Functional hypothalamic amenorrhea
Laboratory testing

A progestin challenge can also be conducted to evaluate levels of estrogen and the anatomic integrity of the outflow tract, as low endometrial estrogen exposure or obstruction of the outflow tract can be consequences of the absence of withdrawal bleeding. It can also provide information about estrogen status when there are questions of whether FHA or PCOS should be the diagnosis. Withdrawal bleeding following the progestin challenge indicates sufficient levels of E2 for endometrial thickening, and that the amenorrhea is a result of anovulation and progesterone deficiency. Other specific cases may warrant other useful measures: for example, IGF-1 may be indicated in FHA patients with AN, as resistance to GH can expose a connection between bone metabolism and malnutrition; this population may also present with low DHEA-S, which may work to actively lower IGF-1 levels.
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