Hypothalamic Amenorrhoea and E2 supplementation?

[j_lipinski]

24yr F with HA.
Since the last 12 months has improved her diet immensely, but she still hasn't had any sign of periods/ovulation/cycling.
U/sound scans show many ovarian follicles.
Blood results show normal FSH, LH, Prolactin, TFT, but very low Oestradiol and Progesterone.
I've been giving her Vitex and HPO/HPA herbs for about 1 month so far.
Her GYN is worried about her bones and would like her to go on ERT.
Would you advise topical E2 (plus micronised oral P4 of course)?
I'm very concerned about the negative feedback caused by exogenous E2 resulting in more issues down the track....?
Thanks

[Lara]

I just had a conversation with Prof Prior about this and I think she has a new paper coming. From what she says, it can be worth starting with cyclic progesterone in a case like this. To see if it induces a bleed. If not, it's usually fine to use an estradiol patch plus cyclic progesterone until she can be fully nourished enough to get her period back.

[j_lipinski]

Thanks very much Lara.
Sorry, I only jut saw your reply now!
Would love to know whether Dr Prior's paper has come out yet?