Functional hypothalamic amenorrhea (FHA) is characterized by all of the following EXCEPT:

• A Low LH pulse frequency and amplitude
• B Elevated cortisol with low IGF-1 (energy-deficient state)
• C Elevated FSH with low estradiol (menopausal pattern) ✓
• D Reduced kisspeptin neuron activity in the hypothalamus

Explanation

Functional hypothalamic amenorrhea (caused by stress, weight loss, or exercise) features GnRH pulse suppression leading to low LH, low FSH, and consequently low estradiol — distinguishing it from premature ovarian insufficiency (POI) where FSH is elevated (>25 IU/L) in a compensatory menopausal pattern. FHA also features elevated cortisol (stress axis activation), suppressed leptin, low IGF-1 (reflecting energy deficit), and diminished kisspeptin neuron activity — as kisspeptin is the primary GnRH pulse regulator. Elevated FSH with low estradiol represents ovarian failure, not FHA.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.