{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:04:34Z","timestamp":1787753074841,"version":"build-2784847793"},"reference-count":57,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T00:00:00Z","timestamp":1725321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Functional Hypothalamic Amenorrhea (FHA) is a condition characterized by the absence of menstruation, which is increasingly affecting young women. However, specific recommendations for treating and preventing this condition are lacking. Based on a review of the available literature, this article provides practical and feasible dietary management recommendations for healthcare professionals and researchers in women\u2019s health and nutrition. It answers the question of what interventions and nutritional recommendations are necessary to restore menstrual function in women struggling with FHA. Physicians recommend an energy availability threshold of 30 kcal\/kg FFM\/day to prevent FHA. Also, energy availability below and above this threshold can inhibit LH pulsation and cause menstrual disorders. In addition, the risk of menstrual disorders increases with a decrease in the caloric content of the diet and the duration of the energy deficit, and women with FHA have significantly lower energy availability than healthy women. It is essential to ensure that adequate kilocalories are provided throughout the day (regular meals that are a source of proper glucose) to avoid a negative energy balance, as glucose has been proven to affect LH pulses and T3 and cortisol concentrations in the body. Dietary intervention should focus on increasing the caloric content of the diet, thus increasing energy availability and restoring energy balance in the body. Treatment and diagnosis should also focus on body composition, not just body weight. An increase in body fat percentage above 22% may be required to restore menstrual function. In women with FHA, even an increase in body fat mass of one kilogram (kg) increases the likelihood of menstruation by 8%. It is advisable to reduce the intensity of physical activity or training volume, while it is not advisable to give up physical activity altogether. It is also important to ensure adequate intake of micronutrients, reduce stress, and incorporate cognitive\u2013behavioral therapy.<\/jats:p>","DOI":"10.3390\/nu16172967","type":"journal-article","created":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T04:06:41Z","timestamp":1725336401000},"page":"2967","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Dietary and Lifestyle Management of Functional Hypothalamic Amenorrhea: A Comprehensive Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Katarzyna","family":"Dobranowska","sequence":"first","affiliation":[{"name":"Division of Basic Medical Sciences, Department of Basic Medical Sciences and Immunology, Wroclaw Medical University, Borowska 211 Str., 50-556 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanis\u0142awa","family":"Pli\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Basic Chemical Sciences, Wroclaw Medical University, Borowska 211a Str., 50-556 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1400-1819","authenticated-orcid":false,"given":"Agnieszka","family":"Dobosz","sequence":"additional","affiliation":[{"name":"Division of Basic Medical Sciences, Department of Basic Medical Sciences and Immunology, Wroclaw Medical University, Borowska 211 Str., 50-556 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1210\/jc.2002-020369","article-title":"Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women","volume":"88","author":"Loucks","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1249\/MSS.0000000000001451","article-title":"Menstrual Disruption with Exercise Is Not Linked to an Energy Availability Threshold","volume":"50","author":"Lieberman","year":"2018","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_3","unstructured":"Rhoades, R., and Bell, D.R. (2013). Female Reproductive System. Medical Physiology: Principles for Clinical Medicine, Wolters Kluwer Health\/Lippincott Williams & Wilkins. [4th ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Marshburn, P.B., and Hurst, B.S. (2011). Infrequent Menstrual Bleeding and Amenorrhea during the Reproductive Years. Disorders of Menstruation, Blackwell Publishing Ltd.","DOI":"10.1002\/9781444391824"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4274\/jcrpe.galenos.2019.2019.S0178","article-title":"Where Have the Periods Gone? The Evaluation and Management of Functional Hypothalamic Amenorrhea","volume":"12","author":"Gibson","year":"2020","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1210\/jc.2017-00131","article-title":"Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline","volume":"102","author":"Gordon","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s40618-014-0169-3","article-title":"Functional hypothalamic amenorrhea and its influence on women\u2019s health","volume":"37","author":"Meczekalski","year":"2014","journal-title":"J. Endocrinol. Investig."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3390\/endocrines2030020","article-title":"Functional Hypothalamic Amenorrhea: A Stress-Based Disease","volume":"2","author":"Podfigurna","year":"2021","journal-title":"Endocrines"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.bbadis.2013.05.009","article-title":"Direct and indirect effects of leptin on adipocyte metabolism","volume":"1842","author":"Harris","year":"2014","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s12970-015-0072-0","article-title":"Energy availability discriminates clinical menstrual status in exercising women","volume":"12","author":"Reed","year":"2015","journal-title":"J. Int. Soc. Sports Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1677\/joe.0.1740121","article-title":"The role of leptin in the regulation of TSH secretion in the fed state: In vivo and in vitro studies","volume":"174","author":"Oliveira","year":"2002","journal-title":"J. