Hormone-Resistant Psychogenic Amenorrhea

FUNCTIONAL amenorrhea resistant to steroid hormone therapy is a known phenomenon although it is not often seen and has not been studied in sufficient detail. We are, therefore, reporting 2 such cases with a study of the mechanism involved. Case 1. R. W. presented herself in May, 1948, at the age of 33, because of amenorrhea of four and one-half years' duration. The menarche occurred at about 13 years; menses were fairly regular except for a four-month period of amenorrhea at the age of 17, which occurred during extended travels. Menstruation was re-induced by hormone therapy of an unknown nature. The patient married at the age of 19 and subsequently became pregnant; the pregnancy was voluntarily terminated during the first trimester. Menstruation was fairly regular thereafter. A change of environment at the age of 23 did not affect the menses. At the age of 29 (seven years after a divorce) she underwent severe psychic stress because of an emotional entanglement with a very unstable individual. Amenorrhea developed and persisted for four and one-half years, despite intensive therapy. Psychic tensions characterized the patient's domestic and personal life from early childhood.