Variation in the diagnosis and management of functional hypothalamic amenorrhea across clinical specialties: A nationwide cross-sectional survey in China
Yu Zhang, Yingying Guo, Chenyan Wan, Yan Liu, Yan Deng, Wei Xue, Xinyue Sun, Wanqi Liang, Yang Wang, Aijun SunObjective
To characterize interspecialty variation and areas of consensus in the understanding and clinical management of functional hypothalamic amenorrhea among physicians from different clinical specialties in China.
Methods
We conducted a nationwide, cross-sectional questionnaire survey of licensed physicians practicing in reproductive endocrinology, obstetrics and gynecology, and related specialties involved in functional hypothalamic amenorrhea care. The survey was administered anonymously via a national continuing medical education platform affiliated with the Peking Union Medical College Hospital Alliance between 1 November and 30 November 2025.
Results
A total of 2026 questionnaires were included in the final analysis, comprising 112 reproductive endocrinologists (5.5%), 1516 obstetricians–gynecologists (74.8%), and 398 physicians from other specialties (19.6%). Overall, only 62.7% of respondents recognized genetic susceptibility as a contributing factor to functional hypothalamic amenorrhea, and only 43.9% of respondents perceived that functional hypothalamic amenorrhea was generally diagnosed appropriately. Compared with physicians from other specialties, reproductive endocrinologists and obstetricians–gynecologists were significantly more likely to prioritize sex hormone evaluation, pelvic ultrasonography, and assessment of the thyroid and adrenal axes (all p < 0.01), whereas physicians from other specialties more frequently reported emphasizing assessments of energy metabolism (p < 0.01). Among women without fertility intentions, reproductive endocrinologists were more likely to report prioritizing elimination of precipitating factors (p < 0.05) and recommending hormone replacement and bone-targeted therapies (both p < 0.01). For women desiring pregnancy, reproductive endocrinologists were more likely to report recommending ovulation induction (p < 0.01), whereas physicians from other specialties reported greater support for the use of pulsatile gonadotropin-releasing hormone pumps (p < 0.01).
Conclusions
Variations were observed in physicians’ self-reported diagnostic and management approaches to functional hypothalamic amenorrhea across clinical specialties in China. These findings suggest the importance of promoting multidisciplinary consensus, developing standardized clinical pathways, and strengthening interdisciplinary collaboration to improve the quality of care for women with functional hypothalamic amenorrhea.