Division of Basic Medical Sciences, Department of Basic Medical Sciences and Immunology, Wroclaw Medical University, Borowska 211 Str., 50-556 Wrocław, Poland.
Department of Basic Chemical Sciences, Wroclaw Medical University, Borowska 211a Str., 50-556 Wrocław, Poland.
Nutrients. 2024 Sep 3;16(17):2967. doi: 10.3390/nu16172967.
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's 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-behavioral therapy.
功能性下丘脑性闭经（FHA）是一种以闭经为特征的病症，越来越多地影响年轻女性。然而，针对这种病症的治疗和预防方法尚未得到明确的推荐。本文基于对现有文献的回顾，为女性健康和营养领域的医疗保健专业人员和研究人员提供了实用且可行的饮食管理建议。本文回答了在 FHA 患者中，恢复月经功能需要进行哪些干预和营养建议的问题。医生建议将能量摄入水平维持在 30 千卡/公斤去脂体重/天，以预防 FHA。此外，低于或高于这一阈值的能量摄入水平都会抑制 LH 脉冲，导致月经紊乱。另外，饮食中的卡路里含量越低、能量不足的持续时间越长，月经紊乱的风险就越高，而 FHA 患者的能量摄入水平明显低于健康女性。因此，全天摄入足够的热量至关重要（定时进餐，以获取适量的葡萄糖），以避免能量负平衡，因为葡萄糖已被证明会影响 LH 脉冲和体内 T3、皮质醇浓度。饮食干预应侧重于增加饮食的热量含量，从而提高能量摄入水平，恢复体内的能量平衡。治疗和诊断也应侧重于身体成分，而不仅仅是体重。可能需要增加体脂百分比，使体脂百分比超过 22%，以恢复月经功能。对于 FHA 患者，即使体脂增加一公斤，也会使月经恢复的可能性增加 8%。建议降低身体活动或训练量的强度，但不建议完全停止身体活动。摄入足够的微量营养素、减轻压力和结合认知行为疗法也很重要。
