بی نظمی قاعدگی در بولیمیا (پرخوری عصبی): عوامل مرتبط با تغییرات و با درمان

Objectives: This study determined the clinical and nutritional variables associated with menstrual disturbance in women with bulimia nervosa (BN). Methods: Eighty-two women with DSM-IV BN underwent psychiatric, nutritional and menstrual related assessments prior to an outpatient treatment programme and at 12 months follow-up. Results: Forty-five percent reported a current irregular menstrual cycle. A high frequency of vomiting, low thyroxine concentrations and low dietary fat intake were independently associated with irregular menses at pretreatment. At 12 months follow-up, 30.5% reported irregular menstrual cycles. A greater difference between past maximum and minimum body weight, smoking and depression were associated with menstrual irregularity at 12 months follow-up. Of those with irregular menstrual cycles at pretreatment, 56.8% became regular at 12 months follow-up. Conclusion: Menstrual irregularity in BN is associated with indices of nutritional restriction that are not reflected by low body weight or energy intake. Depression, cigarette smoking and fluctuations in body weight may act as metabolic stresses that contribute to the perpetuation of menstrual disturbances.

Disturbances in menstrual cycle function are commonly associated with eating disorder pathophysiology. Amenorrhea occurs almost universally in anorexia nervosa and is thought to be a consequence of malnutrition-induced impairments in gonadotropin (particularly luteinizing hormone (LH)) secretory patterns [1]. Despite maintenance of normal body weight, in bulimia nervosa (BN), amenorrhea may occur in 7–40% of patients [2], [3], [4], [5] and [6]. The occurrence of irregular menstrual cycles (oligomenorrhea) appears to be more common. Studies have consistently found that oligomenorrhea occurs within the range of 37–64% of women with BN [3], [7], [8], [9] and [10]. The exact etiology of menstrual dysfunction in BN is yet to be clarified. Biochemical studies have shown that menstrual disturbances in BN are associated with reduced oestradial [11], noradrenalin [12] and LH concentrations, and reduced LH pulse frequency [13] and [14]. Ultrasonograpghy has revealed abnormal ovarian morphology in BN with 76–100% of patients having polycycstic ovaries [10] and [15]. Polycycstic ovary syndrome is a common cause of oligomenorrhea in normal women and is associated with an insulin-induced elevation in circulating androgen concentrations [16]. Thus, it has been suggested that abnormalities in insulin secretion as a result of large fluctuations in food intake may be responsible for the very high prevalence of polycycstic ovary syndrome in BN [10]. Clinical variables that have been associated with menstrual disturbance in normal weight BN include a current weight that is 85% less than past high weight [12], a history of anorexia nervosa and a past weight loss to less than 92% of the ideal body weight [17]. The present analysis determined the association between clinical and nutritional variables and menstrual disturbance in women presenting for treatment with normal weight BN. In addition, we investigated factors associated with the continuation of menstrual disturbance at 12 months follow-up.