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Intensive research in reproductive endocrinology over the past 15 years has resulted in a tremendous accumulation of knowledge concerning the physiology and pathology of the regulation of the menstrual cycle. The regular ovarian function is absolutely dependent on a well-balanced interaction of the CNS, the hypothalamus, the pituitary, and the ovary itself. The normal function of this functional unit depends on a regular pattern of pulsatile secretion of gonadotrophin-releasing hormone (GnRH) in the nucleus arcuatus in the hypothalamus. As an answer to an adequate GnRH secretion the pituitary synthesizes and secretes follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in an adequate amount, which in turn stimulates follicular maturation.

Hypothalamic amenorrhea is the cause of approximately 60% of secondary amenorrheas and three-fourths of these are psychogenic [2,4]. These amenorrheas can be due to a simple loss of weight or can be the consequence of a previous anorexia nervosa. This hypothalamic disorder is functional and resumption of ovulation can be associated with restoration of weight. In this survey I have tried to evaluate how often pregnancy could be obtained through dietary measures without gonadotropin therapy.

Despite its complexity, the rhythmic pattern of hormonal changes which together form the menstrual cycle is relatively robust. The prevalence of amenorrhea and oligomenorrhea in the general population approximate 2% and 5% respectively (Drew 1961; Sher 1942; Petterson and Fries 1973). The report that up to one-half of women collegiate distance runners may be amenorrheic (Feicht et al. 1978) was in contrast to the image that “exercise is good for you.”

Anorexia nervosa (better described as ‘Magersucht’ or ‘pursuit of thinness’) and psychosomatic obesity are well known eating/weight disorders which have to be included in the differential diagnosis of primary or secondary amenorrhea, labeled as ‘psychogenic’ (see e.g. Fries 1974).

Giant pituitary adenomas are a difficult problem to deal with. They are herein considered as Grade IV of Vezina and Sutton, with a clear suprasellar expansion, producing visual defects, endocrinological disorders, increased intracranial pressureand in certain cases psychologic symptoms. So far surgical procedures regardless of their nature are associated with a great morbidity and mortality.

The aim of this report is the presentation of some hypotheses about the psychodynamic processes involved in psychological counseling with patients suffering from secondary amenorrhea.