Main findings
FHA is one of the most common reproductive disorders in females. However, many patients experience delay in diagnosis of FHA due to limited clinical knowledge of its common features. This retrospective study demonstrates the significant impact of FHA on women’s health; associated psychological comorbidities, including EDs, anxiety and depression, occurred at rates of approximately 20%, whilst the effects of hypoestrogenemia on BMD were evident as over 50% of women who received DEXA scans were diagnosed with osteopenia or osteoporosis. Our findings demonstrate that the established FHA risk factors of stress, excessive exercise and weight loss remain important clinical features. We quantitatively demonstrate that low BMI, estradiol, LH and LH:FSH ratio distinguish women with FHA from women with PCOS, most effectively. Our findings call for careful consideration of the above clinical and biochemical features to first suspect and second, diagnose FHA and differentiate from other common causes of menstrual disturbances such as PCOS.