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Author Notes:

Corresponding Author and reprint requests: Sarah L. Berga, MD, Professor and Chairman, Department of Obstetrics and Gynecology, Associate Dean of Women’s Health Research, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, sberga@wakehealth.edu, T: 336.716.4594, F: 336.716.6937

The study was conducted with the invaluable expert technical assistance of Kathleen M. Laychak, R.N., the staff of the Magee-Women’s Satellite Clinical Research Center and the staff of the General Clinical Research Center at the University of Pittsburgh.

We would also like to acknowledge the graphical assistance of Erin Barthold.

Authors VM, FM, TLL, and SLB do not have any conflicts to disclose.


Research Funding:

The study was supported by NIH grants R01MH50748 (SLB), RR00056 (University of Pittsburgh), TL1 RR025010 (VM), and in part by PHS Grant UL1 RR025008 from the Atlanta Clinical and Translational Science Award program, National Institutes of Health, National Center for Research Resources, and the Department of Gynecology and Obstetrics at Emory University.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Obstetrics & Gynecology
  • Reproductive Biology
  • Cognitive behavior therapy
  • cortisol
  • functional hypothalamic amenorrhea
  • reproduction
  • stress

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


Journal Title:

Fertility and Sterility


Volume 99, Number 7


, Pages 2084-+

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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