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Functional hypothalamic amenorrhoea — SCE Endocrinology MCQ

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HardReproductive EndocrinologyFunctional hypothalamic amenorrhoeaSCE Endocrinology

A 22-year-old elite distance runner has secondary amenorrhoea and a stress fracture. BMI is 18 kg/m², oestradiol is low, LH is low, FSH is low-normal and prolactin/TSH are normal. She denies purging but has increased training volume. What is the most likely diagnosis?

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Correct answer: A — Functional hypothalamic amenorrhoea

Low gonadotrophins and low oestradiol in the context of energy deficit and stress fracture indicate functional hypothalamic amenorrhoea. POI would show elevated FSH. The pearl is that treatment targets energy availability and bone protection rather than ovulation induction alone.

Reference: Endocrine Society functional hypothalamic amenorrhoea guideline