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Eating disorders and
reproductive
disturbances
Błażej Męczekalski
04/16/21
1
Eating disorders and
reproductive
disturbances
Błażej Męczekalski
04/16/21
2
Eating disorders
• Primarily affect young women
• Only 5-10% cases are male
• Peak age of onset is during
adolescence
for anorexia nervosa (13-15 years)
for bulimia nervosa (17-25 years)
• in the adolescent age group it has
increased dramatically since 1985
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Eating disorders
• in the adolescent age group it has
increased dramatically since 1985
• In US the prevalance of anorexia
nervosa in adolescent females is
0,5% (following obesity, asthma)
• Prevalance correlates with socio-
economic development
• Mortality rate for AN is 9%
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Anorexia nervosa
• Condition characterized by
excessive weight loss, pre-
occupation with body weight and
shape and cognitive distortion in
body image
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Bulimia nervosa
• Major features are recurrent cycles
of binging followed by inappropriate
compensatory mechanism such
- as self-induced vomiting,
- excessive excercising,
- starvation or the use of laxatives
- diet pills or diuretics
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Anorexia nervosa -
diagnostic criteria
A. Refusal to maintain body weight over a minimally
normal weight for age and height or failure to
make expected weight gain during period of
growth, leading to body weight below 15% of that
expected
B. Intense fear of gaining weight or becoming fat,
even though underweight
C. Disturbance in the way in which one’s body
weight or shape is experienced, undue influence of
body shape and weight on self-evaluation or denial
of the seriousness of current low body weight
D. In post-menarchal females amenorrhea
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Bulimia nervosa –
diagnostic criteria
A. Reccurent episodes of binge eating.
- eating in a discrete period of time an
amount of food that is definitely larger than
most of people would eat in a similar
circumstance
- a sense of lack control over eating during
the episodes
B. Reccurent inaproprate compensatory
behaviour to prevent weight such as self-
induced vomiting, misuse of laxatives,
diuretics
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Bulimia nervosa –
diagnostic criteria
C. The binge eating and inappropriate
compensatory behaviour both occur on
average, at least twice a week for 3
month
D. Self evaluation is unduly influenced by
body shape and weight
E. The disturbance does not occur
exclusively during episodes of anorexia
nervosa
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Anorexia nervosa –
hormonal profile
• Low LH, FSH
• Low estradiol
• High CRH, beta-EP
• Mild hypercortisolism
• GH increased
• Low T3 (decreased conversion of T4 to T3)
• Normal TSH
• Low leptin
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Anorexia nervosa –
complications of eating
disorders
• Cardiovascular (bradycardia,
orthostatic hypotension, dysrythmias)
• Gastrointestinal (constipation,
intestinal atony, oesophagitis)
• Dermatological (brittle hair and nails,
lanugo, Russel’s sign)
• Skeletal (osteopenia, fractures)
• Haematological ( low sedimantation
rate, mild anemia, leucopenia)
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Anorexia nervosa -
osteopenia
• Low estradiol
• Low IGF –1
• Low calcium diet
• High cortisol
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Anorexia nervosa -
osteopenia
• Bone densitometry should be
perform in any patient who has
been amenorrheic for more than 6
months
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Bone mass density
• 60% of peak bone mass is gained
during adolescent years
• Peak bone massis achieved by the
end of second decade of life
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Eating dosorders –
principles of treatment
• Restore weight
• Normalize eating pattern
• Reverse the medical complications
of eating disorder
• Resolve underlying psychosocial
issues that led to its development
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Eating dosorders –
hormone replacement
therapy
• Natural estrogen
• Progesteron and progestins
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Calcium intake
• Dietary calcium intake 1200-1500
kcal/d
• Vitamin D 400 IU
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Eating disorders –
important points
• Prevention of eating disorders
• Management of amenorrhea in
female athletes
• Effective treatments for
osteoporosis in young women with
eating disorders
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Introduction
• State the purpose of the
discussion
• Identify yourself
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Topics of Discussion
• State the main ideas you’ll be
talking about
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Topic One
• Details about this topic
• Supporting information and
examples
• How it relates to your audience
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Topic Two
• Details about this topic
• Supporting information and
examples
• How it relates to your audience
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Topic Three
• Details about this topic
• Supporting information and
examples
• How it relates to your audience
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Real Life
• Give an example or real life
anecdote
• Sympathize with the audience’s
situation if appropriate
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What This Means
• Add a strong statement that
summarizes how you feel or think
about this topic
• Summarize key points you want
your audience to remember
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Next Steps
• Summarize any actions required of
your audience
• Summarize any follow up action
items required of you