Stress amenorrhea responds to psychotherapy: effective in small randomized trial.

DENVER -- Cognitive-behavioral therapy is an effective treatment for women with stress-induced anovulation, Rebecca M. Ringham reported at an international conference of the Academy for Eating Disorders.

The psychological intervention results not only in restoration of ovarian activity, it also addresses the subthreshold eating disorder symptoms and dysfunctional attitudes that are part and parcel of stress-induced anovulation, also known as functional hypothalamic amenorrhea, according to Ms. Ringham of the Western Psychiatric Institute and Clinic, University of Pittsburgh.

"It may provide an alternative to expensive and risky infertility therapy and may also ameliorate other consequences of amenorrhea, such as increased risk of osteoporosis and heart disease," she said at the conference, which was sponsored by the University of New Mexico.

Functional hypothalamic amenorrhea is anovulation that's not attributable to a discernible organic cause. It entails reduced GnRH/LH drive and other neuroendocrine changes.

Ms. Ringham and her coinvestigators had previously demonstrated that women with functional hypothalamic amenorrhea are distinguishable from women having an organic cause for their amenorrhea as well as from normally menstruating women on the basis of their high levels of subthreshold symptoms of disordered eating, with dysfunctional attitudes, mild undernutrition, and/or excessive energy output.

Capitalizing on this observation, they then developed a version of cognitive-behavioral therapy (CBT) specifically tailored for patients with stress-induced anovulation. It was adapted from the form of CBT used in bulimia nervosa, which on the basis of randomized trials data has become the consensus treatment of choice for that ...