Many women with low body weights still continue to get a regular menstrual cycle Also, the previous definition could not be applied to men, prepubertal girls, people taking hormonal contraceptives, or people who are postmenopausal 5. People with eating disorders often experience amenorrhea due to extreme weight loss and starvation of the body 1.
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This particular kind of amenorrhea is called secondary amenorrhea. If the patterns of restrictive eating happen before the onset of puberty, this can cause a delay in the timing of the first menstrual period— primary amenorrhea 1. Processes that are not essential to staying alive—like growth and reproductive function—may get less energy 6. The functionality of the hypothalamus, the control center in your brain which regulates many of the hormonal fluctuations within the body, can become suppressed, and normal hormonal fluctuations like those that regulate the menstrual cycle may be altered or halted 5.
However, not everyone who is anorexic or is in a prolonged energy deficient state will be amenorrheic. Some people will have menstrual periods of normal length, and some people may experience oligomenorrhea long, unpredictable cycles from 30 to 90 days 4,5. Functional Hypothalamic Amenorrhea FHA is the most extreme form of menstrual disturbance that can occur from a chronic restricted energy balance 5.
When someone has a negative energy balance, the levels of hormones released from the hypothalamus may change 5. Click here for a quick refresher on how normal functioning reproductive hormones change throughout the cycle.
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Gonadotropin releasing hormone GnRH , which is normally released in pulses from the hypothalamus throughout the day, can decrease in frequency due to extreme energy restriction 5,7. Without enough stimulation from these hormones, ovarian follicles—the sacs that contain your eggs in the ovary—do not receive enough stimulation to grow, adequate levels of estrogen are not produced, and ovulation may not occur.
People with FHA often demonstrate low estrogen, low progesterone, an absence of LH and estrogen peaking around ovulation , and no menstrual period 5. In amenorrheic people with severe restricting eating disorders, the period itself acts as an extra vital sign — a barometer for health. Its absence indicates that the body cannot maintain itself, and is failing to function normally. This is a warning sign, and should not be taken lightly. Once treatment progresses and energy deficits are improved or restored, a return of menstruation and normal hormone cycling is a positive indicator of health.
Pregnancy is an extremely energy-demanding time, and if someone cannot support their own body functions, that person could not likely support another body growing inside of them, requiring even more energy. Losing your period in times of low energy intake could be seen as a precautionary evolutionary function.
The health consequences of eating disorders may be profound and affect the whole body. In cases of anorexia, where body weight is significantly low, many of these changes are due to the effects of starvation. Vital signs, such as heart rate, blood pressure, and temperature are all often low, and arrhythmias abnormal heart rate patterns are also possible 1.
Many of these changes are reversible when a person recovers and improves their body weight and nutritional intake — but some damage, like bone density loss, may be more persistent 1. People with eating disorders, particularly anorexia nervosa, are more likely to have some concurrent psychological disorders such as obsessive-compulsive traits, depression, anxiety, social phobias, and perfectionistic pursuits. They are more likely to be high-achieving, and to express rigid control over their emotions, environment, and thinking patterns 1,8,9.
The internal drive to continually lose weight and the fear of gaining fat usually do not decrease with actual weight loss. A vicious cycle can develop, where the person becomes even more fixated with losing more weight as their weight continues to fall 1.
People with the binge-purge types of anorexia are often more spontaneous and more likely to abuse drugs and alcohol 1. It is estimated that 1 in 20 people with anorexia die from the illness However, this statistic could be on the low side, as eating disorders are often under-reported or under-diagnosed.
Although this may seem low, the chances of dying from an eating disorder like anorexia are higher than the chances of dying from any other mental illness or disorder 11, However, if you are not menstruating due to HA, your body disagrees with you. Try gaining 5 pounds and see what happens. You may be pleasantly surprised to see your cycles resume. Although healthy body weights vary greatly, most women with HA need to obtain a BMI of 22 to 23 or even higher to resume menses.
Recovery is also facilitated by eliminating intense exercise. Faster recovery is associated with cutting exercise entirely. Slower recovery is achieved when exercise is reduced in intensity or duration or both. Running seems to be the exercise that makes it hardest to regain natural menstrual cycles.
Anorexia and Amenorrhea: What are the Consequences?
Research shows that reducing stress can help with recovering from HA. However, you might be managing your anxiety in ways that can contribute to HA—strenuous exercise or restrictive eating to deal with body image. Learning other coping skills such as relaxation, mindfulness, distress tolerance, and sedentary joyful activities can help complete the recovery puzzle. The length of time it takes to resume regular menses varies based on factors such as rate of weight gain, exercise level, stress level, age, and genetics. One study found no correlation between the length of time a period had been missing and the length of time to recovery.
One survey of women with HA tracked how long it took for women to regain their cycle after making lifestyle changes and found that success rates increased over time:. However, the absence of regular cycles is not normal. You are encouraged to see a medical professional and ask about the possibility of a diagnosis of hypothalamic amenorrhea.
Amenorrhea
You can reduce irreversible damage to your bones by seeking help and following the lifestyle change suggestions above. Learn the best ways to manage stress and negativity in your life. Gordon, Catherine M. Ackerman, Sarah L. Berga, Jay R. Hassan Murad, Nanette F. Santoro, and Michelle P. The Journal of Clinical Endocrinology and Metabolism 5 : — Rinaldi, Nicola J. No Period , Now What? Waltham: Antica Press.
Shufelt, Chrisandra L. Table of Contents View All. What Is Hypothalamic Amenorrhea?
How a Sudden Drop or Increase Affects Your Cycle
Contributing Factors. Medical Consequences. Was this page helpful? Thanks for your feedback! Her TSH and prolactin were normal. The etiology of her FHA was explained to her, and after her laboratory tests, she was told she may be recovering, as her estradiol was normal. She was given a progestin, with withdrawal bleeding as expected. What information was she given as regards the etiology of her FHA? Was it her weight loss alone and had she gained enough weight to allow for recovery?
Not exactly, as her weight had fluctuated between It was because another factor was involved in her case, namely exogenous opiates. In addition, she was on a fentanyl patch for breakthrough pain during this time. The gradual withdrawal from opiates, coinciding with her visit, allowed menses to resume despite lack of significant weight gain.
Thus, the etiology of her amenorrhea was weight loss in the context of systemic illness, compounded by narcotics. Narcotic analgesics shut off the GnRH pulse generator and the pituitary-ovarian axis is also thus shut off [ 7 ], a finding that was illustrated many years ago [ 8 ]. While the Endocrine Society guidelines mention opiates, along with other drugs that may affect the H-P-O axis, the influence of opiates needs to be more strongly emphasized [ 3 ]. This is especially so in the current climate of liberal use and also abuse for the relief of pain in reproductive age women and also men.
A year-old patient was seen for oligomenorrhea. Her menarche was at age 13 and she had irregular cycles for a year.
Amenorrhea & Secondary Amenorrhea: Causes, Diagnosis & Treatment
She had lost Laboratory tests: Her LH was 0. Her T3 was low at 1. She had gained No menses had ensued. Repeat laboratory tests at second visit: LH With the possibility of this high LH being her LH surge, no action was taken.