Ep 37 | When Its NOT Peri: Functional Hypothalamic Amenorrhea (FHA) with Chrisandra Shufelt, MD

Mar 26, 2026

38:07

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Perimenopause is still taking the blame… but in this unexpected third installment (because Amy just got too excited), we're talking about functional hypothalamic amenorrhea (FHA).

Dr. Chrisandra Shuflet joins the Docs in this episode of OvaryActive to explain FHA, tell us why it is often missed or dismissed, and how it's diagnosed. The conversation explores how disrupted brain signaling leads to low estrogen, why it's a diagnosis of exclusion, and how this condition shows up most often in younger women, even though its impact can follow you well into perimenopause and beyond.

As a condition that can look like perimenopause but is actually your brain hitting the pause button on your ovaries. If your cycle disappears and you're nowhere near your forties, it's probably not peri… it's your body responding to stress, under-fueling, over-exercising. Or maybe all of the above.

What you'll hear in this episode:

[0:34] Welcome Chrisandra Shufelt, MD

[3:46] What is FHA?

[6:02] A diagnosis of exclusion

[7:00] Lab patterns to distinguish FHS, PCOS, POI

[8:45] Who is most at risk:

[13:42] Why do so many women go years without a diagnosis?

[18:14] Long-term risks

[20:30] Cardiovascular connection

[22:38] ARCH study

[29:13] What does a history of FHA mean in perimenopause?

[33:34] Treatment approach (sorry, no Rx)