 6 publications

(19 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings were consistent with previous reports [ 1 – 3 , 7 ], where a high overall prevalence of PCOM in FHA patients was found (about 45%). As hypothesized, the stress-associated FHA group revealed a significantly higher prevalence of PCOM compared to the excessive exercise group (Table 2 ).…”

Section: Discussionsupporting

confidence: 94%

“…Stress versus excessive exercise was the most important parameter associated with PCOM (Table 3 ). Women with stress-induced had higher mean AMH levels, as previously reported in women with FHA and PCOM compared to those without PCOM [ 1 – 3 ]. Though these differences were not statistically significant, there were only ten more patients with PCOM in the stress group, which may mean that the lack of a difference was attributable to sample size.…”

Section: Discussionsupporting

confidence: 75%

“…Thus, 76 FHA women (38 “stress-associated”, 38 “excessive exercise”) were included from January 2017 – March 2022. As previously described [ 2 , 3 , 6 ], a strict FHA definition was used (also see Table 1 ): secondary amenorrhea for at least six months and a negative progestogen challenge test with context of intense physical activity or notion of recent psychological stress, confirmed by a psychologic report. Pregnancy, hypothyroidism, and hyperprolactinemia and any organ-related pituitary dysfunction had to be excluded.…”

Section: Methodsmentioning

confidence: 99%

“…On the same day, a vaginal ultrasound was performed with an “Aloka Prosound 6” ultrasound machine and an “UST-9124 Intra Cavity transducer” (frequency range 3.0–7.5 MHz; Wiener Neudorf, Austria). PCOM, the main outcome parameter, was defined as when the number of follicles per ovary exceeded 12 [ 2 , 3 ]. In addition, the following basic patient characteristics were also included: age at evaluation, body mass index (BMI), and the duration of amenorrhea.…”

Section: Methodsmentioning

confidence: 99%

“…The exact reasons remain unclear, why FHA women could be more prone to develop PCOM, and whether women with polycystic ovary syndrome (PCOS) are at increased risk for developing FHA. Regardless, women with FHA-PCOM demonstrate features that are similar to those observed in PCOS, such as high serum anti-Mullerian hormone (AMH), hyper-responsiveness of luteinizing hormone (LH) to a Gonadotropin releasing hormone (GnRH) bolus and insulin resistance [ 1 – 3 ]. These similarities have led some to suggest that some FHA-PCOM patients initially had simple PCOS [ 1 – 3 ].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Stress and polycystic ovarian morphology in functional hypothalamic amenorrhea: a retrospective cohort study

Hager

Dewailly

Marculescu

et al. 2023

Reprod Biol Endocrinol

Self Cite

View full text Add to dashboard Cite

Background Women with functional hypothalamic amenorrhea (FHA) reveal polycystic ovarian morphology (PCOM) in up to 50%. If stress sensitivity in women with polycystic ovary syndrome (PCOS) is the reason why PCOS women are prone to develop FHA, patients with FHA caused by stress should reveal PCOM more often. Methods In a retrospective cohort study, 38 stress-associated and 38 excessive exercise-induced FHA women were included. The main outcome parameter was PCOM. In addition, the focus was on general patient characteristics as well as on prolactin, dehydroepiandrosterone-sulphate (DHEAS), and anti-Mullerian hormone (AMH). Results PCOM was found in 34/76 patients (44.7%). The stress group showed a higher prevalence of PCOM than the excessive exercise group (57.9% versus 31.6%, p = 0.019) as well as higher prolactin levels (median 13.2ng/mL versus 11.7ng/mL, p = 0.008) and a trend towards higher DHEAS levels (p = 0.058). Conclusions In FHA women, the PCOM prevalence was significantly higher in the stress-group than in the excessive exercise-group. The well-known stress sensitivity in women with PCOS might explain why PCOS women are prone to develop FHA as well as the high PCOM prevalence in FHA women.

show abstract

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Stress and polycystic ovarian morphology in functional hypothalamic amenorrhea: a retrospective cohort study

