Stress, infertility linked in study by Magee-Womens Research Institute

Results presented at ‘Endo 2001,’ the 83rd Annual Meeting of the Endocrine Society

DENVER, June 21 – Increased levels of the stress hormone cortisol are clearly elevated in the bloodstream of child-bearing-aged women who have stopped menstruating, a senior researcher at the Magee-Womens Research Institute has found. The study is significant because it also shows that a psychological intervention and stress-reduction therapy can have a positive impact on infertility associated with the cessation of menstruation.

Called functional hypothalamic amenorrhea (FHA), the condition affects some 5 percent of women in their reproductive years. It is characterized by wildly irregular or absent periods – often for as long as two years or more.

"FHA isn’t caused by any real defects in the reproductive system,” said Sarah Berga, M.D., a professor in the departments of obstetrics, gynecology and reproductive sciences and psychiatry at the University of Pittsburgh School of Medicine. "We thought using stress-reduction techniques might reverse the process, and our results show we were right.”

Dr. Berga presented the study findings at the 83rd Annual Meeting of the Endocrine Society, an organization made up of endocrine specialists in internal medicine, pediatrics and gynecology.

Now in its seventh year, the ongoing study has included both human volunteers and primates to link stress and infertility due to FHA. "We are finding out how stress causes infertility,” said Dr. Berga, who is also director of the division of reproductive endocrinology and infertility at the Magee-Womens Hospital of the UPMC Health System.

"This is something I’ve been working on for 15 years,” she said. "Typically, these women are not aware they’re under stress, or don’t acknowledge it.”

Women with FHA also share certain characteristics, such as a tendency toward perfectionism and poor nutritional or lifestyle choices. Many just try to get too much done in a day.

Fourteen women took part in the most recent phase of the study. Seven were treated with sessions of cognitive behavior therapy and dietary counseling, while seven were not. All were observed for a period of 20 weeks.

Of the treated women, six fully recovered normal menstrual cycles, and one partially recovered. Of those not treated, only one fully recovered. One partially recovered, and five continued to experience FHA.

"The endocrine system rewards moderation,” explained Dr. Berga. "We try to teach balance and creative problem solving.”

Long-term FHA affects more than fertility. It also can result in bone loss and affect brain function. If women with FHA take fertility drugs to get pregnant, the underlying stress process may lead to early delivery or poor fetal brain development.

"Without intervention, these women are at risk for a recurrence,” Dr. Berga said. "But the good news is that treatment is effective.”

In addition to Dr. Berga, study authors include Tammy L. Loucks, M.P.H.; Marijane Krohn, Ph.D.; Judy L. Cameron, Ph.D; and Marsha D. Marcus, Ph.D.

Funding for the study was provided by the National Institute of Mental Health, a component of the National Institutes of Health.

Magee-Womens Research Institute is the country’s first research institute devoted to women and infants. It was formed in 1992 by Magee-Womens Hospital of UPMC Health System. The University of Pittsburgh School of Medicine’s department of obstetrics, gynecology and reproductive sciences is one of the top three departments in the nation in NIH funding.

For more information on FHA or this research study, please call 412-641-1602.