Hypothalamic dysfunction or hypothalamic amenorrhea is an uncommon cause of ovulatory dysfunction.
Oftentimes women with this condition are thin with a low percentage of body fat and have almost complete absence of menses when not on hormonal contraception or replacement. This can be due to excessive exercise or conditions such as anorexia nervosa, but is often present without an obvious cause.
The evaluation of women with hypothalamic amenorrhea includes laboratory testing for the pituitary hormones FSH and LH, which are either in the normal range or low, as well as a serum estradiol level which is typically less than 10 pg/ml. On ultrasound evaluation, women with hypothalamic amenorrhea often have a very thin uterine lining and their ovaries may be small as well.
Women with hypothalamic amenorrhea who are given progesterone to induce menses typically will not experience a period due to the absence of an estrogen-primed uterine lining. Women with hypothalamic amenorrhea will occasionally respond to clomiphene citrate for ovulation induction, but often need treatment with human menopausal gonadotropins (see gonadotropin stimulation).