FHA: Characterization of Metabolic Status, Brain Circuitry, and Stress-Reactivity
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Ovarian Cancer, Women's Studies |
| Therapuetic Areas: | Oncology, Reproductive |
| Healthy: | No |
| Age Range: | 18 - 35 |
| Updated: | 5/27/2013 |
| Start Date: | July 2011 |
| Contact: | Kara Barrett, RN |
| Email: | kbarret@emory.edu |
| Phone: | 404-712-9367 |
Functional Hypothalamic Amenorrhea: Characterization of Metabolic Status, Brain Circuitry, and Stress-reactivity
Functional Hypothalamic Amenorrhea (FHA), the spontaneous cessation of the menstrual cycle
for at least 6 months after menstrual cyclicity has been established, is a common and
reversible form of anovulation not due to discernible organic causes. Whereas animal studies
suggest an interaction of metabolic and psychosocial stress in the genesis of FHA, the
distinct central mechanisms in humans are not clear. On a behavioral level, FHA appears to
depend on a complex interplay between individual stress susceptibility, stressful life
events, and enduring metabolic challenge due to inappropriate attitudes towards eating and
body image. We will use a comparison group of ovulatory, eumenorrheic women (EW) and a
contrast group of lean women with polycystic ovary syndrome (PCOS). Although women with FHA
and PCOS present with anovulation, each condition differs markedly in pathobiology (and
health burden). Contrasting women with FHA to those with PCOS will afford an opportunity to
understand more about the interaction between metabolism, stress, and reproduction and to
determine the extent to which differences between FHA and EW are attributable to
reproductive compromise (anovulation) per se versus specific to the pathogenesis of FHA or
PCOS. We have used this approach to great advantage in the past to show that
hypercortisolemia was confined to FHA and not PCOS (Berga 1997) and that dysfunctional
(unrealistic) attitudes and decreased coping skills were reported more often in FHA than in
PCOS and more in PCOS than EW. Further, this approach of comparing 3 groups will allow us
to improve therapeutic approaches for two principle causes of anovulatory infertility in
women. To accomplish this, we will study women with FHA, PCOS, and normal ovulatory women.
The study will take place over 2 months and women will make 4-5 outpatient visits to the
Clinical Integration Network Center and will have one overnight stay for frequent blood
sampling.
Inclusion Criteria:
- Inclusion criteria for participation are a gynecological age (age since menarche) > 5
and < 25 years, and chronological age > 18 years, within 90-110% of ideal body weight
as determined by the 1983 Metropolitan height and weight table for women, and
exercise < 10 h/wk and run < 10 mi/wk, day-awake/night-asleep schedule.
- Women in the FHA and PCOS groups have to fulfill the diagnostic criteria of FHA or
PCOS and to have all other causes of amenorrhea and anovulation excluded.
Exclusion Criteria:
- Exclusion criteria are smoking, medications, including psychotropic or illicit drugs,
medical, neurological, or ophthalmologic disease except acuity problems, a weight
loss or gain of > 10 lb within a year preceding or since the onset of amenorrhea, a
major Axis I disorder other than depression, parturition in the last 12 months and/or
lactating in the last 6 months.
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