Restoring ovulation in functional hypothalamic amenorrhea: impact of polycystic ovarian morpholog… — Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (2026)

Resumo clínico (PT)

Estudo observacional unicêntrico em 41 mulheres com amenorreia hipotalâmica funcional (AHF), comparando resposta à indução da ovulação com GnRH pulsátil entre morfologia ovárica policística (PCOM, n=24) e não-PCOM (n=17). Na linha de base, a AMH era significativamente mais elevada no grupo PCOM. Após 3 meses de tratamento, a terapêutica induziu ovulação (folículo dominante) em ambos os grupos. O aumento marcado de AMH no grupo sem PCOM provavelmente reflecte recuperação da foliculogénese; no grupo PCOM o incremento foi discreto, como seria expectável dado o patamar basal elevado. Implicação clínica: na AHF, o GnRH pulsátil é eficaz independentemente da morfologia ovárica e não parece agravar de forma relevante os níveis de AMH na maioria das doentes.

Abstract (original)

Up to 50% of women with functional hypothalamic amenorrhea (FHA) exhibit polycystic ovarian morphology (PCOM) on ultrasound. We aimed to compare the hormonal response to ovulation induction with pulsatile GnRH therapy in FHA patients with and without PCOM. In this single-center observational study, 41 patients with FHA underwent 3 months of pulsatile GnRH therapy to induce ovulation. Patients were categorized into a PCOM group ( n  = 24) and a non-PCOM group ( n  = 17). Serum levels of Anti-Muellerian-hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, sex hormone-binding globulin (SHBG), testosterone, and thyroid-stimulating hormone (TSH) were assessed at baseline and after 3 months of treatment. At baseline, median AMH levels were significantly higher in the PCOM group (6.21 ng/ml [IQR 4.03-8.87]) compared to the non-PCOM group (1.7 ng/ml [IQR 1.14-2.20]; p   p   p  = 0.218). LH, FSH, and estradiol levels increased in both groups. Pulsatile GnRH therapy effectively induced ovulation (1 dominant follicle in each patient), irrespective of ovarian morphology. The significant AMH rise in women with FHA without PCOM likely reflects restored folliculogenesis. In contrast, the absence of an AMH rise in the PCOM group was expected, given their already elevated baseline levels. Importantly, these findings suggest that pulsatile GnRH therapy does not exacerbate AMH levels in most patients.