Generic placeholder image

Endocrine, Metabolic & Immune Disorders - Drug Targets


ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Review Article

Menstrual Disorders Related to Eating Disorders

Author(s): Walter Milano, Paola Ambrosio, Francesca Carizzone, Valeria De Biasio, Maria Gabriella Foia, Biancamaria Saetta, Maria Francesca Milano and Anna Capasso*

Volume 22, Issue 5, 2022

Published on: 14 January, 2022

Page: [471 - 480] Pages: 10

DOI: 10.2174/1871530321666210625145345

Price: $65


Eating Disorders (ED) are associated with multiple physical complications that strongly affect the physical health of these young and fragile patients and can also cause significant mortality, the highest among psychiatric pathologies. Among the various organic complications, albeit still little known, the gynecological implications, up to infertility, are very widespread. Both among adolescent and adult patients, gynecological symptoms can be very widespread and range from menstrual irregularities to amenorrhea, from vaginitis to ovarian polycystosis, up to complications during the gestational phase and in postpartum, in addition to the possible consequences on the unborn child. Among the most frequent and significant gynecological disorders in women with ED, there are menstrual irregularities that may occur with oligomenorrhea or even amenorrhea. This symptom, although no longer part of the DSM-5 diagnostic criteria for defining Anorexia Nervosa (AN), must be considered a very relevant event in the overall evaluation of young women and adolescents with eating disorders. Functional Hypothalamic Amenorrhea in ED patients is related to psychological distress, excessive exercise, disordered eating, or a combination of these factors which results in suppression of the hypothalamic- pituitary-ovarian axis, resulting in hypoestrogenism. The objective of this paper is to summarize the causes and the mechanism underlying the menstrual disorders and to provide a better understanding of the correlation between the reproductive system and the mechanisms that regulate food intake and eating habits. In addition, early recognition of risk factors for eating disorders for gynecological implications can help put more accurate assessments of patients to prevent potentially fatal complications. The importance of the involvement of specialist gynecologists in the multidisciplinary team that has to follow patients with eating disorders is also discussed.

Keywords: Amenorrhea, Atrophic Vaginitis, Eating Disorders, Menstrual Cycle, Pelvic Pain, Psychiatric Pathologies.

