What is functional anorexia

Hypothalamic ovarian failure

General

Here is a central disorder in the areas of the brain that are responsible for the hormonal control of the ovaries. The hormone GnRH is normally released rhythmically from cells of the hypothalamus every 90 minutes. If this rhythm is disturbed or broken, it leads to a wide range of disorders of the ovarian function. The ovaries are completely intact in their function, but are not sufficiently stimulated.

causes

The cause of hypothalamic ovarian insufficiency is usually caused by psychological stress that affects the hormonal metabolism in the hypothalamus, so that there is a reduced release of GnRH. Frequent triggers are underweight due to anorexia nervosa (anorexia) or competitive sports. So that the clock in the hypothalamus works and can regularly release GnRH, the body needs a minimum fat mass of 22%, or the body mass index must be> 19. Other causes are stress, tumors that hinder the secretion of hormones (e.g. prolactinomas), hypothyroidism or the use of medication.
A rare, genetically inherited cause is Kallmann syndrome. It is defined as a simultaneous occurrence of a disorder of the sense of smell and a lack of control of GnRH production. The male sex is predominantly affected (here it manifests itself in a lack of testicular system), but it can also occur in women. Since the external genital organs are normally developed here, the diagnosis is often not made until puberty or early adulthood.

Clinical picture

Since hypothalamic ovarian insufficiency is often based on psychological causes such as anorexia or bulimia, signs of these diseases can draw attention to a disorder of ovarian function.

Consequences of these diseases are symptoms like

  • Luteal weakness
  • No menstrual period (primary or secondary amenorrhea)
  • Weight loss

If there is a tumor in the brain, headaches, dizziness and visual disturbances can occur.

recognition

So that the gynecologist can get an overview, a detailed anamnesis always starts at the beginning of the diagnostic work-up. As you do this, tell your doctor about changes in your menstrual cycle. The gynecologist will then perform an examination of the patient's external appearance, a general physical examination and a gynecological vaginal and rectal examination. It makes sense to do a pregnancy test. Since pregnancy first manifests itself in the absence of menstrual bleeding, it could be wrongly assumed that ovarian insufficiency is behind it.

For further clarification, analyzes of the hormone concentrations in the blood are required. Since the plasma levels are subject to fluctuations depending on the day and, above all, the cycle, this should definitely be taken into account when taking the blood. Tell your doctor what day of your cycle you are on. If hypothalamic ovarian insufficiency is suspected, the FSH, LH, estradiol and progesterone should be determined. These values ​​can be significantly reduced or they can be in the normal range.

In Kallmann syndrome, other hormone values ​​are also changed: the concentrations of gonadotropins, prolactin, insulin and others are lower than normal.

therapy

Medical therapy

In women who do not want to have children, who have tumors, Kallmann syndrome or medication-induced hypothalamic ovarian insufficiency, the missing hormones should be replaced. This also reduces the risk of osteoporosis and cardiovascular diseases caused by hormone deficiency.

Psychological therapy

For women with eating disorders (anorexia, bulimia), therapy from the psychological or psychiatric side is the first option. The gynecologist should definitely be consulted because of the accompanying physical symptoms. If the weight or the eating disorder normalizes, the cycle usually returns after a while and the ovaries function properly.

Women of normal weight for whom stress is suspected to be the cause of the disorder should seek psychological support in addition to hormone therapy. Relaxation exercises to manage stress can help stabilize hormonal balance.

Competitive athletes

Athletes who have never had their periods (primary amenorrhea) do not necessarily need to be treated with estrogens. The risk of osteoporosis does not yet exist here, because bone loss due to a lack of estrogen only occurs when the bone has come into contact with the hormone. If the woman has not yet had a menstrual period, bone loss due to a lack of estrogen cannot take place. However, the sportswoman should ensure a balanced diet with a high calcium content.

Women who do not have periods due to exercise (secondary amenorrhea) should take hormone therapy. It may be necessary to discuss with the doctor how a possible water retention and thus a slight increase in weight can be avoided in order not to negatively affect the athletic performance. If the athlete has already suffered fatigue or stress fractures, it may be useful to take bisphosphonates to stabilize the bone.

Other internal diseases

Other internal diseases such as B. Diabetes mellitus or a thyroid dysfunction must also be treated, as this hormonal imbalance can also affect the functioning of the ovaries.

Author (s): äin-red