COVID-19 – 

Coronavirus information and updates from RWJBarnabas Health.

TEMPORARY VISITATION POLICY CHANGE:

Eating Disorders and Menstrual Irregularities

From the Desk of Guest Bloggers, Neha Ahuja, M.D., Pediatric Resident, Richmond University Medical Center and Susan Brill, M.D., Chief of Adolescent Medicine, Saint Peter's University Hospital.

Eating disorders are known to have significant effect on psychosocial dynamics, but they also have an impact on changes in several body systems. Adolescents with disordered eating behaviors frequently have menstrual abnormalities that reflect their altered nutritional status.

Amenorrhea is described as the absence of the menstrual cycle in a woman of child bearing age. It can occur on a primary or secondary basis. For example, a female who never begins to menstruate during her teen years suffers from primary amenorrhea. Primary amenorrhea is usually diagnosed if a female has not attained her first period by 16 years of age. If a woman begins to menstruate, but then later stops menstruating, she has secondary amenorrhea. Secondary amenorrhea is of a concern if a female has missed her period for 3 consecutive months. Amenorrhea happens when the normal hormone secretions are interrupted. This can happen due to stress, intense exercise, and significant weight loss.

Weight changes due to poor nutrition or excessive exercise can alter hormones in the body. When a person engages in excessive exercise, especially when accompanied by disordered eating, this results in low body fat and low body weight. As a result, the normal production of hormones from the hypothalamus is suppressed. This leads to disordered secretion of both follicular stimulating hormone (FSH) and luteinizing hormone (LH) which are essential to the normal menstrual cycle and ovulation. Due to less FSH, the ovaries do not produce as much estrogen and the lining of the uterus does not develop. In addition, the signals responsible for triggering release of an egg, or ovulation, do not occur regularly, leading to scanty or absent periods. In fact, fertility is often compromised in these patients.

Amenorrhea also leads to depletion of calcium in bones and loss of bone mineral density, a condition called osteopenia. This occurs because of nutritional deficiencies and low estrogen levels. When menstrual periods stop, it is as a result of decreased estrogen production and this has a significant impact on bone health. Reduced bone mineral density makes bones weak and more susceptible to fractures. Weight gain with resumption of normal menstruation is the most effective way of increasing bone density and reversing damage caused to the bones, but if it is allowed to progress to a condition called osteoporosis, it may not be fully reversible. There are many other long term health effects of eating disorders due to nutritional deficiencies. They include dry hair, brittle nails, dry skin, sensitivity to cold, anemia, kidney problems and heart problems which if severe can lead to poor cardiac function.

The key goal of managing amenorrhea in patients with eating disorders is overall improvement of body weight and normalization of eating patterns. Treatment often includes nutritional counseling, behavior therapy (to change food, eating and/or exercise behaviors), support groups and group therapy.

Amenorrhea is of a concern as it can have a significant impact on health. This does get better if eating disorder resolution is not unduly delayed. Menstruation is an important identity of a woman’s health- so let’s protect it and not let the eating disorder control it!

References:

Copeland, P.M.,Sacks, N.R. & Herzog, D.B. Longitudinal Follow-Up of Amenorrhea in Eating Disorders. Psychosomatic Medicine. 57(2), 121-126 (1995).

Kaplan-Seidenfeld, M.E. & Rickert, V.I. Impact of Anorexia, Bulimia and Obesity on the Gynecologic Health of Adolescents. Am Fam Physician. 64(3), 445-451 (2001).

Polotsky, A.J. Amenorrhea Caused by Extremes of Body Mass: Pathophysiology and Sequelae. Contemporary Ob-Gyn. August (2010).

Robinson, L. et al. A Systematic Review and Meta-Analysis of the Association Between Eating Disorders and Bone Density. Osteoporos Int. Jan 18, 1-14 (2016).