Graphical Abstract
Hay, P; Girosi, F; Mond, J Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. J Eat Dis., 2015, 3, 19.
Hudson, J.I.; Hiripi, E.; Pope, H.G., Jr; Kessler, R.C. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol. Psychiatry, 2007, 61(3), 348-358.
[] [PMID: 16815322]
Diagnostic and statistical manual of mental disorders, DSM 5; American Psychiatric Publishing: Washington, DC, 2013.
Preti, A.; Girolamo, Gd.; Vilagut, G.; Alonso, J.; Graaf, Rd.; Bruffaerts, R.; Demyttenaere, K.; Pinto-Meza, A.; Haro, J.M.; Morosini, P. The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J. Psychiatr. Res., 2009, 43(14), 1125-1132.
[] [PMID: 19427647]
Milano, W.; De Rosa, M.; Milano, L.; Riccio, A.; Sanseverino, B.; Capasso, A. The pharmacological options in the treatment of eating disorders. ISRN Pharmacol., 2013, 2013, 352865.
[] [PMID: 23956871]
Gravina, G; Milano, W; Nebbiai, G; Piccione, C; Capasso, A. Medical Complications in Anorexia and Bulimia Nervosa. Endocr Metab Immune Disord Drug Targets, 2018, 18(5), 477-488.
Fogarty, S; Elmir, R; Hay, P; Schmied, V. The experience of women with an eating disorder in the perinatal period. A Meta- Ethnographic Study BMC Pregnancy and Childbirth, 2018, 1762-1769.
Tabler, J; Utz, RL; Smith, KR; Hanson, HA; Geist, C Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters. Int J Eat Disord., 2018, 51(2), 102-111.
Mehler, P.S.; Andersen, A.E. Eating disorders. A guide to medical care and complications, 3rd; Johs Hopkins University Press, 2017.
Ålgars, M.; Huang, L.; Von Holle, A.F.; Peat, C.M.; Thornton, L.M.; Lichtenstein, P.; Bulik, C.M. Binge eating and menstrual dysfunction. J. Psychosom. Res., 2014, 76(1), 19-22.
[] [PMID: 24360136]
Cousins, A.; Freizinger, M.; Duffy, M.E.; Gregas, M.; Wolfe, B.E. Self-report of eating disorder symptoms among women with and without infertility. J. Obstet. Gynecol. Neonatal Nurs., 2015, 44(3), 380-388.
[] [PMID: 25819743]
Easter, A.; Treasure, J.; Micali, N. Fertility and perinatal attitudes towards pregnancy in women with eating disorders. Br. J. Obstet. Gynaecol., 2011, 118, 1491-1498.
Dalle Grave, R.; Calugi, S.; Marchesini, G. Is amenorrhea a clinically useful criterion for the diagnosis of anorexia nervosa? Behav. Res. Ther., 2008, 46(12), 1290-1294.
[] [PMID: 18848697]
El Ghoch, M.; Bazzani, P.; Dalle Grave, R. Management of ischiopubic stress fracture in patients with anorexia nervosa and excessive compulsive exercising. BMJ Case Rep., 2014, 2014, bcr2014206393.
[] [PMID: 25301426]
Vyver, E.; Steinegger, C.; Katzman, D.K. Eating disorders and menstrual dysfunction in adolescents. Ann. N. Y. Acad. Sci., 2008, 1135, 253-264.
[] [PMID: 18574232]
Poyastro Pinheiro, A.; Thornton, L.M.; Plotonicov, K.H.; Tozzi, F.; Klump, K.L.; Berrettini, W.H.; Brandt, H.; Crawford, S.; Crow, S.; Fichter, M.M.; Goldman, D.; Halmi, K.A.; Johnson, C.; Kaplan, A.S.; Keel, P.; LaVia, M.; Mitchell, J.; Rotondo, A.; Strober, M.; Treasure, J.; Woodside, D.B.; Von Holle, A.; Hamer, R.; Kaye, W.H.; Bulik, C.M. Patterns of menstrual disturbance in eating disorders. Int. J. Eat. Disord., 2007, 40(5), 424-434.
[] [PMID: 17497704]
Seidenfeld, M.E.; Rickert, V.I. Impact of anorexia, bulimia and obesity on the gynecologic health of adolescents. Am. Fam. Physician, 2001, 64(3), 445-450.
[PMID: 11515833]
Zain, M.M.; Norman, R.J. Impact of obesity on female fertility and fertility treatment. Womens Health (Lond), 2008, 4(2), 183-194.
[] [PMID: 19072520]
Linna, M.S.; Raevuori, A.; Haukka, J.; Suvisaari, J.M.; Suokas, J.T.; Gissler, M. Reproductive health outcomes in eating disorders. Int. J. Eat. Disord., 2013, 46(8), 826-833.
[] [PMID: 23996114]
Kimmel, MC; Ferguson, EH; Zerwas, S.; Bulik, CM; Meltzer-Brody, S. Obstetric and gynecologic problems associated with eating disorders. Int. J. Eat. Disord.,, 2016, 49(3), 260-275.
