Summary

All evaluations for amenorrhea should begin with a pregnancy test. If abdominal pain

is present, ectopic pregnancy should be considered. Patients should be questioned about

contraceptive use, because extended-cycle combined Oral Contraceptions, injectable

medroxyprogesterone acetate (Depo-Provera), implantable etonogestrel (Implanon), and

levonorgestrel-releasing intrauterine devices (Mirena) may cause amenorrhea.(1)

Treatment of functional hypothalamic amenorrhea involves nutritional rehabilitation

as well as reductions in stress and exercise levels. Menses typically return after correction of

the underlying nutritional deficit.(1)

For women with hypothalamic amenorrhea who desire pregnancy, ovulation induction

with pulsatile GnRH or injectable gonadotropins is the treatment of choice. By leptin

replacement resulted in recovery of menstruation and corrected the abnormalities in the

gonadal, thyroid, growth hormone, and adrenal axes, but in bone metabolism, there is no

change in bone mineral density. It proved to correct leptin deficiency resulted in restoration

menes and ovulatory.

Administration of oestrogens and progestagens in the form of oestroprogestagen (EP)

therapy is the standard management to stimulate regular menses and also results in the

normalisation of bone mineral density. For bone loss, we can also give combination theraphy

such as calcium, vitamin D to recovery BMD, and combined with EP theraphy, it will results

maximum effective to recover BMD.

Cognitive behavioral therapy improved in women with hypothalamic amenorrhea

which caused by stress or psycopathologic problems. It can returned most woman ovulation

in observational group.