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Resumption of Menses in Anorexia Nervosa

Neville H. Golden, MD; Marc S. Jacobson, MD; Janet Schebendach, MA, RD; Mary V. Solanto, PhD; Stanley M. Hertz, MD; I. Ronald Shenker, MD
Arch Pediatr Adolesc Med. 1997;151(1):16-21. doi:10.1001/archpedi.1997.02170380020003.
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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

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