Resumption of menses in anorexia nervosa during a course of family-based treatment

Abstract

BackgroundThe resumption of menses (ROM) is considered an important clinical marker in weight restoration for patients with anorexia nervosa (AN). The purpose of this study was to examine ROM in relation to expected body weight (EBW) and psychosocial markers in adolescents with AN.MethodsWe conducted a retrospective chart review at The University of Chicago Eating Disorders Program from September 2001 to September 2011 (N = 225 females with AN). Eighty-four adolescents (Mean age = 15.1, SD = 2.2) with a DSM-IV diagnosis of AN, presenting with secondary amenorrhea were identified. All participants had received a course of outpatient family-based treatment (FBT), i.e., ~20 sessions over 12 months. Weight and menstrual status were tracked at each therapy session throughout treatment. The primary outcome measures were weight (percent of expected for sex, age and height), and ROM.ResultsMean percent EBW at baseline was 82.0 (SD = 6.5). ROM was reported by 67.9% of participants (57/84), on average at 94.9 (SD = 9.3) percent EBW, and after having completed an average of 13.5 (SD = 10.7) FBT sessions (~70% of standard FBT). Compared to participants without ROM by treatment completion, those with ROM had significantly higher baseline Eating Disorder Examination Global scores (p = .004) as well as Shape Concern (p < .008) and Restraint (p < .002) subscale scores. No other differences were found.ConclusionsResults suggest that ROM occur at weights close to the reference norms for percent EBW, and that high pre-treatment eating disorder psychopathology is associated with ROM. Future research will be important to better understand these differences and their implications for the treatment of adolescents with AN.

Body composition and menstrual status in adults with a history of anorexia nervosa—at what fat percentage is the menstrual cycle restored?

“…This is in line with a newly published study, also in adults, including a smaller patient sample. 9,21 Both studies were conducted in adolescents, who were considerably younger than our patients with a corresponding shorter duration of illness. A small proportion of the entire sample (8%, n 5 20) was selected for further analyses revealing that BMI and body composition did not differ between their two outcome groups.…”

“…These results were in great contrast with the 22% body fat that was previously described as the minimum threshold for menstrual recovery. 21 However, in a couple of studies a smaller weight difference was associated with menstrual recovery. 22 A longitudinal study from 2005 8 contributed to the conflicting results regarding a threshold for menstrual recovery, reporting that even some patients resumed their menstrual cycle at a fat percentage close to 0%.…”

A systematic review of approaches to refeeding in patients with anorexia nervosa

“…In hospitalized patients, faster weight gain and higher weight upon discharge predict weight recovery at 1 year . Weight recovery is typically defined as 95% of the median Body Mass Index (%mBMI) per CDC data and is associated with the reversal of long‐term medical complications, including amenorrhea . In patients well enough to be managed in ambulatory settings, faster weight gain during the first 3–4 weeks (0.43–0.86 kg week −1 ) of outpatient psychotherapy predicts full remission (both weight and cognitive recovery) at 12 months .…”

Treatment of eating disorders in child and adolescent psychiatry

“…However, there is no consensus about the definition of a healthy body weight and, consequently, of a target weight. Recent studies on adolescent anorexia nervosa indicate an age-adapted BMI percentile of 25 as a necessary condition for the resumption of menses [16,17]; thus, this value may be recommended as a reference weight for the majority of adolescent patients.…”