Hypothalamic amenorrhea: Neuroendocrine mechanisms / stress-induced anomalies

The importance of stress in the occurrence of amenorrhea is clear and it remains of fundamental importance the fact that whatever is the causal factor inducing the reduction of food intake the result is always an impairment of the central neuroendocrine modulation of the hypothalamus-pituiary-gonadel axis. In some cases, such as athletes or dancers excessive training and / or controlled / reduced feeding may induce amenorrhea later than in non- exercising women. This might depend on the fact that training enables to be physically more resistant to stressors and to stressful situations. In any case amenorrhea, especially the one related to weight loss, may be the prelude to anorexia or it may hide psychological or psychiatric diseases. The fact that amenorrhea is characterized by low estradiol plasma levels exposes all amenorrheic patients to all the risks of hypoestrogenemia: reduction of hone density till to osteopenia, increased total cholesterol, altered lipoproteins, abnormally reduced thyroid hormones. Hypothalamic amenorrhea associated with weight loss is considered a complex disease associated with severe stressful physical, psychological events, reduced food intake and neuromodulation of the human reproductive axis.