Reprinted from Eating Disorders Review
March/April 2007 Volume 18, Number 2
©2007 Gürze Books
Q: I have a number of patients with anorexia nervosa (AN) who regained a healthy weight more than a year ago but who still haven’t resumed their menses. What do we know about the relationship of weight gain to return of menses in AN? Are there any predictors of how long this will take? (E.D., Portland, OR)
A: Although there’s no precise relationship between regaining weight and the return of menses, it’s clear that it is necessary for patients with AN to gain back to a healthy weight (i.e., to just about 100% of what was previously healthy when the person was menstruating) before menses will resume. One recent study examined 61 patients with AN over a year of treatment, and found that during that time 69% of these women experienced weight recovery, defined as a weight of at least a body mass index (BMI, or kg/m2) of roughly 19. But, in that time only 39% of those who had weight-recovered resumed menses. Several factors correlated with return of menses. Those regaining menses tended to be a little older (19.8 years of age, compared to 16.9 years of age, on average), and to have had higher initial levels of follicle-stimulating hormone, or FSHon average 3.8 IU/L in those regaining menses vs. 2.0 IU/L in those not regaining menses. They also had initially higher levels of two other endocrine measures, inhibin B and anti-Mullerian hormone (AMH). Thus, patients whose ovarian function is suppressed less profoundly at the start of treatment are more likely to have earlier menstrual cycle recovery when they regain weight. A multivariate prediction combining all of the endocrine factors demonstrated that although each marker was weak by itself, by combining all three investigators could derive a reasonably sensitive way of predicting who would recover menstrual function within the year (Fertil & Steril 2007; 87; 902).