Marcus, M. D., Loucks, T. L., & Berga, S. L. (2001). Psychological correlates of functional hypothalamic amenorrhea. Fertility and Sterility, 76(2), 310-316. https://doi.org/10.1016/s0015-0282(01)01921-5
Marcus MD, Loucks TL, Berga SL. Psychological correlates of functional hypothalamic amenorrhea. Fertil Steril. 2001;76(2):310-316. doi:10.1016/s0015-0282(01)01921-5
Marcus, Marsha D., et al. "Psychological correlates of functional hypothalamic amenorrhea." Fertility and Sterility, vol. 76, no. 2, 2001, pp. 310-316.
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Functional hypothalamic amenorrhea is linked to more disordered eating
Women with functional hypothalamic amenorrhea reported more disordered eating symptoms than both comparison groups. A cross-sectional study of 77 women compared 28 with this condition (FHA), 24 with organic amenorrhea and 25 with regular cycles. Women with FHA also reported more depressive symptoms than women with regular cycles.
Key Findings
Bulimia Test Revised averages in the 50-woman eating subset were 67.10 for FHA, 48.42 for organic amenorrhea and 38.00 for regular cycles. Women with FHA scored significantly higher than both other groups.
Half of the women with FHA in that subset reported binge eating at least 2 to 3 times a month, against 10.5% of women with organic amenorrhea and none with regular cycles.
In the subset, 3 women with FHA (18.8%) reported repeated self-induced vomiting. No woman in the subset reported laxative or diuretic misuse.
Women with FHA averaged 7.9 on the Beck Depression Inventory and 126.7 on the Dysfunctional Attitude Scale, against 2.9 and 99.3 for women with regular cycles.
Women with organic amenorrhea averaged 6.3 and 110.2 on those two scales, between the other groups and not significantly different from either.
Interpretation
This cross-sectional study assessed each of the 77 women once, comparing self-report measures across the three groups; eating measures came from a subset of 50 women. The authors read the results as consistent with stress and metabolic challenge together contributing to FHA. Women with organic amenorrhea scored between the other groups, and the authors suggest some of the attitude increase may be attributable to reproductive impairment. The findings support further study of psychological screening and support for women with FHA.
RRM Context
Doctors reach the diagnosis of functional hypothalamic amenorrhea by ruling out other causes of missed periods. The authors call it common and, in theory, reversible, and estimate it makes up 15%–35% of secondary amenorrhea. They were testing a 16-week cognitive-behavioral program meant to lower cortisol and restore the brain's signal to the ovaries. Restorative reproductive medicine treats missed ovulation as a question of cause.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine whether mood, attitudes, or symptoms of disordered eating discriminated women with functional hypothalamic amenorrhea (FHA) from those with organic causes of amenorrhea and eumenorrhea.
Design
Cross-sectional comparison of women with FHA, women with organic amenorrhea, and eumenorrheic control women.
Setting
Clinical research center in an academic medical institution.
Patients
Seventy-seven women > or =18 years old with time since menarche > or =5 and < or =25 years were recruited by advertisement.
Interventions
Ovulation was confirmed in eumenorrheic control women. Causes of anovulation were carefully documented in amenorrheic participants and LH pulse profiles were obtained to document the diagnosis of FHA. All participants were interviewed and completed questionnaires.
Main Outcome Measures
Self-report measures of dysfunctional attitudes, coping styles, and symptoms of depression and eating disorders.
Results
Women with FHA reported more depressive symptoms and dysfunctional attitudes than did eumenorrheic women, but not significantly more than women with organic amenorrhea. However, women with FHA reported significantly more symptoms of disordered eating than did either anovulatory or ovulatory women.
Conclusions
The findings are consistent with the hypothesis that FHA is precipitated by a combination of psychosocial stressors and metabolic challenge.
