Resumption of menses in anorexia nervosa
N. H. Golden, M. S. Jacobson, J. Schebendach, M. V. Solanto, S. M. Hertz and I. R. Shenker
Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY, USA.
OBJECTIVE: To determine factors associated with resumption of menses (ROM)
in adolescents with anorexia nervosa. DESIGN: Cohort study with 2-year
follow-up. SETTING: Tertiary care referral center. PATIENTS: Consecutive
sample of 100 adolescent girls with anorexia nervosa. INTERVENTIONS: Body
weight, percent body fat, and luteinizing hormone, follicle-stimulating
hormone, and estradiol levels were measured at baseline and every 3 months
until ROM (defined as 2 or more consecutive spontaneous menstrual cycles).
Treatment consisted of a combination of medical, nutritional, and
psychiatric intervention aimed at weight gain and resolution of
psychological conflicts. MAIN OUTCOME MEASURES: Body weight, body
composition, and hormonal status at ROM. RESULTS: Menses resumed at a mean
(+/-SD) of 9.4 +/- 8.2 months after patients were initially seen and
required a weight of 2.05 kg more than the weight at which menses were
lost. Mean (+/-SD) percent of standard body weight at ROM was 91.6% +/-
9.1%, and 86% of patients resumed menses within 6 months of achieving this
weight. At 1-year follow-up, 47 (68%) of 69 patients had resumed menses and
22 (32%) remained amenorrheic. No significant differences were seen in body
weight, body mass index, or percent body fat at follow-up in those who
resumed menses by 1 year compared with those who had not. Subjects who
remained amenorrheic at 1 year had lower levels of luteinizing hormone (P
< .001) and follicle-stimulating hormone (P < .05) at baseline and
lower levels of luteinizing hormone (P < .01) and estradiol (P <
.001) at follow-up. At follow-up, a serum estradiol level of more than 110
pmol/L (30 pg/mL) was associated with ROM (relative risk, 4.6; 95%
confidence interval, 1.9-11.2). CONCLUSIONS: A weight approximately 90% of
standard body weight was the average weight at which ROM occurred and is a
reasonable treatment goal weight, because 86% of patients who achieved this
goal resumed menses within 6 months. Resumption of menses required
restoration of hypothalamic-pituitary-ovarian function, which did not
depend on the amount of body fat. Serum estradiol levels at follow-up best
assess ROM.