El Ghoch, M.; Milanese, C.; Calugi, S.; Pellegrini, M.; Battistini, N.C.; Dalle Grave, R. Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: a longitudinal study. Am. J. Clin. Nutr., 2014, 99(4), 771-778.
[] [PMID: 24500157]
Abraham, S.F.; Pettigrew, B.; Boyd, C.; Russell, J.; Taylor, A. Usefulness of amenorrhoea in the diagnoses of eating disorder patients. J. Psychosom. Obstet. Gynaecol., 2005, 26(3), 211-215.
[] [PMID: 16295519]
Resch, M; Szendei, G Bulimia from a gynecological view. Hormonal Changes J. Obstet. Gynaecol., 2004, 24(8), 907-910.
ACOG committee opinion no. 740: gynecologic care for adolescents and young women with eating disorders. Obstet. Gynecol.,, 2018, 131(6), e205-e213.
[] [PMID: 29794682]
Abebe, D.S.; Lien, L.; Torgersen, L.; von Soest, T. Abebe, D.S.; Lien, L.; Torgersen, L.; von Soest, T. Binge eating, purging and non-purging compensatory behaviours decrease from adolescence to adulthood: A population-based, longitudinal study. BMC Public Health, 2012, 13, 12-32.
[] [PMID: 22244266]
Stunkard, A.J. Eating disorders and obesity. Psychiatr. Clin. North Am., 2011, 34(4), 765-771.
[] [PMID: 22098802]
Bartholome, L.T.; Raymond, N.C.; Lee, S.S.; Peterson, C.B.; Warren, C.S. Detailed analysis of binges in obese women with binge eating disorder: Comparisons using multiple methods of data collection. Int. J. Eat. Disord., 2006, 39(8), 685-693.
[] [PMID: 16937383]
Coulston, A.M.; Liu, G.C.; Reaven, G.M. Plasma glucose, insulin and lipid responses to high-carbohydrate low-fat diets in normal humans. Metabolism, 1983, 32(1), 52-56.
[] [PMID: 6336816]
Morgan, J.F.; McCluskey, S.E.; Brunton, J.N.; Hubert Lacey, J. Polycystic ovarian morphology and bulimia nervosa: A 9-year follow-up study. Fertil. Steril., 2002, 77(5), 928-931.
[] [PMID: 12009345]
Shufelt, C.L.; Torbati, T.; Dutra, E. Hypothalamic amenorrhea and the long- term health consequences. Semin. Reprod Med., 2017, 35(3), 256-262.
Misra, M; Klibanski, A. Anorexia nervosa and its associated endocrinopathy in young people. Horm. Res. Paediatr., 2016, 85(3), 147-157.
Misra, M; Klibanski, A. Endocrine consequences of anorexia nervosa. Lancet Diabetes Endocrinol., 2014, 2(7), 581-592.
Gordon, C.M. Clinical practice. Functional hypothalamic amenorrhea. N. Engl. J. Med., 2010, 363(4), 365-371.
[] [PMID: 20660404]
Boyar, R.M.; Katz, J.; Finkelstein, J.W.; Kapen, S.; Weiner, H.; Weitzman, E.D.; Hellman, L. Anorexia nervosa. Immaturity of the 24-hour luteinizing hormone secretory pattern. N. Engl. J. Med., 1974, 291(17), 861-865.
[] [PMID: 4412035]
Kluge, M.; Schüssler, P.; Uhr, M.; Yassouridis, A.; Steiger, A. Ghrelin suppresses secretion of luteinizing hormone in humans. J. Clin. Endocrinol. Metab., 2007, 92(8), 3202-3205.
[] [PMID: 17550958]
Ackerman, KE; Slusarz, K; Guereca, G; Pierce, L; Slattery, M; Mendes, N Higher ghrelin and lower leptin secretion are associated with lower LH secretion in young amenorrheic athletes compared with eumenorrheic athletes and controls. Am. J. Physiol. Endocrinol. Metab., 2012, 302(7), E 800-E 806.
Welt, C.K.; Chan, J.L.; Bullen, J.; Murphy, R.; Smith, P.; DePaoli, A.M.; Karalis, A.; Mantzoros, C.S. Recombinant human leptin in women with hypothalamic amenorrhea. N. Engl. J. Med., 2004, 351(10), 987-997.
[] [PMID: 15342807]
Katz, M.G.; Vollenhoven, B. The reproductive endocrine consequences of anorexia nervosa. BJOG, 2000, 107(6), 707-713.
[] [PMID: 10847224]
Mason, H.D.; Key, A.; Allan, R.; Lask, B. Pelvic ultrasonography in anorexia nervosa: what the clinician should ask the radiologist and how to use the information provided. Eur. Eat. Disord. Rev., 2007, 15(1), 35-41.
[] [PMID: 17676670]
Miller, K K; Grinspoon, S; Gleysteen, S; Grieco, KA; Ciampa, J; Breu, J; Herzog, DB; Klibanski, A Preservation of neuroendocrine control of reproductive function despite severe undernutrition. J. Clin. Endocrinol. Metab., 2004, 89(9), 4434-4438.
Pinhas-Hamiel, O.; Pilpel, N.; Carel, C.; Singer, S. Clinical and laboratory characteristics of adolescents with both polycystic ovary disease and anorexia nervosa. Fertil. Steril., 2006, 85(6), 1849-1851.
