Skip to main content
SpringerLink
Log in

Hypothalamic Amenorrhea and Hidden Nutritional Insults

  • Original Article
  • Published:
The Journal of the Society for Gynecologic Investigation: JSGI Aims and scope Submit manuscript

Abstract

Objective

We examined whether abnormal nutrition is an associated event in idiopathic hypothalamic amenorrhea.

Methods

Eighteen amenorrheic subjects were compared to 36 normal controls using endocrine, nutritional, and psychological evaluations.

Results

Controls were closer to their ideal weight (97.2 versus 89.7%; P < .05) than amenorrheics despite similar ages and heights. Amenorrheics denied eating disorders; however, our evaluation showed more eating disorders (55 versus 26%; P < .05), higher scores on a scale of eating behavior (22.28 versus 10.36; P < .001), twice as much fiber intake (26.14 versus 14.69 g/day) and less fat intake (20.7 versus 27.10 g/day) (P <.001), more aerobic activity (85 versus 58%) despite expending fewer calories per day (2303.7 versus 2576.7 kcal/day; P < .05), and similar caloric intake.

Conclusions

Significant abnormalities suggest that a greater percentage of hypothalamic amenorrhea occurs on a nutritional basis than previously suspected and should be searched for in depth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yen SSC, Rebar R, VandenBerg G, Judd H. Hypothalamic amenorrhea and hypogonadotropism: Response to synthetic LRF. J Clin Endocrinol Metab 1973;36: 811–6.

    Article  CAS  Google Scholar 

  2. Lachelin GCL, Yen SSC. Hypothalamic chronic anovulation. Am J Obstet Gynecol 1978;130: 825–31.

    Article  CAS  Google Scholar 

  3. Rebar RW, Harman SM, Vaitukaitis JL. Differential responsiveness for LRF after estrogen therapy in women with hypothalamic amenorrhea. J Clin Endocrinol Metab 1978; 46: 48–54.

    Article  CAS  Google Scholar 

  4. Warren MP. The effects of undernutrition on reproductive function in the human. Endocr Rev 1983;4: 363–77.

    Article  CAS  Google Scholar 

  5. Reifenstein EC Jr. Psychogenic or ‘hypothalamic’ amenorrhea. Med Clin North Am 1946;30: 1103–14.

    Article  Google Scholar 

  6. Warren MP. The effects of altered nutritional states, stress and systemic illness on reproduction in women In: Vaitukaitis J, ed. Clinical reproductive neuroendocrinology. New York: Elsevier-North Holland, 1982:177–206.

    Google Scholar 

  7. Reame NE, Sauder SE, Case GD, Kelch RP, Marshall JC. Pulsatile gonadotropin secretion in women with hypothalamic amenorrhea: Evidence that reduced frequency of go-nadotropin-releasing hormone secretion is the mechanism of persistent anovulation. J Clin Endocrinol Metab 1985; 61: 851–8.

    Article  CAS  Google Scholar 

  8. Quigley ME, Sheenan KL, Casper RF, Yen SSC. Evidence for an increased dopaminergic and opioid activity in patients with hypothalamic hypogonadotropic amenorrhea. J Clin Endocrinol Metab 1980;50: 949–54.

    Article  CAS  Google Scholar 

  9. Berga SL, Mortola JF, Girton L, et al. Neuroendocrine aberrations in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 1989;68: 301–8.

    Article  CAS  Google Scholar 

  10. Biller BMK, Federoff HJ, Koenig JI, Klibanski A. Abnormal Cortisol secretion and responses to corticotropin-releasing hormone in women with hypothalamic amenorrhea. J Clin Endocrinol Metab 1990;70: 311–7.

    Article  CAS  Google Scholar 

  11. Schweiger U. Menstrual function and luteal-phase deficiency in relation to weight changes and dieting. Clin Obstet Gynecol 1991;34: 191–7.

    Article  CAS  Google Scholar 

  12. Biller BMK, Coughlin JF, Saxe V, Schoenfeld D, Spratt DI, Klibanski A. Osteopenia in women with hypothalamic amenorrhea: A prospective study. Obstet Gynecol 1991;78: 996–1001.

    CAS  PubMed  Google Scholar 

  13. Warren MP, Brooks-Gunn J, Fox RP, Lancelot C, Newman D, Hamilton WG. Lack of bone accretion and amenorrhea: Evidence for a relative osteopenia in weight-bearing bones. J Clin Endocrinol Metab 1991;72: 847–53.

    Article  CAS  Google Scholar 

  14. Jonnavithula S, Warren MP, Fox RP, Lazaro MI. Bone density is compromised in amenorrheic women despite return of menses: A 2-year study. Obstet Gynecol 1993;81: 669–74.

    CAS  PubMed  Google Scholar 

  15. Dhuper S, Warren MP, Brooks-Gunn J, Fox RP. Effects of hormonal status on bone density in adolescent girls. J Clin Endocrinol Metab 1990;71: 1083–8.

    Article  CAS  Google Scholar 

  16. Durnin JVGA, Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: Measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974;32: 77–97.

