Women with functional hypothalamic amenorrhea but not other forms of anovulation display amplified cortisol concentrations

Fertil Steril. 1997 Jun;67(6):1024-30. doi: 10.1016/s0015-0282(97)81434-3.


Objective: To test the hypothesis that increased cortisol secretion is specific to women with decreased GnRH drive and not found in eumenorrheic women or those with other causes of anovulation.

Design: Cortisol concentrations in blood were determined at 30-minute intervals for 24 hours in three well-characterized groups: women with functional hypothalamic amenorrhea, those with other causes of anovulation, and eumenorrheic women.

Setting: Academic medical center.

Patient(s): Women aged 20 through 35 years, with well-defined reproductive states.

Intervention(s): Venous blood samples were obtained from, and psychometric inventories were completed by, the participants.

Main outcome measure(s): Twenty-four-hour cortisol levels, 24-hour LH pulse patterns, and serial P levels were measured in women with functional hypothalamic amenorrhea, eumenorrheic women, and those with other causes of anovulation.

Result(s): Cortisol secretion was higher in women with functional hypothalamic amenorrhea (n = 19) than in those with other causes of anovulation (n = 19) or eumenorrheic women (n = 19). Six women who recovered from functional hypothalamic amenorrhea had cortisol levels comparable to those of eumenorrheic women and those with other causes of anovulation.

Conclusion(s): These data underscore the association between increased hypothalamic-pituitary-adrenal activity and reduced GnRH drive and support the concept that functional hypothalamic amenorrhea develops in response to stress-induced alterations in central neural function that modify hypothalamic function.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Amenorrhea / blood*
  • Anovulation / blood*
  • Estradiol / blood
  • Female
  • Gonadotropin-Releasing Hormone / metabolism*
  • Humans
  • Hydrocortisone / blood*
  • Hydrocortisone / metabolism
  • Hypothalamus / physiopathology*
  • Prolactin / blood
  • Reference Values
  • Stress, Physiological
  • Thyrotropin / blood


  • Gonadotropin-Releasing Hormone
  • Estradiol
  • Prolactin
  • Thyrotropin
  • Hydrocortisone