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Mental and Sexual Health

While it is known that mental and sexual health is related to estrogen levels in women, there are limited studies concerning FHA and mental and sexual health. Links to serotonin, dopamine, and allopregnanolone fluctuations have been found in FHA women. Ghrelin concentrations have been found to be linked higher levels of disordered eating behaviors in FHA patients compared to both exercising and sedentary controls. The degree of disordered and restrictive eating behaviors have been positively associated with PYY concentrations in women with AN, and fasting PYY has been linked to drive for thinness in exercising women. This suggests that increased PYY may decrease the drive to increase energy intake which typically occurs when ghrelin levels are elevated: it is this dysregulation which may directly cause the psychopathological phenotype that increases susceptibility to developing chronic negative energy through restrictive eating patterns. The increased cortisol release caused by FHA can contribute to fluctuating moods, difficulty coping with common life events and stresses, and disordered eating, as serum cortisol levels correlate with the Hamilton Rating Scale for Depression (HAM-D) and Anxiety (HAM-A). Psychological well-being can be altered in response to low energy availability (LEA), but LEA may also preclude psychological problems. It has been suggested that a higher drive for thinness may serve as a proxy for LEA; a higher drive for thinness has been reported in amenorrheic females than eumeorrheic females. Studies have shown similarities between women affected with FHA and women affected with anorexia nervosa, including a tendency towards depression, bulimic tendencies, cognitive restraint problems with maturity and social security, introversion, inability to manage stress and an obsession with dieting and weight.