Secondary amenorrhea due to excessive weight loss or weight disorders
A woman’s weight has a very important effect on the regulation and release of gonadotropins. In fact, the cycle may not occur if the Body Mass Index (BMI) is less than 19 kg/m2.
Fat plays a very important role in the regulation of the hypothalamic-pituitary-ovarian axis and it has been estimated that 22% of body weight must be represented by adipose tissue in order to maintain normal ovulatory cycles.
As a result, girls who are severely underweight prior to development may experience primary amenorrhea, while those who are severely underweight after puberty may experience secondary amenorrhea.
For there to be weight-related secondary amenorrhea, weight loss must be 10-15% of normal weight calculated as a function of the woman’s height.
Weight can be lost for a variety of reasons including voluntarily abstaining from food, prolonged fasting, excessive exercise or illness. Each of these causes can lead to a reduction in the secretion of gonoadotropins and therefore to the absence of the menstrual cycle.
Anorexia nervosa is responsible for a large part of the causes of secondary amenorrhea, a widespread problem nowadays also due to the pressures of a society increasingly based on external appearance. I too suffered from it as a teenager and therefore I can say that I know the problem very well and closely.
In these cases the patients can be managed in collaboration with the psychiatrist, and it is essential to encourage weight gain. Weight-related amenorrhea can have long-term effects. If it occurs before peak bone density is reached (before the age of 25), the likelihood of suffering from severe osteoporosis increases.
On the other hand, ovulatory function slowly returns as nutrition and adequate weight are restored. The return of the cycle to normal weight recovery is not immediate, it could take weeks, months or even more for ovarian activity to recover. However, it is always a good idea to keep the hormonal values monitored and to carry out all the necessary checks to rule out other problems.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.