It is hard to reconcile some statements in the article on anorexia nervosa by Golden et al in the January 1997 issue of the Archives, namely, "psychogenic factors may contribute to loss of menses,"1(p 17) "one fifth of our patients experienced amenorrhea before weight loss,"1(p 20) and "we believe [hypothalamic dysfunction] is secondary to malnutrition."1(p 21) Certainly, the pathology in anorexia involves a sick hypothalamus; emissions from the "pulse generator" are regressed to a juvenile level, with consequent refractoriness of the pituitary and gonad; but also there can be paradoxical elaboration of non–gonad-directed hormones such as somatotropin. It does seem that the sicker the hypothalamus, the longer it takes for the restitution of menses. The question of what causes the endocrine distortions has not been answered. The article correlates nutritional improvement with endocrine recovery; it is equally important to correlate psychological improvement with nutritional and endocrine status.
Needles CF. Resumption of Menses in Anorexia Nervosa. Arch Pediatr Adolesc Med. 1997;151(6):634-635. doi:10.1001/archpedi.1997.02170430100024