Amenorrhoea and Anorexia Nervosa in Adolescent Girls

Abstract

Anorexia nervosa (AN) is characterized by an intense fear of becoming fat despite an obvious thinness and extreme behaviours for weight loss, such as food restriction with or without self-induced vomiting or use of laxatives. The result is a massive weight loss and/or pathological thinness. Amenorrhoea is an important associated feature of the disease. Amenorrhoea in AN is related to a functional hypothalamic disorder. Levels of gonadal steroids are low and secretion of gonadotropin releasing hormone (GnRH) is also reduced. Amenorrhoea is involved in bone mineral density deficits and possibly to some cognitive impairment found in AN. Until the last revision diagnostics criteria, one of the necessary criteria for the diagnosis of AN was amenorrhoea. Amenorrhoea was removed as a diagnostic criterion for AN in DSM-5 mainly because amenorrhoea reflects nutritional state rather than illness severity, and this requirement is irrelevant diagnosis for men and for females taking oral contraceptives. To date, oestrogens replacement showed no significant benefit in AN. Further studies with a better subgroups characterized and an assessment of a possible long-term protective effect are needed.