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Understanding Functional Hypothalamic Amenorrhea and Psychological Stress

Learn about the definition, causes, importance of seeking medical attention, and long-term consequences of functional hypothalamic amenorrhea (FHA). Explore the impact of stress on the reproductive system, including psychological stress factors and the effects of low energy availability. Discover the signs and consequences of FHA if left untreated, and the treatment options available.

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Understanding Functional Hypothalamic Amenorrhea and Psychological Stress

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  1. Chapter 11. PSYCHOLOGICAL STRESS AND FUNCTIONAL AMENORRHEA Reid L. Norman, PhD Professor, Pharmacology and Neuroscience, TTUHSC

  2. Learning Objectives • The definition of functional hypothalamic amenorrhea (FHA) • The causes of FHA • The importance of seeking medical attention for this condition • The long-term medical consequences of low estrogen levels

  3. Functional hypothalamic amenorrhea • FHA is the absence of menstrual cycles for more than six months without any anatomic or pathologic cause • In FHA, there is no organic problem, rather, the system is not functioning properly because there is insufficient GnRH release from the hypothalamus

  4. Stress • Hans Selye (1939) was the first to recognize that stress negatively impacted the reproductive system • Refeinstein (1946) was also among the first to link disrupted menstrual cycles with “overt or latent psychological disturbances” even before GnRH was identified

  5. Psychological stress • Chronic psychological stress is thought to be a major contributor to FHA • Other factors contributing to this effect are: • Dieting • Exercise • Body image concerns • Performance pressure • Unrealistic expectations

  6. Acute stress • Acute psychological stress stimulates ACTH and cortisol and can inhibit LH release • This effect can be blocked by naloxone, an opioid antagonist • Implicates endorphins as mediators of the inhibitory effect of stress on gonadotropin secretion

  7. Low energy availability • One school of thought is that this is the reason for FHA in most instances, particularly in athletes • Contributing factor are the same as listed before • Dieting – reduces energy intake • Exercise – increases energy expenditure • Body image concerns - psychological • Performance pressure - psychological • Unrealistic expectations - psychological

  8. FHA • Women with this condition have • More dysfunctional attitudes • Did not cope with ordinary stresses • More interpersonal dependence • Increased stress hormone levels

  9. Consequences of FHA if untreated • Osteoporosis • Increased cardiovascular disease • Depression • Psychological disease • Dementia

  10. Treatment • Can be treated with hormonal therapy • Treats the symptoms of low estrogen • Does not address the underlying problem • Behavioral problems should be treated with psychological therapy

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