[] [PMID: 16650415]
Sum, M.; Warren, M.P. Hypothalamic amenorrhea in young women with underlying polycystic ovary syndrome. Fertil. Steril., 2009, 92(6), 2106-2108.
[] [PMID: 19589515]
Vadakkadath Meethal, S.; Atwood, C.S. The role of hypothalamic-pituitary-gonadal hormones in the normal structure and functioning of the brain. Cell. Mol. Life Sci., 2005, 62(3), 257-270.
[] [PMID: 15723162]
Sowińska-Przepiera, E.; Andrysiak-Mamos, E.; Jarząbek-Bielecka, G.; Walkowiak, A.; Osowicz-Korolonek, L.; Syrenicz, M.; Kędzia, W.; Syrenicz, A. Functional hypothalamic amenorrhoea — diagnostic challenges, monitoring, and treatment. Endokrynol. Pol., 2015, 66(3), 252-260.
[PMID: 26136135]
Gordon, CM; Ackerman, KE; Berga, SL; Kaplan, JR; Mastorakos, G; Misra, M; Murad, MH; Santoro, NF; Warren, MP Functional hypothalamic amenorrhea : An endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab., 2017, 102(5), 1413-1439.
Doufas, A.G.; Mastorakos, G. The hypothalamic-pituitary-thyroid axis and the female reproductive system. Ann. N. Y. Acad. Sci., 2000, 900, 65-76.
[] [PMID: 10818393]
Mehler, PS; Brown, C Mehler, PS; Brown, C Anorexia nervosa - medical complications. J. Eat. Disord., 2015, 3(11)
Hoffman, E.R.; Zerwas, S.C.; Bulik, C.M. Reproductive issues in anorexia nervosa expert. Rev. Obstet. Gynecol., 1586, 6(4), 403-414.
Bulik, C.M.; Hoffman, E.R.; Von Holle, A.; Torgersen, L.; Stoltenberg, C.; Reichborn-Kjennerud, T. Unplanned pregnancy in women with anorexia nervosa. Obstet. Gynecol., 2010, 116(5), 1136-1140.
[] [PMID: 20966699]
Koubaa, S.; Hällström, T.; Lindholm, C.; Hirschberg, A.L. Pregnancy and neonatal outcomes in women with eating disorders. Obstet. Gynecol., 2005, 105(2), 255-260.
[] [PMID: 15684148]
Lawson, E.A.; Donoho, D.; Miller, K.K.; Misra, M.; Meenaghan, E.; Lydecker, J.; Wexler, T.; Herzog, D.B.; Klibanski, A. Hypercortisolemia is associated with severity of bone loss and depression in hypothalamic amenorrhea and anorexia nervosa. J. Clin. Endocrinol. Metab., 2009, 94(12), 4710-4716.
[] [PMID: 19837921]
Amin, Z.; Canli, T.; Epperson, C.N. Effect of estrogen-serotonin interactions on mood and cognition. Behav. Cogn. Neurosci. Rev., 2005, 4(1), 43-58.
[] [PMID: 15886402]
Lawson, E.A.; Eddy, K.T.; Donoho, D.; Misra, M.; Miller, K.K.; Meenaghan, E.; Lydecker, J.; Herzog, D.; Klibanski, A. Appetite-regulating hormones cortisol and peptide YY are associated with disordered eating psychopathology, independent of body mass index. Eur. J. Endocrinol., 2011, 164(2), 253-261.
[] [PMID: 21098684]
Lawson, E.A.; Miller, K.K.; Blum, J.I.; Meenaghan, E.; Misra, M.; Eddy, K.T.; Herzog, D.B.; Klibanski, A. Leptin levels are associated with decreased depressive symptoms in women across the weight spectrum, independent of body fat. Clin. Endocrinol. (Oxf.), 2012, 76(4), 520-525.
[] [PMID: 21781144]
Grosman-Rimon, L.; Wright, E.; Freedman, D; Kachel, E; Hui, S; Epstein, I; Gutterman, D; Eilat-Adar, S. Can improvement in hormonal and energy balance reverse cardiovascular risk factors in athletes with amenorrhea? Am. J. Physiol. Heart Circ. Physiol., 2019, 317(3), H487-H495.
Lawson, EA; Holsen, LM; Santin, M; Meenaghan, E; Eddy, KT; Becker, AE Oxytocin secretion is associated with severity of disordered eating psychopathology and insular cortex hypoactivation in anorexia nervosa. J. Clin. Endocrinol. Metab., 2012, 97(10), E 1898-E 1908.
Sophie Gibson, M.E.; Fleming, N.; Zuijdwijk, C.; Dumont, T. Where have the periods gone? The evaluation and management of functional hypothalamic amenorrhea. J. Clin. Res. Pediatr. Endocrinol., 2020, 12(Suppl. 1), 18-27.
[] [PMID: 32041389]
Toosy, S.; Sodi, R.; Pappachan, J.M. Lean polycystic ovary syndrome (PCOS): An evidence-based practical approach. J. Diabetes Metab. Disord., 2018, 17(2), 277-285.
[] [PMID: 30918863]

Rights & Permissions Print Export Cite as
© 2023 Bentham Science Publishers | Privacy Policy