Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: a controlled comparison

To assess the association of cognitive function, emotional, and psychiatric history in women with functional hypothalamic amenorrhea compared with amenorrheic and eumenorrheic controls.

Each subject was medically evaluated for origin of amenorrhea or to establish eumenorrhea. Subjects completed a structured psychiatric interview and self-report questionnaires.

Patients were recruited from a large reproductive endocrinology practice within a tertiary referral center.

Consecutive patients who were eligible for the study were invited to participate. Eumenorrheic controls were recruited to match women with functional hypothalamic amenorrhea by age, sex, weight, and season.

Cognitive measures assessed expectation of control, perfectionism, rigidity of ideas and concern about judgments of others (dysfunctional attitudes), coping ability, interpersonal and achievement functioning, and interpersonal dependence. Measures of mood and symptoms included both clinical and self-report scales. Psychiatric diagnoses were determined using Research Diagnostic Criteria and DSM III-R.

Women with functional hypothalamic amenorrhea endorsed more dysfunctional attitudes, had greater difficulty in coping with daily stresses, and tended to endorse greater interpersonal dependence than eumenorrheic women. Women with organic amenorrhea were statistically not different from either group but tended to report less dysfunctional attitudes and interpersonal dependence, although they displayed comparable difficulty in coping, compared with functional hypothalamic amenorrhea women. Women with functional hypothalamic amenorrhea more often had a history of psychiatric disorders, primarily mood disorders, than eumenorrheic women but were not different from women with organic amenorrhea.

Women with functional hypothalamic amenorrhea showed increased cognitive dysfunction and psychiatric morbidity.