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Management

Improving energy balance status, often through behavioral change, is the recommended means for restoring HPO function, and this commonly requires the adoption of behaviors which promote weight gain. Avoidance of chronic stressors and modification of the stress-response with cognitive behavioral therapy (CBT) may also help in cases of FHA associated with significant stress. For while the obvious solution to this problem appears to be a natural return to menses through restoration of energy balance and reduction in external stressors, the fact that FHA often presents in women who suffer from patterns of disordered eating and display concerns about body image and/or athletic performance, increased caloric consumption and decreased physical activity may be rejected. In this population, where success in sport is highly emphasized, decreasing training intensity is typically not an option. Parents and legal guardians should be made aware of the long-term risk factors for osteoporosis and infertility which underlie this condition when deciding on a treatment plan. A multi-disciplinary team approach in management that includes a medical doctor, dietitian, and a psychiatrist or psychologist to provide psychological support is recommended.