The effects of weight loss-related amenorrhea on women's health and the therapeutic approaches: a narrative review

Ling Chen; Ye Lu; Yi-Fan Zhou; Yang Wang; Hai-Feng Zhan; Yu-Ting Zhao; Yu-Lu Wang; Fei-Fei Zhang; Hang Chen; Xin Li

doi:10.21037/atm-22-6366

The effects of weight loss-related amenorrhea on women's health and the therapeutic approaches: a narrative review

Ann Transl Med. 2023 Jan 31;11(2):132. doi: 10.21037/atm-22-6366.

Authors

Ling Chen^#^{1

2}, Ye Lu^#¹, Yi-Fan Zhou^#¹, Yang Wang¹, Hai-Feng Zhan^{1

3}, Yu-Ting Zhao¹, Yu-Lu Wang¹, Fei-Fei Zhang¹, Hang Chen¹, Xin Li¹

Affiliations

¹ Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
² Department of Gynecology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China.
³ Department of Gynecology, Shanghai Jing'an Central Hospital of Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Background and objective: Weight loss-related amenorrhea is defined as the reversible functional inhibition of the hypothalamic-pituitary-ovarian (HPO) axis associated with weight loss or low body weight, which occurs mostly in adolescents and women of reproductive age. The specific pathological mechanisms of this disease have not yet been elucidated, and the optimal evidence-based guidelines for its clinical assessment and management are limited. This review summarizes its adverse effects on female health, and the individualized, emerging, and multidisciplinary therapeutic approaches used to treat it.

Methods: We searched the PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases for Chinese and English literature on functional hypothalamic amenorrhea (FHA), and retrieved original articles (on basic and clinical research) and reviews published up to December 2022.

Key content and findings: We reviewed the findings on the unfavorable effects of weight loss-related amenorrhea with a focus on reproduction, the skeletal and cardiovascular system, other endocrine effects, and mental health. Lifestyle changes and hormonal replacement have been shown to alleviate the underlying causes and lead to the recovery of menstruation. However, the efficacy of treatments is affected by many factors, such as psychological stress and heterogeneity.

Conclusions: Weight loss-related amenorrhea, which is an important type of FHA, is manifested by anovulation and hypoestrogenism, and has both short- and long-term adverse effects on women's overall health. It is difficult to alleviate its underlying causes. Individualized treatments need to be optimized and emerging or multidisciplinary therapeutic approaches need to be explored that aim to recover normal menstruation and ovulation, eliminate the undesirable effects of prolonged hypoestrogenism and alleviate psychological disorders.

Keywords: Weight loss; emerging treatment; female health; functional hypothalamic amenorrhea (FHA); hormonal replacement.

Publication types

Review