Impacts of amenorrhea on fertility and pregnancy outcomes
in patients with anorexia nervosa
A literature Review Study
Alkaissi A, PhD
Faculty of Higher Studies
Nursing and Midwifery Department
An-Najah National University, Nablus-Palestine
Introduction: Anorexia nervosa (AN) has the highest mortality of all psychiatric conditions (Treasure et al 2005). It was believed that pregnancy in females with anorexia nervosa was rare, because of the endocrinological, and psychosocial aspects of the disorder (Strimling 1984). Some studies suggest that fertility may not be compromised (Bulik et al 1999).
Objective: To investigate the effects of amenorrhea on fertility and pregnancy outcome in patients with anorexia nervosa.
Method: An extensive review of the literature was undertaken. CINAHL and MEDLINE were used to locate international publications on this topic.
Results: AN is associated with multiple endocrine abnormalities. Hypothalamic monoamines (especially serotonin), neuropeptides (especially neuropeptide Y and cholecystokinin) and leptin are involved in the regulation of human appetite, and in several ways they are changed in anorexia nervosa. AN appears to be a reflection of the female ability to alter maturation rates and reproductive function in response to environmental conditions (Surbey 1987).
Amenorrhea occurs when there is relative caloric deficiency due to inadequate nutritional intake for the amount of energy expended (Laughlin et al 1998, Loucks et al 1998). Increased secretion of corticotropin-releasing hormone and proopiomelanocortin seems to be secondary to starvation, however, there is evidence that it may maintain and intensify anorexia, excessive physical activity and amenorrhea. Hypothalamic amenorrhea, is not solely related to the low body weight and exercise. Growth hormone resistance with low production of insulin-like growth factor I and high growth hormone secretion reflect the nutritional deprivation. (Støving 1999).
The physical appearance of a young woman with active anorexia may reveal muscle wasting, minimal breast tissue, and vaginal atrophy. Many women cease to menstruate and are not fertile during severe periods (Bulik 1999). A history of infertility may be another indicator of past eating disorders. Among women who presented for treatment of infertility in one study, as many as 17 percent had a diagnosed eating disorder (Stewart 1987). Both actively ill women and women with a history of anorexia nervosa have a higher rate of miscarriage than healthy women (Gieleghem 2002).
Conclusion: By maintaining a normal weight, girls can prevent primary amenorrhea caused by excessive weight loss. Thus, novel approaches are urgently needed.
Key words: amenorrhea; anorexia nervosa; infertility; pregnancy;