New research now shows that a common cause of infertility in women, called functional hypothalamic amenorrhea, or FHA, indeed may be caused by stress. So removing the stress cures the problem.
Women with FHA cannot become pregnant because the hormones responsible for reproduction aren't produced in high enough amounts for women to ovulate. Ovulation is the point in a woman's menstrual cycle when an egg is released from her ovary in hopes of meeting a friendly sperm.
Study author and infertility expert Tammy L. Loucks, MPH, tells WebMD that it is possible to give women hormones to make them ovulate. This, however, isn't a great solution for people with FHA, because the fact that their reproductive hormones are off kilter means that if they did get pregnant, they are more likely to have complications or have children with developmental problems. Loucks, a research associate in the division of reproductive endocrinology at Magee-Women's Hospital in Pittsburgh, discussed her study on FHA at the Endocrine Society's annual meeting held last month in Denver.
Loucks and her colleagues know from their research that women with FHA tend to be more stressed out than average women or women with infertility problems due to another cause. But giving them drugs to improve their mood is not a great solution, because these drugs might negatively affect a developing child.
Instead, Loucks and company tried a type of psychological therapy called cognitive behavior therapy. During this talking therapy, the women identify their stresses and ways discuss ways to of cope with them. Fourteen women with FHA underwent cognitive behavior therapy and also talked with a reproductive endocrinologist about stress, FHA, and how they are related.
After 20 weeks, all of these women had increased levels of reproductive hormones in their bodies, and 80% actually had the amount of hormones required to make them ovulate.
"I've always felt that FHA is in fact behavioral," she tells WebMD. "I think it's mainly nutritional." She believes severe stress may lead some women to develop unusual diets. "Certainly, our work has suggested that a lot of these girls have very abnormal eating patterns, which persist for quite a long period of time."
And their eating changes can be very subtle changes, Warren adds. Women with FHA tend to eat diets high in fiber with very little fat, "which is generally considered healthy, but in many of these instances, sometimes it's [too] low in calories as well," she says. "There may be other stress-induced issues as well that combine with [poor nutrition] to shut down the reproductive system."
Behavior therapy is worth a try for FHA, says Warren. "This is a very noninvasive way of treating this problem," she says, "and right now we don't have any [other] way of treating it."