title: 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.
  
  
  METHODS
  Randomized, prospective, controlled intervention.
  
  
  METHODS
  Clinical research center in an academic medical institution.
  
  
  METHODS
  Sixteen women participated who had functional hypothalamic amenorrhea; were of normal body weight; and did not report psychiatric conditions, eating disorders, or excessive exercise.
  
  
  METHODS
  Subjects were randomized to CBT or observation for 20 weeks.
  
  
  METHODS
  Serum levels of E(2) and P and vaginal bleeding were monitored.
  
  
  RESULTS
  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%), chi(2) = 7.14.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. sberga@emory.edu
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Berga
authors.forename: Marsha D
authors.initials: MD
authors.lastname: Marcus
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Loucks
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hlastala
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ringham
authors.forename: Marijane A
authors.initials: MA
authors.lastname: Krohn
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000209:etiology* / Q000503:physiopathology*; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications* / Q000628:therapy*; D010053:Ovary / Q000503:physiopathology*; D010060:Ovulation; D016896:Treatment Outcome