Every month, your body undergoes delicate hormonal changes, triggering your period. Anorexia disrupts this cycle, and in some women, their periods stop altogether.

Amenorrhea can seem like a minor issue. Periods can be uncomfortable and inconvenient, and missing a few may go unnoticed. But if left untreated, amenorrhea can come with a host of serious problems, including bone loss.

Gaining weight is one of the most reliable ways to address amenorrhea. But this step is hard for people with anorexia to contemplate.

Entering an eating disorder treatment program and working with a trusted team of experts may help.

Article Contents

What Is Amenorrhea?
Why Are Amenorrhea & Anorexia Linked?
3 Consequences of Amenorrhea
How Is Amenorrhea Treated?
Anorexia & Amenorrhea FAQs
References

What Is Amenorrhea?

Women of reproductive age should have a period once about every 30 days. When you’ve started your period but skip three in a row, you qualify for a diagnosis of amenorrhea.[1]

Many women have irregular periods, and they may miss one periodically due to stress, sleep loss, or some other external trigger. But missing three in a row (or more) is a serious condition that’s closely related to anorexia. Sometimes, it’s the first symptom a woman notices when she changes her eating.

Of women with anorexia, up to 25% developed amenorrhea before they lost a lot of weight. And up to 75% will experience amenorrhea during the course of their anorexia.[2]

Why Are Amenorrhea & Anorexia Linked?

Periods often happen without conscious thought. But several systems are involved, and they must all work together to trigger your menstruation. Depriving these vital systems of nutrition, either through restricted eating or excessive exercise, can halt your periods.

Many women with anorexia won’t have periods at all, and the issue persists as long as they remain underweight.

Up to 8% of women with anorexia won’t have pure amenorrhea, as they will have their periods sometimes.[3] But their cycles are unpredictable, and they may skip a session or two.

Experts say decreased estrogen is to blame for amenorrhea.[3] Starvation stops your body from producing this hormone, and without it, your body can’t start the ovulation and menstruation cycle.

In essence, your body believes that you’re in grave danger, and it attempts to protect you. Shutting down your reproductive cycle helps to conserve energy, and it ensures that you don’t get pregnant and attempt to nurture another body when you’re not eating enough to feed yourself.

3 Consequences of Amenorrhea

Missing your period can have a deep and lasting impact on your health. The longer it’s left untreated, the more significant the problems.

These are three issues common in women with amenorrhea:

1. Fertility Issues

Some women with amenorrhea don’t ovulate, so they can’t get pregnant. They may desperately want to get pregnant but can’t do so because of their amenorrhea. They may struggle to get pregnant long after they’ve entered eating disorder treatment.

Ovulation and menstruation aren’t tightly linked, so some women ovulate even without having a typical period. A woman who believes she can’t get pregnant can have an unexpected surprise.

Half of pregnant women with anorexia say their pregnancies were unplanned. Just 19% of nonanorexic women say the same.[4]

If you want to start a family, getting pregnant while you’re struggling with anorexia isn’t easy. Your baby has a higher risk of the following issues:

Premature birth
Low birth weight
Early death

Your pregnancy could also worsen your anorexia, as your body changes could entice you to further limit your food intake.

2. Bone Loss

Hormones regulate bone density. When your levels are imbalanced due to anorexia, your bones can thin. This problem is most acute in young women with anorexia, as your body puts down the greatest amount of bone during adolescence.

When compared to peers, girls with anorexia have very low rates of bone accrual.[5] They can strengthen their bones later in life, but their amenorrhea puts them behind their peers in building a healthy and strong body.

You may not notice your thinning bones at all. But women with severe bone loss can experience fractures due to a tiny stimulus, like tripping on a curb.

3. Early Menopause

All women stop having their periods at some point. For older women, menopause marks the end of both ovulation and menstruation, and it’s accompanied by a series of uncomfortable symptoms.

Entering menopause can mean living with the following:

Hot flashes: Your face flushes, your body is bathed in sweat, and you feel faint.
Night sweats: You awaken feeling incredibly hot and struggle to get back to sleep.
Vaginal dryness: Sex becomes uncomfortable due to a lack of natural lubricant.

Menopause is also associated with health problems, including heart and blood vessel disorders.[6]

Women with longstanding amenorrhea may experience some or all of these problems.

How Is Amenorrhea Treated?

You need more than simple hormones to help address amenorrhea. You must address your low body weight. A treatment team is crucial.

A refeeding program can help you gain needed weight while avoiding complications from eating too much too soon. Your team can carefully manage what you eat and when, and with their help, you can regain your strength and weight. As you heal and your hormone levels stabilize, your periods may return.

Researchers say women who go through these programs likely regain their fertility.[7] And as you heal, you’ll be strong enough to carry and nurture a healthy baby. Medical care is important to ensure you have the support you need as you heal.

If you entered an eating disorder treatment program with extreme weight loss, and you had to stay in the hospital for longer to get better, your recovery may be more complicated.[8] But your team can work with you on recovery strategies and stay involved with you as you regain weight. With their help, you can get better.

Anorexia & Amenorrhea FAQs

What does anorexia do to your period?

Losing a significant amount of weight can stop your body’s hormonal processes. Without those natural hormones, you may develop irregular periods. Some women stop having their periods altogether.

Does starving yourself affect your period?

Yes. You need consistent, constant nutrition to ensure that your hormone levels remain elevated enough to trigger ovulation and menstruation. Starving your body of food and nutrients halts this process.

Why does amenorrhea occur in anorexia?

Women with anorexia limit their caloric intake through food restriction or excessive exercise. If your body can’t access nutrition, hormone levels dip, and your period stops. For some women, amenorrhea occurs long before they lose a significant amount of weight.

How do you know If you have amenorrhea?

If you’ve had periods in the past, but you’ve skipped at least three in a row, you have amenorrhea. Gaining the weight you’ve lost could help to restart your system, so you get your period again.

References

FAQs: Amenorrhea—Absence of Periods. The American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/amenorrhea-absence-of-periods. October 2020. Accessed July 2022.
Anorexia Nervosa: Medical Complications. Journal of Eating Disorders. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-015-0040-8. March 2015. Accessed July 2022.
Reproductive Issues in Anorexia Nervosa. Medscape. https://www.medscape.com/viewarticle/747339_2. 2011. Accessed July 2022.
Amenorrhea Notwithstanding, Women with Anorexia Nervosa Are at Risk for Unplanned Pregnancy. New England Journal of Medicine. https://www.jwatch.org/wh201011100000001/2010/11/10/amenorrhea-notwithstanding-women-with-anorexia. November 2010. Accessed July 2022.
Amenorrhea Due to Anorexia Remains Difficult to Treat. Healio. https://www.healio.com/news/endocrinology/20140303/amenorrhea-due-to-anorexia-remains-difficult-to-treat. March 2014. Accessed July 2022.
Absence of Menstrual Periods. Merck Manual. https://www.merckmanuals.com/home/women-s-health-issues/menstrual-disorders-and-abnormal-vaginal-bleeding/absence-of-menstrual-periods. February 2021. Accessed July 2022.
Fertility and Reproduction After Recovery from Anorexia Nervosa: A Systematic Review and Meta-Analysis of Long-Term Followup Studies. Diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768504/. December 2020. Accessed July 2022.
Predictors of the Resumption of Menses in Adolescent Anorexia Nervosa. BMC Psychiatry. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-308. November 2013. Accessed July 2022.

Anorexia and Amenorrhea: What are the Consequences?