Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy☆

Abstract 

Objective:

To determine whether cognitive behavior therapy (CBT) targeted to problematic attitudes common among women with functional hypothalamic amenorrhea would restore ovarian function.

Design:

Randomized, prospective, controlled intervention.

Setting:

Clinical research center in an academic medical institution.

Patient(s):

Sixteen women participated who had functional hypothalamic amenorrhea; were of normal body weight; and did not report psychiatric conditions, eating disorders, or excessive exercise.

Intervention(s):

Subjects were randomized to CBT or observation for 20 weeks.

Main outcome measure(s):

Serum levels of E₂ and P and vaginal bleeding were monitored.

Result(s):

Of eight women treated with CBT, six resumed ovulating, one had partial recovery of ovarian function without evidence of ovulation, and one did not display return of ovarian function. Of those randomized to observation, one resumed ovulating, one had partial return of ovarian function, and six did not recover. Thus, CBT resulted in a higher rate of ovarian activity (87.5%) than did observation (25.0%), χ² = 7.14.

Conclusion(s):

A cognitive behavioral intervention designed to minimize problematic attitudes linked to hypothalamic allostasis was more likely to result in resumption of ovarian activity than observation. The prompt ovarian response to CBT suggests that a tailored behavioral intervention offers an efficacious treatment option that also avoids the pitfalls of pharmacological modalities.

Keywords:  Hypothalamic amenorrhea, cognitive behavior therapy, anovulation, stress