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Menstrual and Uterine Disorders
Diagnostic Evaluation of Amenorrhoea Related to Weight Control
Metella Dei,
1
Floriana Di Maggio
2
and Vincenzina Bruni
1
1. Paediatric and Adolescent Gynaecology Unit, University of Florence; 2. Adolescent Health Services, Naples
Abstract
Menstrual ailments are frequently the motivating factor for subjects with eating disorders to seek medical help. A careful clinical history,
the evaluation of body mass index (BMI) and body composition parameters (fat and lean mass) and specific endocrine tests can clarify the
diagnosis. Along with the pathogenesis of the hypothalamic dysfunction related to poor energy availability, low FT3, insulin and leptin levels
and high cortisol concentrations are useful diagnostic markers, together with luteinising hormone (LH) levels in the low range. An attentive
therapeutic approach in co-operation with competent psychologists and dieticians is needed to overcome negative weight control
behaviour and, consequently, to resume menstrual function.
Keywords
Eating disorders, menstrual dysfunction, diagnostic markers
Disclosure: The authors have no conflicts of interest to declare.
Received: 20 January 2009 Accepted: 23 February 2009
Correspondence: Metella Dei, Via il Prato 67, 50123 Florence, Italy. E: meteldei@alice.it
The prevalence of eating disorders in young women is probably and the average time devoted to it (see Table 1). The evaluation of
underestimated. Adhering strictly to the criteria of the Diagnostic and nutrient intake using a three-day dietary record could be a useful
Statistical Manual of Mental Health Disorders IV (DSM-IV),
1
the incidence approach as long as the self-report is reliable. A dietician can help
of anorexia nervosa and bulimia nervosa is around 0.5% and around to estimate the mean daily energy intake of the patient so that we
2%, respectively. However, if we take into consideration the entire can gauge whether the energy available is lower than the threshold
broad spectrum of eating disorders and weight control that may be required for the maintenance of normal hormonal pulsatility and
associated with a compulsive desire to keep fit, the prevalence reproductive function based on the value proposed by Loucks of
reaches almost epidemic levels. The definitions of eating disorders 30kcal/kg fat-free mass (FFM) per day.
2
A qualitative evaluation of
not otherwise specified (EDNOS) may not encompass all situations the nutrients is also important because a hyperproteic diet (where
that present in clinical settings. protein accounts for more than 25–30% of calories consumed each
day) with relatively insufficient carbohydrate intake (less than 45%
A very large percentage of girls with serious disorders in the earlier of total calories) is common and has a negative effect on
stages of puberty or disturbances of eating behaviour without neuroendocrine function.
serious psychopathological involvement present with menstrual
dysfunction. Consequently, gynaecologists are frequently the first We generally consider a body mass index (BMI) (weight in
medical contacts for such patients, and clearly early identification kilograms/height m
2
) below 18 to be a risk marker for menstrual
makes it possible to plan a correct management strategy and, at disorders; however, this measurement is influenced by gynaecological
least partially, to avoid the clinical sequelae of drastic weight loss. An age, increased lean body mass in subjects who perform physical
understanding of the serum markers that identify the adaptive activity and individual metabolic homeostasis. It is well documented
responses of the body to energy deficiency and of the possible that 25% of underweight patients still have regular menstrual cycles.
3
complications (especially bone loss) is of paramount importance for For the same reason, the calculation of ideal bodyweight according to
a correct diagnosis. Lorenzi’s formula is not always useful. The changes in BMI values in
the individual over time are a more valuable diagnostic marker.
Clinical History, Anthropometric
Measurements and Ultrasonographic Data The study of body composition yields a better understanding. The
A detailed interview about eating preferences and habits, recent most widely accepted method for studying body composition in
changes in weight and significant life events that could have patients with suspected eating disorders is dual-energy X-ray
triggered the emergence of a disturbance in eating behaviour can absorptiometry (DEXA), which enables the simultaneous evaluation
sometimes be illuminating. Involvement in physical activity needs of bone mineral density, total fat mass, per cent fat mass and lean
to be thoroughly documented and the total weekly energy body mass (both total and related to specific areas of the body). From
expenditure estimated according to the type of sport undertaken a diagnostic point of view, the fat mass percentage is particularly
© TOUCH BRIEFINGS 2009 17
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