Neuroendocrine recovery initiated by cognitive behavioral therapy in women with functional hypothalamic amenorrhea: a randomized, controlled trial

• Authors: Vasiliki Michopoulos, Emory University; Fulvia Mancini, Institut Universitari Dexeus; Tammy L Loucks, Emory University; Sarah L. Berga, Wake Forest University
• Journal Title: Fertility and Sterility
• Volume: Volume 99, Number 7
• Publisher: Elsevier | 2013-06-01, Pages 2084-+
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.fertnstert.2013.02.036
• Subjects: Health Sciences, Obstetrics and Gynecology; Health Sciences, General
• Keywords: Science & Technology; Life Sciences & Biomedicine; Obstetrics & Gynecology; Reproductive Biology; Cognitive behavior therapy; cortisol; functional hypothalamic amenorrhea; reproduction; stress; GONADOTROPIN-RELEASING-HORMONE; CORTISOL RESPONSES; NEUROPSYCHOLOGICAL DEVELOPMENT; MATERNAL HYPOTHYROXINEMIA; CEREBROSPINAL-FLUID; SEX-DIFFERENCES; STRESS; SUPPRESSION; SECRETION; PREGNANCY

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. Design: Randomized controlled trial. Setting: Clinical research center at an academic medical university. Patient(s): Seventeen women with FHA were randomized either to CBT or observation. Intervention(s): CBT versus observation. Main Outcome Measure(s): 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.) Result(s): 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. Conclusion(s): 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.