What is the first-line treatment for amenorrhea secondary to hypothalamic dysfunction?

The first-line treatment for amenorrhea secondary to hypothalamic dysfunction focuses on addressing the underlying issue of insufficient gonadotropin releasing hormone (GnRH) secretion. Clomiphene citrate is often the preferred choice in this context because it is a selective estrogen receptor modulator that can stimulate the hypothalamus and pituitary gland to increase the secretion of gonadotropins, which in turn can help restore ovulatory cycles.

By blocking estrogen receptors in the hypothalamus, clomiphene helps to normalize the feedback loop, prompting the pituitary to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This cascade can lead to the restoration of ovarian function in cases where amenorrhea is due to hypothalamic dysfunction.

Other treatment options, such as gonadotropin injections, are typically reserved for cases where clomiphene is ineffective or when the patient requires more direct stimulation of the ovaries. Progestin therapy may induce withdrawal bleeding and is useful in cases of anovulation but does not address the underlying hypothalamic dysfunction. Leuprolide, which acts as a GnRH agonist, is more commonly used in conditions like endometriosis or precocious puberty rather