Linked to amenorrhea accompanied by elevated ACTH levels, indicating a potential association between antidepressant exposure and menstrual dysfunction [29]. These findings suggest that escitalopram may exert reproductive effects through HPA-axis activation, with secondary suppression of the HPO axis via stress-related hormonal pathways. This highlights the interplay between stress regulation and reproductive function in antidepressant-associated menstrual changes [29]. This evidence concerns the gene GFER and amenorrhea.