Clinical Implications of Prolonged Hypothalamic Amenorrhea

Abstract

History – A 26-year-old woman presents to the office with concerns about irregular menstrual periods. The patient reports normal developmental milestones, including menarche at age 13, and regular monthly periods until age 19. Her periods became irregular during college. The physician who saw her attributed the irregular cycles to the stress of college and prescribed oral contraceptive pills (OCPs) to regulate her cycles. The patient did not like the side effects from the OCPs, and so she stopped taking the pill after about 6 months. She reports no more than two episodes of very light vaginal bleeding per year in the past 3 years. She reports regular exercise and that she follows a heart-healthy diet. However, she often skips meals or grabs a piece of fruit for lunch because she is too busy and forgets to eat. She is concerned that her amenorrhea may be impacting her long-term health and in particular her bones. Her mother (age 58) was recently diagnosed with osteopenia and the patient has had two stress fractures in the last 4 years.