Hormone replacement therapy (HRT) is effective for the treatment of hypoestrogenism and for the treatment of both perimenopausal and postmenopausal related symptoms . The Food and Drug Administration ( FDA) approved hormone therapy for treatment of moderate to severe symptoms associated with menopause, such as vasomotor symptoms or vulvar and vaginal atrophy.^[1] Low dose estrogen can be used with or without a pro-gestational agent to improve symptoms relating to estrogen deficiency such as hot flashes, sweating, insomnia, and vaginal dryness and discomfort.^[1]

Treatments for hypoestrogenism vasomotor symptoms include:

• Conjugated equine estrogens (0.3 to 0.625 mg)
• Micronized 17β-estradiol (0.5 to 1 mg)
• Transdermal estradiol (14 to 100 μg)
• Ethinyl estradiol (0.01 to 0.02 mg)
• Vaginal estrogenic preparations (estradiol ring)

Common pro-gestational agents to protect the inner layer of the uterus, the endometrium, include:

• Medroxyprogesterone acetate (MPA) (2.5 mg daily or 5 mg for 10 to 12 days/mo)
• Micronized progesterone (100 mg daily or 200 mg for 10 to 12 days/mo)
• Norethindrone acetate (0.35 mg daily or 5 mg for 10 to 12 days/mo)
• Drospirenone (3 mg daily)
• Levonorgestrel (0.075 mg daily)

The FDA recommend HRT to be avoided in patients with a history or potential of breast cancer, undiagnosed genital bleeding, untreated high blood pressure, history of unexplained blood clots, and history of liver disease, etc. ^[1]

Functional hypothalmic amenorrhea (FHA) is diagnosed based on findings of amenorrhea (at least 3 consecutive months), low serum gonadotropins and estradiol (E2) <50 pg/ml, FSH<10 mIU/ml, and LH<10 mIU/ml.^[2] Diagnosis of FHA is also usually based on history of a precipitating factor such as exercise, low weight, and stress. FHA is further diagnosed based on history of menstrual problems, and after other conditions such as thyroid dysfunction, hyperprolactinemia, premature ovarian insufficiency (POI), and polycystic ovary syndrome are ruled out. The evaluation of amenorrhea includes a view of patient's history and physical examination, biochemical testing, assessment of estrogen status, and also imaging, such as ultrasound.^[3]

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