Amenorrhea in Eating Disorders

Abstract

Eating disorders are serious diseases affecting mostly young women during their reproductive years. Anorexia nervosa (AN) is characterized by severe underweight, intense fear of becoming fat, disturbed body perception, and amenorrhea. The diagnosis of bulimia nervosa (BN) is based on recurrent episodes of binge eating in combination with inappropriate compensatory behavior like self-induced vomiting. Although body weight often remains normal, menstrual disturbances are also common in BN. Amenorrhea in AN is usually ascribed to inhibition of the hypothalamic-pituitary-gonadal axis, resulting in low levels of estradiol. Functional hypothalamic amenorrhea (FHA) can be normalized once body weight is restored. If there is a lack of response to psychotherapy and nutritional counseling, hormone substitution can be considered to prevent consequences of estrogen deficiency. The transdermal route is then recommended to overcome the suppressive effect of oral estrogen on bone trophic factors like insulin-like growth factor I. In BN, different mechanisms of amenorrhea have been proposed including FHA due to temporary starvation. In addition, BN seems to be linked to polycystic ovary syndrome (PCOS) since elevated prevalence of polycystic ovaries, acne, and hirsutism as well as high serum levels of androgens have been observed in bulimic women. It has been suggested that androgens may promote bulimic behavior and antiandrogenic oral contraceptives may therefore be beneficial in BN. Amenorrhea in women with eating disorders should be carefully evaluated in order to offer proper treatment depending on the underlying cause.