Amenorrheic Women Have High Rates of Axis I Disorders

Reprinted from Eating Disorders Review
January/February 1999 Volume 10, Number 1
©1999 Gürze Books

Endocrine findings associated with amenorrhea include hypoestrogenic, hyperandrogenic, and hyperprolactinemic states. One group of researchers detected Axis I psychiatric disorders among the majority of amenorrheic women in a nonpsychiatric population. The 95 women all presented to an endocrinology unit (Int J Eat Disord 24:137, 1998).

The women had been amenorrheic for at least 6 months. Of the 45 women with hypogonadotropic amenorrhea (low serum levels of luteinizing hormone), 80% had psychiatric disorders. Many had several co-morbidities: 73% had eating disorders, 40% had mood disorders, and 65% had anxiety disorders. Among the 44 women with hyperandrogenic states (diagnosed by elevated levels of delta 4 androstenedione levels associated with acne and hirsutism or ultrasound evidence of polycystic ovaries), nearly 80% had Axis I disorders, including 41% with eating disorders, 50% with mood disorders, and 65% with anxiety disorders.

Among the 6 women with hyperprolactinemia (with or without pituitary adenoma), about 80% had Axis I disorders, including 17% with eating disorders. Most of the women with hyperprolactinemia had mood and anxiety disorders.

Comment

Malnutrition in patients with eating disorders leads to decreased secretion of luteinizing hormone and follicle-stimulating hormone, contributing to amenorrhea. However, up to 30% of patients with anorexia nervosa develop amenorrhea before significant weight loss occurs. Changes in energy intake, increases in serum cortisol, or other stress-related endocrine mechanisms may be at work. Other alterations in hyperandrogenic and hyperprolactinemic states may lead to the “final common pathway” of amenorrhea.

Although the results of this study could not be used to determine whether psychiatric disturbances precede or follow endocrine disturbances, it does suggest that all female psychiatric patients should be asked about menses. It also indicates that psychiatric disorders are common among women with amenorrhea.

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