January 1997

Resumption of Menses in Anorexia Nervosa

Author Affiliations

From the Division of Adolescent Medicine (Drs Golden, Jacobson, and Shenker and Ms Schebendach) and the Division of Child and Adolescent Psychiatry (Drs Solanto and Hertz), Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY.

Arch Pediatr Adolesc Med. 1997;151(1):16-21. doi:10.1001/archpedi.1997.02170380020003

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.Arch Pediatr Adolesc Med. 1997;151:16-21