Secondary amenorrhea: two kinds of psychogenic disorder--a case report

Women's experiences of infertility after the Holocaust

Nuremburg trial evidence demonstrated that Nazis sought methods of mass sterilization of Jewish women. Immediately upon arrival at the concentration camps, over 98% of women stopped menstruating. There has been minimal investigation as to the cause(s) of amenorrhea, beyond malnutrition and trauma. The major objectives of this article are to 1) provide an alternate hypothesis to explain women's amenorrhea, i.e., surreptitious administration of exogenous hormones to women; 2) detail survivors' reproductive histories so as to demonstrate long-term sequellae, especially pregnancy losses; 3) provide women's subjective narratives of the short- and long-term experience of reproductive losses; 4) link women's amenorrhea, subsequent primary and secondary infertility and the evidence for the hypothesized causal mechanism, i.e., the administration of sex steroids which might have led to both immediate and long-term reproductive impacts. We conducted telephone interviews from 2018 to 2021 with Holocaust survivors internationally in 4 languages. We collected 93 testimonies from female Holocaust survivors (average age 92.5) or offspring who could provide complete reproductive histories for survivors. The interviews focused on reproductive histories, including amenorrhea beginning in 1942-45, subsequent attempts to conceive, numbers of pregnancies, miscarriages and stillbirths. Ninety-eight percent of women interviewed were unable to conceive or carry to term their desired number of children. Of 197 confirmed pregnancies, at least 48 (24.4%) ended in miscarriages, 13 (6.6%) in stillbirths and 136 (69.0%) in live births. The true number of pregnancy losses is likely much higher. Only 15/93 (16.1%) of women were able to carry more than two babies to term, despite most wanting more children desperately. Amenorrhea among Jewish women arriving at concentration camps was too uniform and sudden to be effected only by trauma and/or malnutrition. Survivors' narratives and historical evidence suggest the role of exogenous hormones, administered without women's knowledge to induce amenorrhea as well as subsequent primary and secondary infertility.

The etiology of some menstrual disorders: a gynecological and psychiatric issue

Some menstrual disorders with distinct gynecological character such as amenorrhea or menometrorrhagia (MMR) may have psychogenic etiology. On the other hand, in menstrual psychosis (MP), a distinctly psychiatric disorder, the etiology is not necessarily psychogenic, but rather is hormonal-biological. We present 4 cases, one each of primary and secondary amenorrhea, MMR, and MP, respectively. In the first 3 cases (2 amenorrhea and 1 MMR), we found psychogenic factors: an insult to feminine development after rape (case 1) or marriage problems (cases 2 and 3). In the case of a recurrent MP, no relevant psychological etiology was found. Furthermore, some of the patient's relatives had menstrual or peripartum psychiatric disorders. Menstrual disorders' etiology can be psychogenic or hormonal. The correct etiology is the guide for the adequate therapeutic way: psychotherapy based in psychogenic disorders and neuroleptic or antiovulatory drugs in those of biological etiology.