Infertility and Menstrual Problems: Suspect Disordered Eating

Infertility and menstrual problems can serve as sensitive indicators of bulimia in normal-weight or slightly obese patients who are hiding pathological eating habits, according to Maria Resch, MD, and a team of Hungarian researchers (Fertil Steril 2004;81:1151).

Dr. Resch reported that subclinical eating disorders occur frequently in women who come to gynecologic outpatient departments for treatment for gynecologic disorders. The Bulimia Investigation Test (BITE) was given to 72 Hungarian women aged 19 to 38 years of age who had sought treatment for problems of infertility and to assess eating disorders symptoms. None was taking oral contraceptives. Fifty-eight of the 72 women completed the questionnaire

Subclinical eating disorders uncovered

Overall, 28 of the 58 women (48%) reported significant eating problems. Secondary amenorrhea was identified in 11 women, oligomenorrhea in 27 women, and anovulation in 20 others.

Seven women (11.8%) had already been hospitalized for pathological eating behaviors and disorders. Of the 58 infertile women, 6 met criteria for clinical bulimia nervosa, 8 met the definition of subclinical bulimia (mean BMI: 26 kg/m2), and 30 showed no eating disorders. Five very slim patients (BMI<17.5 kg/m2) matched clinical anorexia nervosa.

Endocrine disorders

The women in the study had pathologically low luteinizing hormone and follicle-stimulating hormone (two hormones critical to reproductive health) values. The levels were in proportion to the severity of the symptoms of their eating disorders. The authors note that the results of this study can be better understood by considering that the severity factors on the BITE test include not only binge eating but weight-reducing activity, for example, through excessive physical exercise. Dramatic changes in eating, such as crash dieting—rather than malnutrition and low weight—could also be responsible for the low hormone levels.