From the Guidelines
The initial management of amenorrhea associated with eating disorders should focus on weight restoration and nutritional rehabilitation, with a target of reaching at least 90% of ideal body weight, as recommended by the American Psychiatric Association 1. The management plan should include a comprehensive review of systems, assessment of vital signs, and laboratory tests, such as a complete blood count and comprehensive metabolic panel, to identify any co-occurring health conditions 1. Patients should aim for a gradual weight gain of 0.5-1 kg per week for outpatients or 1-1.5 kg per week for inpatients, with nutritional counseling establishing a meal plan of approximately 1500-1800 calories initially, gradually increasing to 3000-4000 calories daily as needed 1. Hormonal replacement therapy, such as combined oral contraceptives, is generally not recommended as first-line treatment, as it may mask the biological marker of malnutrition that amenorrhea represents and create a false sense of normalcy 1. Psychological interventions, particularly cognitive behavioral therapy, family-based therapy for adolescents, and treatment of any comorbid psychiatric conditions, are essential components of care 1. Amenorrhea typically resolves when weight is restored to approximately 90% of ideal body weight, though this may take 6-12 months after weight restoration 1. The physiological basis for amenorrhea in eating disorders involves hypothalamic dysfunction due to energy deficit, leading to suppression of gonadotropin-releasing hormone pulsatility and subsequent reduction in luteinizing hormone and follicle-stimulating hormone secretion 1.
Some key points to consider in the management of amenorrhea associated with eating disorders include:
- Weight restoration and nutritional rehabilitation as the primary goal
- Comprehensive review of systems and assessment of vital signs
- Laboratory tests to identify co-occurring health conditions
- Gradual weight gain and nutritional counseling
- Psychological interventions, such as cognitive behavioral therapy and family-based therapy
- Avoidance of hormonal replacement therapy as first-line treatment
- Monitoring for resolution of amenorrhea and improvement in overall health.
From the FDA Drug Label
Progesterone, USP Capsules are used for the treatment of secondary amenorrhea (absence of menstrual periods in women who have previously had a menstrual period) due to a decrease in progesterone. Progesterone, USP Capsules may be given as a single daily dose of 400 mg at bedtime for 10 days.
The initial management of amenorrhea associated with eating disorders may involve the use of progesterone to induce withdrawal bleeding.
- The recommended dose is 400 mg at bedtime for 10 days.
- This treatment may help regulate menstrual cycles in women with secondary amenorrhea due to a decrease in progesterone levels 2.
- However, it is essential to note that this treatment should be used under the guidance of a healthcare provider, as it may have potential side effects and interactions with other medications.
- Additionally, addressing the underlying eating disorder through a comprehensive treatment plan, including nutritional counseling and psychological support, is crucial for overall health and well-being.
From the Research
Initial Management of Amenorrhea Associated with Eating Disorders
The initial management of amenorrhea associated with eating disorders involves a multidisciplinary approach, focusing on restoration of nutritional status and somatic health, as well as psycho-educational counseling and support for the patient and their family 3.
Key Components of Treatment
- Restoration of nutritional status through an individualized diet plan based on a healthy consumption pattern 4
- Treatment of complications and comorbidities 4
- Nutritional education based on healthy eating and nutritional patterns 4
- Correction of compensatory behaviors and relapse prevention 4
- Psychotherapy, which is the most effective treatment modality for eating disorders 5
Hormone Therapy
Hormone therapy, including estrogen or birth control pills, is not recommended for young women with anorexia nervosa and amenorrhea, as it may create a false picture of protected skeletal health and reduce motivation to regain weight and adhere to treatment 6.
Importance of Weight Restoration
Restoration of menstrual periods through increased nutrition is a crucial intervention, and weight gain is associated with resumption of menses 7. Patients who regained menses within 1 year had gained an average of 7.3% of their ideal body weight 7.
Treatment Settings
Treatment may be performed in outpatient clinics, day hospitals, or ambulatory clinics, depending on the patient's clinical situation, and hospitalization may be necessary in cases of serious medical or psychiatric complications 4.