Stress-induced anovulation

Stress-induced anovulation (SIA), often termed functional hypothalamic amenorrhea results when behavioral challenges and energetic imbalance reduce hypothalamic gonadotropin-releasing hormone drive and cause anovulation and amenorrhea. In this context, the reproductive compromise aligns reproduction with the external and internal milieu. Women and clinicians alike readily recognize the presence of amenorrhea, and its presence generally prompts an appropriate clinical evaluation aimed at identifying known organic causes. Because clinicians and patients find the link between amenorrhea and behavioral factors more difficult to appreciate, the treatment of functional forms of hypothalamic hypogonadism generally presents a therapeutic conundrum. Delineating the behavioral determinants of SIA yields novel and refined therapeutic interventions and offers the promise of improving reproductive and multigenerational health. This chapter focuses on behavioral determinants of anovulation and amenorrhea in women.