Functional hypothalamic and drug-induced amenorrhea: an overview

  • A. Lania
  • L. Gianotti
  • I. Gagliardi
  • M. Bondanelli
  • W. VenaEmail author
  • M. R. Ambrosio
Short Review



Functional hypothalamic amenorrhea (FHA) is a form of chronic anovulation not due to identifiable organic causes and with adverse health consequences. The identification of women with this disorder or the precocious identification of women at risk is based on the knowledge of lifestyle risk factors or behaviors such as stress, weight loss, and excessive physical exercise that are known to negatively impact gonadal axis activity.


In this overview, we described the most common forms of FHA, in particular stress-induced amenorrhea and overtraining-induced amenorrhea. In addition, although its mechanisms can differ from those involved in FHA, we reviewed the available literature on drug-induced amenorrhea, highlighting the clear connection between this condition and psychoactive drugs such as antipsychotics, antidepressants and anti-epilectics thus raising concern about the role that the abuse of substances such as opioids or alcohol can possibly have on the growing unexplained infertility of the female population.


Functional amenorrhea Hypothalamic amenorrhea Drug-induced amenorrhea Hypoestrogenism Opiates Alcohol 



The authors acknowledge Mrs. Racca Anna ( for her contribution to this paper.


None of the authors received funding for the realization of this paper.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This is a review paper, therefore, no ethical approval was necessary.

Informed consent

This is a review paper, therefore, no informed consent was necessary.


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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • A. Lania
    • 1
  • L. Gianotti
    • 2
  • I. Gagliardi
    • 3
  • M. Bondanelli
    • 3
  • W. Vena
    • 1
    Email author
  • M. R. Ambrosio
    • 3
  1. 1.Endocrinology Unit, Department of Biomedical SciencesHumanitas University and Humanitas Research HospitalRozzanoItaly
  2. 2.Division of Endocrinology Diabetology and MetabolismS. Croce and Carle HospitalCuneoItaly
  3. 3.University of FerraraFerraraItaly

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