Bulimia from a gynecological view: hormonal changes

Abstract

Gynecological problems are one of the most frequent somatic complications of eating disorders. The purpose of the present study was to assess the role of improper eating habits in the aetiology of menstrual disturbances, anovulation and hormonal related changes. Bulimia nervosa is the focus of attention since amenorrhea is considered a diagnostic criterium in anorexia nervosa. Subjects of the BITE (Bulimia Investigation Test, Edinburgh) test who were infertile were studied (n = 58) In the studied population there were 6 cases of clinical and 8 cases of subclinical bulimia nervosa. Symptoms and severity subscales of the BITE test significantly correlated with body mass index (p = 0.003). All 14 patients suffering from clinical and subclinical bulimia nervosa had pathologically low FSH and LH hormone levels. In those with clinical bulimia nervosa (n = 6) we diagnosed 4 cases of multicystic ovary (MCO) and in the eating disorder not otherwise specified (EDNOS) group (n = 22) there were 2 cases of MCO and 5 cases of polycystic ovary syndrome (PCOS). The results suggest that unsatisfactory nutrition (binges and "crash diet") in bulimia nervosa results in hormonal dysfunction, menstrual disturbances and infertility. The authors question the necessity for immediately estrogen replacement: they consider the reversibility of the hormonal status by early treatment of eating disorders is more appropriate. Excessive use of hormonal contraceptives in therapy has to be questioned.

Detrimental psychological outcomes associated with early pubertal timing in adolescent girls

“…Although early maturing girls begin to produce DHEAS prior to peers, they do not seem to differ in overall levels of DHEAS production (Vihko & Apter, 1984). In fact, the symptoms of eating disorders --particularly binging and restricting dieting --can actually result in dysfunctional hormone levels (Resch, Szendei, & Haasz, 2004). This renders conclusions about the role of biology in eating pathology and early menarche particularly nebulous.…”

Eating Disorders and Menstrual Dysfunction in Adolescents

“…Menstrual dysfunction in BN is associated with disruption of the HPG axis. Some normal‐weight women with BN have low LH and FSH levels, low estradiol, and reduced 24‐hour LH secretion patterns 34,80–85 …”

“…Some normal-weight women with BN have low LH and FSH levels, low estradiol, and reduced 24-hour LH secretion patterns. 34,[80][81][82][83][84][85] There is also an association between BN and polycystic ovary syndrome (PCOS) which may contribute to the menstrual dysfunction observed in woman with BN. The prevalence of PCOS in BN has been reported to be as high as 76-100% when only ovarian morphology is examined using ultrasound.…”

Sex differences in the physiology of eating

“…In addition, testosterone levels are decreased in symptomatic women with anorexia nervosa and increased in symptomatic women with bulimia nervosa (30,504,709). Changes in gonadal steroid hormone levels, however, are consequences of weight loss and extreme dieting rather than being causes of disordered eating (7,30,277,483,586). Nevertheless, pharmacological treatments that affect gonadal hormone levels may be useful in the treatment of disordered eating, as least in selected patients (30,63,334,366,483,504).…”