Nutritional, physical, and psychological stress and functional amenorrhea

Abstract

The lack of regular, cyclic menstruation in reproductive-aged women in whom there is no organic or anatomic cause is called functional hypothalamic amenorrhea (FHA). The cause of this malfunction in the hypothalamicpituitary- ovarian axis is generally attributed to psychological, physical, or nutritional stress, and the underlying deficit is the suppression of gonadotropin- releasing hormone release by the hypothalamus. The diagnosis of FHA is reached by the exclusion of all other factors and conditions that could cause amenorrhea. FHA, by definition, is a chronic condition and can have serious health consequences if not treated. Since the underlying causes of the FHA are thought to be either low energy availability or dysfunctional attitudes and behaviors that result in stimulation of the hypothalamic-pituitary- adrenal axis and/or suppression of thyroid function, cognitive behavioral therapy and hypnotherapy are the best potential approaches for ameliorating this condition. Finally, increasing food intake and reducing stressful activities can be very effective in restoring menstruation.