Nutritional amenorrhoea: long-term sequelae

Joanna L. Fried; Russalind Ramos; Michelle P. Warren

doi:10.1017/CBO9780511527036.040

39 - Nutritional amenorrhoea: long-term sequelae

from Part III - Management of specific disorders

Published online by Cambridge University Press: 04 May 2010

Russalind Ramos and

Edited by

Jane MacDougall and

Joanna L. Fried: Affiliation:
Columbia Presbyterian Medical Center, New York, USA
Russalind Ramos: Affiliation:
Columbia Presbyterian Medical Center, New York, USA
Michelle P. Warren: Affiliation:
Columbia Presbyterian Medical Center, New York, USA
Adam H. Balen: Affiliation:
Leeds Teaching Hospitals, University Trust
Sarah M. Creighton: Affiliation:
University College London Hospitals
Melanie C. Davies: Affiliation:
University College London
Jane MacDougall: Affiliation:
Addenbrooke's Hospital, Cambridge
Richard Stanhope: Affiliation:
Great Ormond Street Hospital

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Summary

Introduction

The amenorrhoea associated with energy deficit or nutritional imbalance has far-reaching long-term effects, including reduced bone density, stress fractures, osteopenia, osteoporosis, and infertility. This can be illustrated by referring to EG, a 54-year-old woman. She is a former professional ballet dancer who has performed on stages all over the world. Today, she relies on a walker in order to get from place to place. After a lifelong struggle with anorexia nervosa, she suffers from severe osteoporosis. She has suffered numerous fractures in the last 20 years and today her bone mineral density (BMD) is comparable to that of an 80-year-old woman. This is an extreme, though not uncommon, result of long-term nutritionally induced amenorrhoea.

Figure 39.1 shows the BMD scans for three women: a normal 25-year-old woman with regular periods; a 25-year-old woman who has had amenorrhoea for 5 years and has 30% lower total bone mass than most women her age; and a woman in her thirties with a 15 year history of amenorrhoea and osteoporotic bones.

There are a number of different environmental stressors thought to be associated with hypothalamic amenorrhoea (HA). Reproductive function may be affected by weight loss, exercise, nutritional deprivation or emotional stress. Recent research suggests that it may be an adaptive response to chronic low energy intake, and that metabolic factors may mediate reproductive adaptations in response to nutritional insults.

Type: Chapter
Information: Paediatric and Adolescent Gynaecology
A Multidisciplinary Approach
, pp. 522 - 532

DOI: https://doi.org/10.1017/CBO9780511527036.040 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2004

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