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Diagnosis: period

Posted Aug 24 2008 3:34pm

One of the big debates for the next edition of the Diagnostic and Statistical Manual ( DSM ) is the use of amenorrhea as a criterion for anorexia. Some of the issues raised include:

--Girls who haven't reached puberty

--Women in menopause

--Women on oral contraceptives


Furthermore, even women who meet the weight criteria for anorexia might not lose their periods. This is especially true as women get older. My very well researched slightly random opinion is that menstruation is better established once women hit 20 and older. Which means that it takes more damage to the body before menstruation ceases. There are also plenty of teens who don't lose their periods, and there are plenty of older women who do.

So what are we to make of this? Can amenorrhea be a clinical criterion for anorexia? If it can, should it be?

Researchers at the New York State Psychiatric Institute looked at this issue in recent research published in the International Journal of Eating Disorders. From a clinical standpoint, does amenorrhea really make a difference - They found that women who had lost their periods had a lower lifetime BMI and a lower BMI when admitted to the inpatient unit. However, no other significant differences were found. The researchers concluded:

"These results indicate that amenorrhea does not distinguish between groups on a number of important measures of clinical severity. It may be that amenorrhea reflects weight and nutritional status, rather than providing useful diagnostic information . Future studies are needed to examine the potential prognostic value of menstrual status."

(Emphasis mine)

The bolded sentence leads me to a second study in the Journal of Adolescent Health titled " Irregular menses linked to vomiting in a nonclinical sample ." The title basically reflects what they saw: girls who vomited even one to three times per month were 1.5 times more likely to have irregular periods. And this is far from the clinical criteria for bulimia. The risk for irregular menses was 3 times higher for girls who vomited once a week. These findings held true even when underweight and overweight girls were excluded from the sample. The researchers also controlled for "other eating disorder symptoms, weight status, age, race/ethnicity, and school clusters."

Remember: these are not girls with clinical eating disorders. Certainly vomiting for weight control is a HUGE sign for disordered eating. But amenorrhea may be a sign that something is going wrong with your endocrine system.

So perhaps maybe amenorrhea isn't useful as a diagnostic criterion. But it can (and perhaps should ) be used as an indicator of issues with physical and mental health.
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