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kjaer, M., Krogsgaard, M., Magnusson, P., Engebretsen, L., Roos, H., Takala, T., and Woo, S.L. (2003). Amenorrhea, Osteoporosis, and Eating Disorders in Athletes. Textbook of Sports Medicine: Basic Science and Clinical Aspects of Sports Injury and Physical Activity, Blackwell Science.","DOI":"10.1002\/9780470757277"},{"key":"ref_13","unstructured":"Carrell, D.T., and Peterson, C.M. (2010). Secondary Amenorrhea. Reproductive Endocrinology and Infertility: Integrating Modern Clinical and Laboratory Practice, Springer."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1210\/clinem\/dgz030","article-title":"Energy availability is associated with luteinizing hormone pulse frequency and induction of luteal phase defects","volume":"105","author":"Koltun","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Practice Committee of the American Society for Reproductive Medicine (2015). Current clinical irrelevance of luteal phase deficiency: A committee opinion. Fertil. Steril., 103, e27\u2013e32.","DOI":"10.1016\/j.fertnstert.2014.12.128"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E29","DOI":"10.1152\/ajpendo.00386.2013","article-title":"Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction","volume":"308","author":"Williams","year":"2015","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1093\/epirev\/mxt012","article-title":"Negative Spinal Bone Mineral Density Changes and Subclinical Ovulatory Disturbances\u2014Prospective Data in Healthy Premenopausal Women With Regular Menstrual Cycles","volume":"36","author":"Li","year":"2013","journal-title":"Epidemiologic Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1111\/sms.13030","article-title":"Within-day energy deficiency and reproductive function in female endurance athletes","volume":"28","author":"Fahrenholtz","year":"2018","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ryterska, K., Kordek, A., and Za\u0142\u0119ska, P. (2021). Has Menstruation Disappeared? Functional Hypothalamic Amenorrhea\u2014What Is This Story about?. Nutrients, 13.","DOI":"10.3390\/nu13082827"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1055\/s-0041-1730289","article-title":"The female athlete Triad\/Relative energy deficiency in sports (RED-S)","volume":"43","author":"Coelho","year":"2021","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1093\/humrep\/deab149","article-title":"Randomised controlled trial of the effects of increased energy intake on menstrual recovery in exercising women with menstrual disturbances: The \u2018REFUEL\u2019 study","volume":"36","author":"Mallinson","year":"2021","journal-title":"Hum. Reprod."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s12970-014-0052-9","article-title":"Nine\u2013month nutritional intervention improves restoration of menses in young female athletes and ballet dancers","volume":"11","author":"Kapczuk","year":"2014","journal-title":"J. Int. Soc. Sports Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1093\/ajcn\/nqac044","article-title":"Bone mineral density in response to increased energy intake in exercising women with oligomenorrhea\/amenorrhea: The REFUEL randomized controlled trial","volume":"115","author":"Ricker","year":"2022","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/1550-2783-10-34","article-title":"A case report of recovery of menstrual function following a nutritional intervention in two exercising women with amenorrhea of varying duration","volume":"10","author":"Mallinson","year":"2013","journal-title":"J. Int. Soc. Sports Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1159\/000367895","article-title":"Menstrual cycle recovery in patients with anorexia nervosa: The importance of insulin-like growth factor 1","volume":"82","author":"Cominato","year":"2014","journal-title":"Horm. Res. Paediatr."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Dempfle, A., Herpertz-Dahlmann, B., Timmesfeld, N., Schwarte, R., Egberts, K.M., Pfeiffer, E., Fleischhaker, C., Wewetzer, C., and B\u00fchren, K. (2013). Predictors of the resumption of menses in adolescent anorexia nervosa. BMC Psychiatry, 13.","DOI":"10.1186\/1471-244X-13-308"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1097\/EDE.0000000000000804","article-title":"25-Hydroxyvitamin D and Long Menstrual Cycles in a Prospective Cohort Study","volume":"29","author":"Jukic","year":"2018","journal-title":"Epidemiology"},{"key":"ref_28","first-page":"979","article-title":"Association between serum 25-hydroxy vitamin D level and menstrual cycle length and regularity: A cross-sectional observational study","volume":"19","author":"Singh","year":"2021","journal-title":"Int. J. Reprod. Biomed."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/S2213-8587(13)70180-3","article-title":"Endocrine consequences of anorexia nervosa","volume":"2","author":"Misra","year":"2014","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Pickering, G., Mazur, A., Trousselard, M., Bienkowski, P., Yaltsewa, N., Amessou, M., Noah, L., and Pouteau, E. (2020). Magnesium status and stress: The vicious circle concept revisited. Nutrients, 12.","DOI":"10.3390\/nu12123672"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1684\/mrh.2017.0419","article-title":"Magnesium in the gynecological practice: A literature review","volume":"30","author":"Parazzini","year":"2017","journal-title":"Magnes. Res."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Boyle, N.B., Lawton, C., and Dye, L. (2017). The effects of magnesium supplementation on subjective anxiety and stress\u2014A systematic review. Nutrients, 9.","DOI":"10.3390\/nu9050429"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1017\/S1368980016002603","article-title":"The relationship between micronutrient status and sleep patterns: A systematic review","volume":"20","author":"Ji","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Reid, B.M., and Georgieff, M.K. (2023). The Interaction between Psychological Stress and Iron Status on Early-Life Neurodevelopmental Outcomes. Nutrients, 15.","DOI":"10.3390\/nu15173798"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1210\/en.2011-1599","article-title":"Zinc depletion causes multiple defects in ovarian function during the periovulatory period in mice","volume":"153","author":"Tian","year":"2012","journal-title":"Endocrinology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1093\/advances\/nmz082","article-title":"The effects of psychological and environmental stress on micronutrient concentrations in the body: A review of the evidence","volume":"11","author":"Lopresti","year":"2020","journal-title":"Adv. