Predictors of the resumption of menses in adolescent anorexia nervosa

Abstract

BackgroundThe resumption of menses is an important indicator of recovery in anorexia nervosa (AN). Patients with early-onset AN are at particularly great risk of suffering from the long-term physical and psychological consequences of persistent gonadal dysfunction. However, the clinical variables that predict the recovery of menstrual function during weight gain in AN remain poorly understood. The aim of this study was to investigate the impact of several clinical parameters on the resumption of menses in first-onset adolescent AN in a large, well-characterized, homogenous sample that was followed-up for 12 months.MethodsA total of 172 female adolescent patients with first-onset AN according to DSM-IV criteria were recruited for inclusion in a randomized, multi-center, German clinical trial. Menstrual status and clinical variables (i.e., premorbid body mass index (BMI), age at onset, duration of illness, duration of hospital treatment, achievement of target weight at discharge, and BMI) were assessed at the time of admission to or discharge from hospital treatment and at a 12-month follow-up. Based on German reference data, we calculated the percentage of expected body weight (%EBW), BMI percentile, and BMI standard deviation score (BMI-SDS) for all time points to investigate the relationship between different weight measurements and resumption of menses.ResultsForty-seven percent of the patients spontaneously began menstruating during the follow-up period. %EBW at the 12-month follow-up was strongly correlated with the resumption of menses. The absence of menarche before admission, a higher premorbid BMI, discharge below target weight, and a longer duration of hospital treatment were the most relevant prognostic factors for continued amenorrhea.ConclusionsThe recovery of menstrual function in adolescent patients with AN should be a major treatment goal to prevent severe long-term physical and psychological sequelae. Patients with premenarchal onset of AN are at particular risk for protracted amenorrhea despite weight rehabilitation. Reaching and maintaining a target weight between the 15th and 20th BMI percentile is favorable for the resumption of menses within 12 months. Whether patients with a higher premorbid BMI may benefit from a higher target weight needs to be investigated in further studies.

Treatment of eating disorders in child and adolescent psychiatry

“…However, there is no consensus about the definition of a healthy body weight and, consequently, of a target weight. Recent studies on adolescent anorexia nervosa indicate an age-adapted BMI percentile of 25 as a necessary condition for the resumption of menses [16,17]; thus, this value may be recommended as a reference weight for the majority of adolescent patients.…”

Obstetric and gynecologic problems associated with eating disorders

“…Reaching and maintaining a target weight between the 15th and 20th BMI percentile is recommended as a favorable treatment goal for resumption of menses within 12 months as found in a study of 172 adolescent patients with first‐onset AN . Of note, patients with higher BMI prior to onset of AN were not as likely to resume menstruation, which provides further evidence for reaching the weight at which the cessation of menses occurred at least in some subgroups of patients . In one small study of adolescents with AN, when compared with those who had persisting amenorrhea, those that had resumption of menses had a significantly higher mean weight (48.4 kg v 43.8 kg), mean weight per height (96.5% vs. 87.5%), mean ovarian volume (6.2 mL vs. 4.9 mL), and mean uterine volume (14.6 mL vs. 10.8 mL) .…”

“…The literature regarding the degree of weight restoration needed for resumption of menses is conflicting; some experts advocate a goal of reaching ninety percent of ideal body weight and others recommend a goal of the weight at which cessation of menses occurred , . Reaching and maintaining a target weight between the 15th and 20th BMI percentile is recommended as a favorable treatment goal for resumption of menses within 12 months as found in a study of 172 adolescent patients with first‐onset AN . Of note, patients with higher BMI prior to onset of AN were not as likely to resume menstruation, which provides further evidence for reaching the weight at which the cessation of menses occurred at least in some subgroups of patients .…”

Neue Aspekte bei der Behandlung der adoleszenten Anorexia nervosa

“…The aim of this short review is to introduce new as pects on the somatic and psychotherapeutic treat ment of AN, such as nutritional rehabilitation, prophylaxis of osteoporosis as well as new fin dings on the effect of treatment settings and new psychotherapeutic methods. für das verzögerte Eintreten der Menstruation trotz Gewichts normalisierung ist ein prämenarchaler Krankheitsbeginn [9]. Hinweis auf die Normalisierung der endokrinen Funktionen ist in erster Linie die Normalisierung des Zyklus.…”

“…Ein wesentlicher prognostischer Indikator hierfür ist ein adäquates Ziel-bzw. Ent lassungsgewicht [9,10]. In der Literatur finden sich sehr wider sprüchliche Angaben zu seiner Höhe, die zwischen der 10. und 75.…”