Aetiology, previous menstrual function and patterns of neuro-endocrine disturbance as prognostic indicators in hypothalamic amenorrhoea

BACKGROUND: Hypothalamic amenorrhoea (HA) is a syndrome associated with inf ertility and osteopenia in reproductive-age women. METHODS: To understand b etter the natural history of this disorder, 28 women participated in a retr ospective, questionnaire-based analysis to elucidate factors associated wit h spontaneous recovery. RESULTS: 54% of subjects developed HA related to an eating disorder, 21% related to stress +/- weight loss, and 25% without ob vious contributing factors (idiopathic). HA associated with a clear precipi tant had a better prognosis than idiopathic HA (71 versus 29% recovery; P < 0.05). Reversal of the inciting factor appeared necessary but not sufficie nt 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-appeari ng pulses. Pulse pattern at baseline did not predict recovery. CONCLUSIONS: The aetiology of HA at the time of presentation predicts subsequent recove ry of menstrual function. In stress, weight loss, or eating disorder-relate d HA, rates of recovery exceeded 80% when precipitating factors were revers ed. Idiopathic HA may represent a different disorder as recovery rates were < 30%.