Return of Menses in Previously Overweight Patients with Eating Disorders

Medical complications and management of atypical anorexia nervosa

“…Similarly, for patients without available growth records, we suggest using the clinical signs of recovery as above. One study of females with AAN showed that patients who were previously overweight did need to gain weight in order to resume menses, though slightly less than females with typical AN, 7.2 ± 5.9 kg compared with 8.9 ± 5.1 kg, p = 0.25 [22]. Seetharaman et al found that in females who were previously overweight, resumption of menses occurred on average at 106.1% ± 11.7% median BMI, compared to 94.2 ± 8.9 in those who were not previously overweight (p < 0.001) [31].…”

“…Significant derangements in hypothalamic-pituitarygonadal (HPG) function due to malnutrition have been described in AAN. Malnutrition suppresses pulsatile release of gonadotropic releasing hormone leading to amenorrhea in females and suppression of testosterone in males in AAN [22]. Sawyer et al noted in a study including 42 patients with AAN, 33% presented with secondary amenorrhea and an additional 7% of patients with AAN had missed 1 or 2 consecutive menstrual periods prior to presentation [3].…”

“…Determining the patient's treatment goal weight should be individualized and based on the individual's previous growth trajectory, which may translate to a treatment goal weight above the 50th percentile BMI for age. For adolescent patients who were previously above the 95th percentile BMI, we suggest using the patient's vital signs and menstrual history (in individuals assigned female sex at birth) to guide treatment goal weight; if vital signs and menses stabilize before reaching the patient's premorbid weight, additional weight gain may not be necessary [22]. Similarly, for patients without available growth records, we suggest using the clinical signs of recovery as above.…”

The Reproductive Impact of Eating Disorders in Adolescents

“…29 However, amenorrheic adolescent women with eating disorders who were premorbidly overweight may have to be at higher BMI for return of menses compared with previously normal weight peers. 32,33 Even despite adequate weight gain and normalization of eating disorder behavior, there still may be a delay of 6 months or longer until return of menses. 34,35…”

Adolescents with anorexia nervosa or atypical anorexia nervosa with premorbid overweight/obesity: What should we do about their weight loss?

“…This finding is reassuring as medical complications of patients with premorbid overweight/obesity need to be thoroughly examined and monitored by medical providers. They often present with greater velocity and larger percentage of weight loss (Lebow et al, 2015; Meierer et al, 2018), have more significant bradycardia (Meierer et al, 2018), and similar rates of amenorrhea (Rastogi Ba et al, 2019) compared to their more recognizable, underweighted counterparts. Additionally, they present with similar psychiatric concerns, such as depression, anxiety (Moskowitz & Weiselberg, 2017), emotion dysregulation (Harrison et al, 2012), and suicidality (Yao et al, 2016).…”