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CARS Archives

Stress Amenorrhea and Caloric Intake- an Important Relationship
Title: Functional hypothalamic amenorrhea: hypoleptinemia and disordered eating
Author: M. Warren et al.
Address: New York, New York
Source: Journal of Clinical Endocrinology and Metabolism 84: 873-877 (March) 1999
Summary: Functional hypothalamic amenorrhea (FHA) tends to be a diagnosis of exclusion with precise etiology of FHA unknown. While commonly thought to be stress induced, recent findings indicate that FHA may be due to metabolic/nutritional insult. This controlled and carefully matched study( age ,height, weight) compares 14 amenorrheic non-athletic subjects with 14 cycling control subjects. Study subjects initially denied eating disorder behaviors although through the use of a detailed questionnaire, scores of abnormal eating patterns (bulimia especially) were found to be twice as likely in the study group when compared to the control group of women. The amenorrheic study group expended more than twice the energy via high intensity exercise and had twice the fiber intake as the control group. Leptin, T4 and T3 and total T4 levels were significantly reduced in the study group. TSH did not reveal significant differences. Bone mineral density (BMD) was significantly lower in study subjects at the wrist with a trend for lower BMD appearing in the spine. Emotional distress and depression scores were comparable in both groups. The suggest that "FHA may be a function of altered metabolic state due to nutritional alteration or energy expenditure than purely stress induced." It is also thought (and suggested in other studies) that nutritional abnormalities in FHA are subtle and that small or unreported nutritional insufficiencies such as those uncovered in the questionnaire) may actually cause "idiopathic" hypothalmic amenorrhea.
Comment: In the past a complex theory of percent of body fat and weight was used to explain FHA, usually called stress or weight-related amenorrhea. It now seems that it is the body's energy requirements and an issue of caloric intake. This is an important concept in diagnosis and intervention.

 

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