title: Neuroendocrine recovery initiated by cognitive behavioral therapy in women with functional hypothalamic amenorrhea: a randomized, controlled trial.
abstract: OBJECTIVE
  To determine whether cognitive behavior therapy (CBT), which we had shown in a previous study to restore ovarian function in women with functional hypothalamic amenorrhea (FHA), could also ameliorate hypercortisolemia and improve other neuroendocrine and metabolic concomitants of in FHA.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Clinical research center at an academic medical university.
  
  
  METHODS
  Seventeen women with FHA were randomized either to CBT or observation.
  
  
  METHODS
  CBT versus observation.
  
  
  METHODS
  Circulatory concentrations of cortisol, leptin, thyroid-stimulating hormone (TSH), total and free thyronine (T(3)), and total and free thyroxine (T(4)) before and immediately after completion of CBT or observation. (Each woman served as her own control.)
  
  
  RESULTS
  Cognitive behavior therapy but not observation reduced cortisol levels in women with FHA. There were no changes in cortisol, leptin, TSH, T(3), or T(4) levels in women randomized to observation. Women treated with CBT showed increased levels of leptin and TSH, but their levels of T(3) and T(4) remained unchanged.
  
  
  CONCLUSIONS
  In women with FHA, CBT ameliorated hypercortisolism and improved the neuroendocrine and metabolic concomitants of FHA while observation did not. We conclude that a cognitive, nonpharmacologic approach aimed at alleviating problematic attitudes not only can restore ovarian activity but also improve neuroendocrine and metabolic function in women with FHA.
  
  
  BACKGROUND
  NCT01674426.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Michopoulos
authors.forename: Fulvia
authors.initials: F
authors.lastname: Mancini
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Loucks
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Berga
mesh_terms: D000046:Academic Medical Centers; D000568:Amenorrhea / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D000704:Analysis of Variance; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007027:Hypothalamic Diseases / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D020738:Leptin / Q000097:blood; D009490:Neurosecretory Systems / Q000378:metabolism* / Q000503:physiopathology; D010414:Pennsylvania; D020127:Recovery of Function; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000097:blood
chemical_list: D020738:Leptin; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine; D006854:Hydrocortisone