The Menstrual Cycle and Eating Disorders

Eating disorders bring with them the possibility of long-term health effects, and disruption to the menstrual cycle is just one of these possibilities. Particularly with anorexia, low reproductive hormones have been reported in severe cases and the absence of menstrual periods is actually required before this eating disorder can be diagnosed. Though these disruptions won’t necessarily have long-term effects on a woman’s reproductive health, there is also no guarantee that they won’t.

Amenorrhea

One of the diagnostic criteria of anorexia is the loss of the menstrual period for at least three months. This loss is known as amenorrhea. In anorexics, severe weight loss (resulting in weight of at least 15% less than a normal body weight for the woman’s age and height) reduces fat stores in the body which in turn reduce thyroid levels but results in an increase of the stress hormone cortisol. This state, known as hypercortisolism, then reduces reproductive hormones. When reproductive hormones are insufficient to regulate the monthly menstrual cycle, amenorrhea or the cessation of monthly periods occurs.

In the short term, amenorrhea poses few health risks and is usually reversed when weight is put back on, fat is stored in the body and cortisol levels reduce to appropriate levels. In the long-term, however, the low oestrogen levels associated with amenorrhea can cause a woman’s bones to fail to reach proper growth levels or for the woman to develop osteoporosis, a condition in which bone mineral density is reduced and bones become porous and susceptible to breaks. For this reason, if a female reaches a state of amenorrhea medical help should be sought immediately.

Low Reproductive Hormones

Though low levels of reproductive hormones is a feature of the amenorrhea that results from severe weight loss and low body weight, some studies have reported that in 30 – 50% of cases of anorexia, disturbances to the menstrual cycle were present before severe weight loss ever occurred and indeed remained problematic even after weight was put back on. This has led researchers to believe that in fact some menstrual disturbances precede anorexia, though no causal link has been found between low reproductive hormones and resulting eating disorders.

Treating Menstrual Cycle Disruptions and Eating Disorders

Menstrual cycle disruptions, when they occur in relation to eating disorders, are treated as part of a holistic treatment plan. The first things treated in cases of anorexia are any physical health issue. Sometimes this will require hospital or clinic stays. When an anorexic regains some physical health, they general reach a more healthy weight and menstrual cycles often return on their own. Once some physical health is restored, mental health issues can be addressed. Often these treatments include counselling or talk therapy, family counselling, cognitive behaviour therapy (to change food, eating and/or exercise behaviours), the use of support groups or group therapy, and nutritional counselling and planning. Rarely is medication used to treat anorexia unless it is prescribed to treat associated condition such as depression. Some synthetic hormones may be used to supplement naturally lower levels of hormones, but this will always be done under medical supervision.

Further information about menstrual cycle disruptions and eating disorders should be obtained from a GP, private mental health professional or from the Eating Disorders Association and/or National Centre for Eating Disorders.

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