    Article  CAS  Google Scholar 

  17. Warren MP, Brooks-Gunn J. Mood and behavior at adolescence: Evidence for hormonal factors. J Clin Endocrinol Metab 1989;69(suppl 1):77–83.

    Article  CAS  Google Scholar 

  18. Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985;122(suppl 2):51–65.

    Article  CAS  Google Scholar 

  19. Frank GC, Berenson GS, Schilling PE, et al. Adopting the 24-hour recall for epidemiologic studies of school children. J Am Diet Assoc 1977;71: 26–31.

    CAS  PubMed  Google Scholar 

  20. Rickels K, Garcia C, Lipman R, Derogatis L, Fisher E. The Hopkins Symptom Checklist: Assessing emotional distress in obstetric-gynecologic practice. Primary Care 1976;3: 751–64.

    CAS  PubMed  Google Scholar 

  21. Khoury SA, Reame NE, Kelch RP, Marshall JC. Diurnal patterns of pulsatile luteinizing hormone secretion in hypothalamic amenorrhea: Reproducibility and responses to opiate blockage and an α2-adrenergic agonist. J Clin Endocrinol Metab 1987;64: 755–62.

    Article  CAS  Google Scholar 

  22. Boesgaard S, Hagen C, Andersen AN, Djursing H, Fenger M. Cortisol secretion in patients with normoprolactinemic amenorrhea. Acta Endocrinol (Copenh) 1988;118: 544–50.

    Article  CAS  Google Scholar 

  23. Suh BY, Liu JH, Berga SL, Quigley ME, Laughlin CA, Yen SS. Hypercortisolism in patients with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 1988;66: 733–9.

    Article  CAS  Google Scholar 

  24. Grossman A, Moulte PJA, Mclntyre H, et al. Opiate mediation of amenorrhea in hyperprolactinemia and in weight loss-related amenorrhea. Clin Endocrinol (Oxf) 1982;17: 379–88.

    Article  CAS  Google Scholar 

  25. Giusti M, Cavagnaro P, Torre R, et al. Endogenous opioid blockade and gonadotropin secretion: Role of pulsatile luteinizing hormone-releasing hormone administration in anorexia nervosa and weight loss amenorrhea. Fertil Steril 1988;49: 797–801.

    Article  CAS  Google Scholar 

  26. Boyar R, Hellman L, Roffwarg H, et al. Cortisol secretion and metabolism in anorexia nervosa. N Engl J Med 1977; 296: 190–3.

    Article  CAS  Google Scholar 

  27. Gold P, Gwirtsman H, Avgerinos P, et al. Abnormal hy-pothalamic-pituitary-adrenal function in anorexia nervosa. N Engl J Med 1986;314: 1335–42.

    Article  CAS  Google Scholar 

  28. Hotta I, Shebasoki K, Masuda A, et al. The responses of plasma adrenocorticotropin and Cortisol to corticotropin releasing hormone (CRH) and cerebrospinal fluid immuno-reactive CRH in anorexia nervosa patients. J Clin Endocrinol Metab 1986;62: 319–24.

    Article  CAS  Google Scholar 

  29. Rickels K, Garcia CR, Fisher E. A measure of emotional distress in private gynecologic practice. Obstet Gynecol 1971;38: 139–46.

    CAS  PubMed  Google Scholar 

  30. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: Psychometric features and clinical correlates. Psychol Med 1982;12: 871–8.

    Article  CAS  Google Scholar 

  31. Tuschl RJ, Platte P, Laessle RG, Stichler W, Pirke KM. Energy expenditure and everyday eating behavior in healthy young women. Am J Clin Nutr 1990;52: 81–6.

    Article  CAS  Google Scholar 

  32. United States Department of Health and Human Services. Dietary intake source data: United States, 1976-1980. Vital and Health Statistics, National Health Survey, Series 11, no. 231. (DHHS publication no. PHS 83-1681). Hyatts-ville, Maryland: National Center for Health Statistics.

  33. Marlett JA, Bokram RL. Relationship between calculated dietary and crude fiber intakes of 200 college students. Am J Clin Nutr 1981;34: 335–42.

    Article  CAS  Google Scholar 

  34. Thompson FE, Sowers MF, Frongillo EA Jr, Parpia BJ. Sources of fiber and fat in diets of US women aged 19 to 50: Implications for nutrition education and policy. Am J Public Health 1992;82: 695–702.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Obstetrics and Gynecology and Medicine, St. Luke’s-Roosevelt Hospital and Columbia College of Physicians and Surgeons and Teacher’s College, Columbia University, New York, New York, USA

    Michelle P. Warren MD, Claire C. Holderness, Valerie Lesobre MD, Raphaelle Tzen, Farnaz Vossoughian & J. Brooks-Gunn PhD

Authors
  1. Michelle P. Warren MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claire C. Holderness
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valerie Lesobre MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raphaelle Tzen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Farnaz Vossoughian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Brooks-Gunn PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by National Institutes of Health grant #R01HD22171.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Warren, M.P., Holderness, C.C., Lesobre, V. et al. Hypothalamic Amenorrhea and Hidden Nutritional Insults. Reprod. Sci. 1, 84–88 (1994). https://doi.org/10.1177/107155769400100117

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/107155769400100117

Key words

Search

Navigation