Hager

Dewailly

Marculescu

et al. 2023

Reprod Biol Endocrinol

Self Cite

View full text Add to dashboard Cite

show abstract

Prevalence of functional hypothalamic amenorrhea in a cohort of women referred because of polycystic ovary syndrome

Holzer,

Marculescu,

Begemann

et al. 2024

Reprod Medicine & Biology

Self Cite

View full text Add to dashboard Cite

PurposeTo study how many women are misdiagnosed with polycystic ovary syndrome (PCOS) instead of functional hypothalamic amenorrhea (FHA), which is important to improve overall well‐being, long‐term health, and fertility issues.MethodsThe FHA prevalence in a cohort of 401 women previously diagnosed with PCOS (revised Rotterdam criteria) was estimated retrospectively based on experts and previous studies: luteinizing hormone (LH) <2 IU/mL, LH <5.36 IU/mL, sex hormone binding globulin (SHBG) >53.3 nmol/L, Testosterone <0.36 ng/mL, and the formula of Beitl et al. [(7.05*testosterone ng/mL) − (0.005*SHBG nmol/L) + (0.117*LH mIU/mL) − 2.463 < 0].ResultsThe highest rate of women with suspicion of FHA in patients referred for PCOS was found when the SHBG cut‐off of ≥53.3 nmol/L was used (36.9%), followed by the use of the LH cut‐off of <5.36 IU/mL (12.5%). The minimal suspected rate was achieved with the LH cut‐off <2.0 IU/mL (1.7%). Women who fulfilled the criteria for PCOS phenotype D (ovulatory dysfunction and polycystic ovarian morphology) revealed the maximum rate for suspected FHA (up to 47.6%).ConclusionIt is still necessary to evaluate reliable markers for the differential diagnosis between PCOS and FHA to avoid incorrect treatment, which might lead to negative long‐term effects in women with undiagnosed FHA.

show abstract

Prolactin levels in functional hypothalamic amenorrhea: a retrospective case–control study

Selzer,

Ott,

Dewailly

et al. 2023

Arch Gynecol Obstet

Self Cite

View full text Add to dashboard Cite

Purpose Functional hypothalamic amenorrhea (FHA) is due to hypothalamic dysregulation. Literature lacks data about prolactin in FHA women, although both prolactin levels and FHA are associated with stress. Moreover, polycystic ovarian morphology is common in FHA and there is an association between FHA and polycystic ovary syndrome. Thus, the aim of this study was to assess prolactin levels in FHA patients and controls with a special focus on factors influencing prolactin levels, that could be considered as “sensors” of the hypothalamic–pituitary dysregulation. Methods In a retrospective cohort study, 140 women with clearly defined FHA were compared to 70 healthy, normally ovulating women matched for age. The main outcome parameter was prolactin. Factors associated with prolactin levels > 12 µg/L were tested using a multivariable binary logistic regression model. Results The median prolactin level was 11.5 µg/L (interquartile range, IQR 7.5–14.4), which was similar to the control group (median 10.7, IQR 8.3–14.5; p = 0.065). Only two women had hyperprolactinemia (prolactin > 25 µg/L; 1.4%). In a multivariable binary logistic regression model eating disorder (odds ratio, OR 0.206; p = 0.040), excessive exercise (OR 0.280; p = 0.031) and TSH (OR 1.923; p = 0.020) were significantly associated with prolactin levels > 12 µg/L. Conclusion Women with FHA have similar prolactin levels to healthy age-matched individuals. Eating disorders and excessive exercise where associated with prolactin levels < 12 µg/L, in contrast to TSH.

show abstract

Functional hypothalamic amenorrhea with or without polycystic ovarian morphology: a retrospective cohort study about insulin resistance

Cited by 6 publications

References 5 publications

Stress and polycystic ovarian morphology in functional hypothalamic amenorrhea: a retrospective cohort study

Stress and polycystic ovarian morphology in functional hypothalamic amenorrhea: a retrospective cohort study

Prevalence of functional hypothalamic amenorrhea in a cohort of women referred because of polycystic ovary syndrome

Prolactin levels in functional hypothalamic amenorrhea: a retrospective case–control study

Contact Info

Product

Resources

About