Restoration of ovarian and uterine maturity in adolescents with anorexia nervosa

Key, Adrienne; Mason, Helen; Allan, Rosie; Lask, Bryan

doi:10.1002/eat.10087

Cited by 22 publications

(25 citation statements)

References 20 publications

(13 reference statements)

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“…With increasing gonadal recovery, a dominant follicle may be seen, and menstruation has been observed within a month in 50%. 43 Only 41% of adolescents recovering from AN have mature ultrasound appearance of the ovaries and uterus at a weight to height ratio of 95%, 45 illustrating the delay between weight recovery and complete recovery of gonadal function, and the importance of nutritional factors. 7 A promising new tool for monitoring recovery in AN may be inhibin B, a marker of ovarian follicular development.…”

Section: Hormone Adaptation In Anmentioning

confidence: 99%

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Jayasinghe

Grover

Zacharin

2008

BJOG

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Anorexia nervosa (AN) initiates an adaptive response at the level of the hypothalamus, which results in a complex interplay involving most elements of the neuroendocrine axis. Consequences of onset of disease in adolescence include amenorrhoea, pubertal arrest with potential loss of target height, and osteoporosis with reduced capacity for future attainment of peak bone mass. With recovery, delay in restoration of menses is common. Hormonal therapies for restoration of bone mineral density (BMD) in adolescents have shown limited efficacy. This review will discuss the reproductive endocrine effects of AN in adolescence, and discuss new investigative tools for monitoring restoration of reproductive function and BMD in this population.Keywords Adolescence, amenorrhoea, anorexia nervosa, bone mineral density, eating disorders. IntroductionNinety percent of eating disorders present before the age of 25 years, and in the early stages they may present with menstrual dysfunction. 1 Therefore, it is important that gynaecologists have a good understanding of current concepts of hypothalamic regulation, as those physicians may be the first point of contact in subsyndromal eating disorders. Leptin, a hormone produced by adipocytes, appears to be the critical link between energy homeostasis and neuroendocrine regulation. 2 Since its discovery in 1994, 3 rapid gains in understanding of the hormonal and nutritional regulation of anorexia nervosa (AN) have occurred. 4 These findings are likely to have a significant impact on clinical management of the reproductive-endocrine aspects of AN. Bone loss consequent upon estrogen deficiency may be severe, of long duration with reduced capacity for recovery. Understanding bone loss mechanisms, correct interpretation of bone density measurements and consideration of treatment modalities to ameliorate the problems of eating disorders are an essential part of overall management strategies. EpidemiologyThe Society for Adolescent Medicine together with other medical bodies has recognised that strict Diagnostical and Statistical Manual of Mental Health Disorders-IV (DSM-IV) criteria 5 for AN (particularly requiring weight below 85% of normal and amenorrhoea for 3 months), may not apply to all women. 6,7 This is particularly so in adolescents because of their normal variability in development, and also because adverse health effects occur even in partial syndromes. In adolescence, prevalence of AN is 0.5%, bulimia nervosa is 1% and partial syndromes (eating disorders not otherwise specified) is 2.4-5.0%. 6,[8][9][10] Clinical sequelaeThe clinical sequelae of AN depend on timing of disease in relation to puberty. These may include pubertal delay and primary amenorrhoea, pubertal arrest with potential loss of target height, or secondary amenorrhoea. 11-13 Amenorrhoea has been reported to precede weight loss in 20% of women, which may lead to diagnostic confusion.Low bone mineral density (BMD) is an established risk in AN, with 50% of anorexics demonstrating osteopenia within 20 months of ameno...

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Section: Hormone Adaptation In Anmentioning

confidence: 99%

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Jayasinghe

Grover

Zacharin

2008

BJOG

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“…Several authors have described the use of ultrasonographic appearances of the uterus and ovaries as a more objective, accurate, reliable and valid means of tracking progress of patients with AN (Treasure, Gordon, Wheeler & Russell, 1985;Lai, de Bruyn, Lask, Bryant-Waugh & Hankins, 1994;Key et al, 2002;Mason, Key, Allan & Lask, 2007). Their findings have suggested that the WfH ratios needed for reproductive maturity are higher than those that are generally set as targets.…”

Section: Introductionmentioning

confidence: 95%

“…Their findings have suggested that the WfH ratios needed for reproductive maturity are higher than those that are generally set as targets. For example Frisch and McArthur (1974) and Golden et al (2008) have suggested a target range of between 87 and 92% WfH whereas Lai et al (1994) and Key et al (2002), using pelvic ultrasound have found that the majority of such patients do not reach reproductive maturity with a WfH ratio below 96.5%.…”

Section: Introductionmentioning

confidence: 96%

“…Unfortunately, patient self-reporting of menstruation is frequently unreliable, since individuals may recall inaccurately, or may report small bleeds that are dysfunctional and do not represent resumption of regular ovulatory cycles or report fictitious menstruation to avoid further weight gain (Key et al, 2002). Also, the resumption of regular menses, whilst an important milestone in reproductive maturity, represents the end point of a developmental process.…”

Section: Introductionmentioning

confidence: 98%

“…However, target weights are not consistently reliable at predicting onset of menstruation (Key, Mason, Allan & Lask, 2002). More recently, the use of target body mass index (BMI) percentiles has been proposed as a more reliable option (Golden, Jacobson, Sterling & Hertz, 2008) in a study of two groups of patients who either did or did not resume menstruation following treatment for AN.…”

Section: Introductionmentioning

confidence: 99%

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Predicting the weight gain required for recovery from anorexia nervosa with pelvic ultrasonography: An evidence‐based approach

Allan

Sharma

Sangani

et al. 2010

Euro Eating Disorders Rev

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Target weights are an arbitrary means of determining return to physical health in patients with anorexia nervosa (AN) and lack reliability and validity. Transabdominal pelvic ultrasound scanning (U/S) offers a more objective method of ascertaining physical well being by the ability to determine reproductive maturity. This study aimed to explore the correlations between the maturity grading on pelvic U/S and weight for height (WfH) ratios and body mass index (BMI) percentiles. Ultrasound studies were performed in 72 female adolescents (aged 11-17 years at intake) with AN. Scans were graded for maturity using published parameters of pelvic maturity and compared with the patient's WfH ratio and BMI percentile. In our sample was a wide variation of WfH ratios and BMI percentiles at each grade of maturity. This supports the view that arbitrary targets for weight, WfH ratio or BMI percentile are likely to be unnecessarily high for some patients and too low for others. We recommend that targets be based upon baseline pelvic U/S grading and follow-up scanning.

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Reproductive health outcomes in eating disorders

Linna

Raevuori

Haukka

et al. 2013

Intl J Eating Disorders

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Restoration of ovarian and uterine maturity in adolescents with anorexia nervosa

Cited by 22 publications

References 20 publications

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Current concepts in bone and reproductive health in adolescents with anorexia nervosa

Predicting the weight gain required for recovery from anorexia nervosa with pelvic ultrasonography: An evidence‐based approach

Reproductive health outcomes in eating disorders

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