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Pathophysiology of functional hypothalamic amenorrhea
Excessive physical training Low-calorie diet, starvation Weight loss Chronic illness Stress, depression Anorexia nervosa ↓ Low leptin; high ghrelin, GABA, beta-endorphins ↓ Hypothalamus makes less GnRH ↓ Pituitary makes less LH, FSH ↓ Ovaries make less estrogen ↓ Amenorrhea Low estrogen state Bone loss
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