Endocrine Abstracts

Background: Functional hypothalamic amenorrhoea (FHA) is associated with reduced bone density and impaired fertility due to prolonged oestrogen deficiency. Existing data describe White populations, with limited knowledge of ethnic variation in FHA. Leicester has a diverse population, 43% Asian. Polycystic Ovarian Syndrome (PCOS), is the commonest cause of secondary amenorrhoea, and is recognised to have increased prevalence in Asians.

Aims: We aimed to assess bone density, management strategies and pregnancy outcomes in patients with FHA. We wished to compare ethnic variation in FHA to that of the PCOS cohort in our clinic.

Methods: A retrospective review of individuals diagnosed with FHA (2000–2025) using our electronic patient record system. Ethnicity data in individuals with FHA were compared with that of the UHL PCOS population (diagnosed 2007–2022), using two-proportion Z-test analysis.

Results: 75 FHA patients were identified, mean age 25.8 years, BMI 20.5 kg/m². Characteristics; low BMI (<18.5 kg/m²) 77.3%, excessive exercise 21.3%, and psychological stress 2.7%. Although 76% (n = 56) were recommended for DEXA, only 45.3% (n = 34) underwent scanning. Of these, 29.3% had reduced bone density, with documented fractures in 10.7%. 6.7% received Bisphosphonates. Pregnancy occurred in 20.0%, miscarriage rate 20.0%, 6.7% required fertility treatment. Hormonal therapy was prescribed in 68%; HRT (29.3%), transdermal oestrogen (45%), oral contraceptive pill (42.7%). Most patients were White British (94.7%), by contrast, only 60.6% of PCOS patients were White, a statistically significant difference 28.9% (95% CI: 23.0–34.8%).

Discussion: Monitoring of bone health was inconsistent, and transdermal oestrogen was infrequently prescribed. FHA predominantly affected White British women, despite Leicester’s ethnic diversity, suggesting biological susceptibility alongside cultural factors.

Conclusion: We highlight significant ethnic differences between FHA and PCOS populations. Genetic susceptibility to FHA warrants further translational research. A structured checklist to guide clinicians may improve a holistic approach to FHA management in the endocrine clinic.