I had a similar reaction to this article, Carrie (although not as well thought and worded as yours). Sometimes it's just the malnutrition, folks!

I think it's an important subject to look into, and I'm curious to see what they find. But I think they're barking up the wrong tree.

What research I really would like to see them do is on ghrelin/leptin levels in people with a family history of EDs and then follow them to see if they develop an eating disorder. It would, however, be a logistical nightmare to design such a study.

It's also interesting that some AN sufferers do not lose their periods until lower weights.

My first bout of AN, I lost my period well within my weight range -- kind of similar to you Carrie. My second relapse I did not lose my period until I was well below my range.

I can't put a lot of weight (no pun intended) into the ammenorhea criteria because it seems so random -- my body just doesn't react the same way every time so it's not really a reflection of my struggles.

Does this make any sense?

A:)

I cannot BELIEVE they didn't connect this with lack of food/fuel - surely it's the obvious connection to make?

I do think that there are a number of factors that contribute to menstrual patterns which vary massively from person to person (that's why some people start to get a period when they're ten, and others don't until their mid-teens) but essentially if your period stops when it was working fine before then your body is in some sort of confusion about something. Team that with the high ghrelin levels and the answer seems obvious.

Out of interest, I did wonder whether girls who lost their period in the earlier stages of anorexia were also the ones who got their first ever period quite early on in life? It would indicate that their bodies may be generally more sensitive/receptive to hormonal changes. I got my first period late-ish (when I was 14) and I didn't lose it again until I was quite seriousy underweight - I always wondered if that was a pattern.

I've stopped menstruating three times, for over five months each time. And each of these times I was losing weight (once unintentionally, the other two ED-related) but the menstruation stopped long before I ever became underweight. I don't know what this means...

Jeez, some people are DENSE. I can see how there's a possibility people who lose their period earlier have some sort of different hormonal predisposition than those whose periods hang on even at similar weights & intakes...but a hormonal disorder? Folks, it's called malnutrition! How is that hard to understand?

I think it would be interesting to see how ghrelin levels (or other hormones) influences the weight at which you lose your period. Or the amount of energy imbalance you need to have.

FWIW, I only lost my period on my first major anorexic episode. Even though the second major crash and burn I was at a lower weight (about 10 pounds) for over a year than when I lost my period the first time. Some purely anecdotal evidence: younger girls are MUCH more likely to lose their periods because the cycles haven't been as established. Women who have had long-term eating disorders are less likely to lose their period because their bodies have adapted to the deprivation.

Also, strenuous exercise (whether or not accompanied by weight loss) puts a tremendous stress on the body, which could also lead to loss of menstruation.

But hormone disorder? Give me a break.

I think it could be some (sum) of all of these parts ... and more.

I have had anorexia since childhood and never started my period. Fast-forward to post-college, in the first year of my marriage, thinking I couldn't get pregnant/have children b/c of the previous condition/circumstances. I found out, almost four months into the pregnancy, that I *was* pregnant ... without ever having had a period.

I was in the body-composition study at NYSPI, and Dr. Walsh theorized that my body released a random egg that "got lucky" and my brain thought: "Well, we're pregnant; we're nursing; we must be OK," despite body weight during the ensuring years (maintained appropriate weight and healthy pregnancies X 3) that persisted at less than 60 percent IBW and worse during hospitalization crises.

All of these times I maintained regular cycles, including through complications that included functional paraplegia from the AN, pump-dependent gastroparesis, malabsorption, cardiomyopathy, and peripheral nerve damage.

They say my brain probably re-set its setpoint for this function at each critical weight when followed by re-feeding, i.e., that then became the new low threshold at which AN and menstruation could still co-exist.

We thought maybe I was an internally "fat" anorexic, but my body-fat testing didn't support that. I never took birth-control pills, even though they were recommended to help with endometriosis.

The upside to this is that I am now in my 40s, after nearly 30 years of illness (though doing better now than ever before, aside from pregnancies), and I don't have osteoporosis. I feel very lucky and very thankful.

So, who knows what might be up with my ghrelin, hypothalmus, etc., but it underscores the argument to drop amenorrhea as criteria.

It seems to me that until we develop a model for EDs that makes OPTIMAL body composition the MINIMUM standard, we will continue to fail patients.

Instead of keeping people out of intensive care, we need to keep them in best health.

To this day, no clinician treating my daughter's eating disorder has ever asked for any medical information. No one in her medical treatment ever asked for information on mental health. It's crazy.

Laura,

Ditto. I suppose there would be a slight difference given that I was pretty much an adult when I got sick (therefore my starting weight would be pretty much what I needed to be at). But still. Other than "what did you weigh before the eating disorder?" I never got asked anything else.