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1007\/s00404-020-05499-1","article-title":"Adolescents and young women with functional hypothalamic amenorrhoea: Is it time to move beyond the hormonal profile?","volume":"301","author":"Tranoulis","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/S0015-0282(03)01124-5","article-title":"Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy","volume":"80","author":"Berga","year":"2003","journal-title":"Fertil. Steril."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s40279-016-0669-8","article-title":"Effect of exercise on ovulation: A systematic review","volume":"47","author":"Hakimi","year":"2017","journal-title":"Sports Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1159\/000445149","article-title":"Exercise and the Hypothalamo-Pituitary-Adrenal Axis","volume":"47","author":"Duclos","year":"2016","journal-title":"Sports Endocrinol."},{"key":"ref_41","first-page":"783","article-title":"Exercise as a stressor to the human neuroendocrine system","volume":"1","author":"Hackney","year":"2006","journal-title":"Medicina"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"230.e1","DOI":"10.1016\/j.ajog.2017.11.579","article-title":"Heightened cortisol response to exercise challenge in women with functional hypothalamic amenorrhea","volume":"218","author":"Sanders","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.clinthera.2020.01.016","article-title":"Menses Requires energy: A review of how disordered eating, excessive exercise, and high stress lead to menstrual irregularities","volume":"42","author":"Huhmann","year":"2020","journal-title":"Clin. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ejogrb.2016.01.018","article-title":"Functional hypothalamic amenorrhoea: Leptin treatment, dietary intervention and counselling as alternatives to traditional practice\u2014Systematic review","volume":"198","author":"Kyriakidis","year":"2016","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2042018820945854","DOI":"10.1177\/2042018820945854","article-title":"Current understanding of hypothalamic amenorrhoea","volume":"11","author":"Roberts","year":"2020","journal-title":"Ther. Adv. Endocrinol. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Syed-Abdul, M.M., Soni, D.S., and Wagganer, J.D. (2018). Impact of a Professional Nutrition Program on a Female Cross Country Collegiate Athlete: A Case Report. Sports, 6.","DOI":"10.3390\/sports6030082"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1080\/02640414.2011.588958","article-title":"Energy availability in athletes","volume":"29","author":"Loucks","year":"2011","journal-title":"J. Sports Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1136\/bjsports-2014-093502","article-title":"The IOC consensus statement: Beyond the Female Athlete Triad\u2014Relative Energy Deficiency in Sport (RED-S)","volume":"48","author":"Mountjoy","year":"2014","journal-title":"Br. J. Sports Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1152\/jappl.1998.84.1.37","article-title":"Low energy availability, not stress of exercise, alters LH pulsatility in exercising women","volume":"84","author":"Loucks","year":"1998","journal-title":"J. Appl. Physiol."},{"key":"ref_50","first-page":"219","article-title":"2014 Female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad","volume":"13","author":"Joy","year":"2014","journal-title":"Optom. Vis. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1080\/17461391.2014.969323","article-title":"Low energy availability and low body fat of female gymnasts before an international competition","volume":"15","author":"Silva","year":"2015","journal-title":"Eur. J. Sport Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1136\/bjsports-2013-093240","article-title":"The LEAF questionnaire: A screening tool for the identification of female athletes at risk for the female athlete triad","volume":"48","author":"Melin","year":"2014","journal-title":"Br. J. Sports Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1093\/nutrit\/nuy001","article-title":"Fundamentals of glycogen metabolism for coaches and athletes","volume":"76","author":"Murray","year":"2018","journal-title":"Nutr. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1080\/02640414.2011.585473","article-title":"Carbohydrates for training and competition","volume":"29","author":"Burke","year":"2011","journal-title":"J. Sports Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"868","DOI":"10.3945\/ajcn.115.119321","article-title":"Dietary fat intake and reproductive hormone concentrations and ovulation in regularly menstruating women","volume":"103","author":"Mumford","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_56","unstructured":"Jarosz, M., Rychlik, E., Sto\u015b, K., and Charzewska, J. (2020). Normy \u017bywienia dla Populacji Polski i ich Zastosowanie (eng. Nutrition Standards for the Polish Population and Their Application), Narodowy Instytut Zdrowia Publicznego-Pa\u0144stwowy Zak\u0142ad Higieny. [1st ed.]."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.cmet.2019.05.008","article-title":"Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake","volume":"30","author":"Hall","year":"2019","journal-title":"Cell Metab."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/17\/2967\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:47:44Z","timestamp":1760111264000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/17\/2967"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,3]]},"references-count":57,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["nu16172967"],"URL":"https:\/\/doi.org\/10.3390\/nu16172967","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,3]]}}}