Functional hypothalamic amenorrhoea in adolescent aged 15 hormon therapy with

Appropriate hormone therapy for a 15-year-old adolescent with functional hypothalamic amenorrhoea (FHA) currently receiving oral contraceptives involves careful consideration of both the underlying cause and bone health implications.

Functional hypothalamic amenorrhoea is usually related to energy deficiency caused by factors such as weight loss, excessive exercise or stress and often occurs in adolescents with eating disorders or relative energy deficiency syndrome (RED-S) NICE CKS Indirli et al. 2022. The first-line management is non-pharmacological, emphasizing restoration of energy balance through nutritional rehabilitation and reduction of excessive exercise, which is crucial for recovery of menstrual function and bone health NICE CKS,NICE NG69,Williams et al. 2026,Wood and Soundy A. 2025.

Use of combined oral contraceptives (COCs), as the patient is currently receiving, is common but evidence suggests they do not improve bone mineral density in FHA and may mask the underlying hypoestrogenism without restoring normal hypothalamic-pituitary-ovarian function Indirli et al. 2022 Wood & Soundy A 2025. Therefore, COCs are not the ideal hormone therapy solely for bone protection or menstrual restoration in FHA NICE CKS Indirli et al. 2022.

For adolescents with FHA and low bone mineral density who have persistent hypoestrogenism after lifestyle intervention, physiological estrogen replacement in the form of transdermal 17-beta estradiol with cyclic progestogen is preferred over oral contraceptives to mimic more natural hormone levels and better support bone accrual NICE NG69 Williams et al. 2026. This approach reduces first-pass liver metabolism and has a more favorable effect on IGF-1 and bone density than oral estrogens NICE NG69,Williams et al. 2026.

Physiologic estrogen replacement is especially considered in those with long-term low body weight, delayed puberty, or documented low bone mineral density, ideally under specialist paediatric or endocrinology guidance NICE NG69. Incremental dosing based on bone age and developmental status is recommended to promote normal pubertal progression NICE NG69.

In summary, for a 15-year-old adolescent with FHA currently on oral contraceptives, the appropriate hormone therapy is generally to transition from oral contraceptives to physiological transdermal estrogen therapy combined with cyclic progesterone after optimizing nutritional and psychosocial support. This strategy is expected to provide better bone protection and support reproductive hormone recovery than continued oral contraceptives alone NICE CKS,NICE NG69 Indirli et al. 2022 Williams et al. 2026 Wood & Soundy A 2025.