She walked slowly and reluctantly into my consultation room with her parents. She looked thin and listless.
H, a 17-year-old teenager came to see me because her mother had noticed that she had drastic weight loss and her menses had stopped for the past 4 months.
She was the youngest of 3 children. She was bright academically and had been of normal body weight. Eight months ago, she started to get conscious about her body image after her cousin commented that she had put on weight during a social gathering. Thereafter, she started comparing her body weight with her peers. She tried to lose weight by becoming a vegetarian and began to eat less and exercise more. She felt good about herself only when she lost weight.
She weighed herself almost daily. She spent most of her time worrying about her weight. As a result, she spent less time on the social activities she used to enjoy. She became very quiet and withdrawn, often keeping to herself in her room.
H was undernourished with sunken eyes. Her BMI was way below normal and her skin was dry with soft downy hairs. Her nails were brittle. Her blood pressure was low and her heart rates were slow and sometimes irregular.
H was diagnosed with anorexia nervosa, an eating disorder characterized by
· An abnormally low body weight
· Extreme restriction of food intake
· Intense fear of gaining weight or becoming fat
· Distorted perception of weight
How does anorexia affect the reproductive health?
With severe reduction of food intake, our body does not have enough “energy” to function properly It has to prioritize which bodily functions are not essential. Reproductive function gets the least priority. As a result, the control centre in our brain which regulates menstruation becomes suppressed, resulting in prolonged cessation of menses (amenorrhea).
With amenorrhea, the levels of female hormone (oestrogen) are low and hormonal imbalances occur. These imbalances may lead to symptoms such as loss of sleep, night sweats and irritable moods which may further aggravate anorexia
Oestrogen is also important in maintaining the levels of calcium in the bones. With amenorrhea, depletion of calcium in the bones (osteopenia) can occur. This may lead to osteoporosis or brittle bone disease if left untreated.
Amenorrhea may result in infertility too. For many young women, the idea of not being able to have children in the future may be alarming. The sooner the menstrual period is restored, the higher the chances of resuming fertility, but the longer a woman goes without having her period, the less likely it is for her to become pregnant on her own.
To treat H, I had to seek help from my psychiatrist colleague, a psychologist, nutritionist and nurse therapist. With the support of the family, H was finally able to start eating normally by this multidisciplinary approach.
Her physical health gradually improved and her menses returned after about 6 months of intense therapy.
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