The LH:FSH Ratio in Functional Hypothalamic Amenorrhea: An Observational Study.

ABSTRACT

BACKGROUND: In functional hypothalamic amenorrhea (FHA), luteinizing hormone and follicle-stimulating hormone levels show high interindividual variability, which significantly limits their diagnostic value in differentiating FHA from polycystic ovary syndrome (PCOS). Our aim was to profile the LHFSH ratio in a large sample of patients with well-defined FHA. METHODS: This observational study included all consecutive patients with FHA presenting to the Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, between January 2017 and August 2023. The main parameters of interest were the LH level, the FSH level, and the LHFSH ratio. In a subgroup analysis, we compared the LHFSH ratio of patients with PCO morphology (PCOM) on ultrasound with that of patients without PCOM. RESULTS: A total of 135 patients were included. Only a minority of patients revealed FSH and LH levels ≤ 2.0 mIU/mL (13% and 39%, respectively). Most patients (81.5%) had an LHFSH ratio ≤ 1.0, while a minority (2.2%) had a ratio ≥ 2.1. The LHFSH ratio was similar in patients with and without PCOM. CONCLUSION: In a well-defined FHA sample, the LHFSH ratio was ≤ 1 in most patients. The LHFSH ratio may prove useful in distinguishing FHA from PCOS but needs further investigation.