Anorexia Nervosa and otherWeight-Loss-Associated Amenorrheas

The human female reproductive system is regulated by complex neuroendocrinological control mechanisms that are exquisitely sensitive to changes in both the endogenous central and peripheral endocrine milieus as well as to modifying factors in the environment. A loss of body weight is one such factor that may be induced by internal or external motivation and that may result in hypothalamic- pituitary-ovarian dysfunctions manifested by menstrual disturbances. The extent to which menstrual aberrations occur after weight loss is quite variable, ranging from the amenorrheas associated with anorexia nervosa to the lesser, concerning oligomenorrheas usually seen with bulimia, simple weight loss, or as part of exercise programs. To attribute menstrual changes in these situations solely to alterations in body weight, however, would be unrealistically simplistic. Reproductive dysfunctions attributable to undernutrition are complicated in their etiology and, although poorly understood, are thought to involve not only peripheral endocrine changes due to a loss of weight, but also central modifications of neuroendocrine reproductive cycle control brought about by psychodynamic stress and metabolic and neural inputs to the hypo- thalamic-pituitary axis.1