Eating disorders in gynecologic patients

We review the epidemiology, etiology, diagnosis, medical complications, and treatment of patients with eating disorders. The gynecologic aspects of an orexia and bulimia nervosa are discussed. Osteopenia due to hypoestrogenemi a, malnutrition, hypercortisolism and low IGF-1 levels are frequent complic ations of anorexia. Treatment frequently includes estrogen replacement. Nea rly all patients with eating disorders have menstrual abnormalities such as anovulation, oligomenorrhea and amenorrhea. Hypothalamic amenorrhea caused by impaired pulsatile GnRH secretion is one of the four diagnostic criteri a for anorexia nervosa and an early sign of the disorder. Patients with bul imia frequently have inadequate follicular maturation or a disturbed luteal phase. Nonetheless pregnancies can occur and often have an unfavorable eff ect on the eating disorder. Pregnancies are at increased risk for spontaneo us pregnancy loss, premature delivery, and intrauterine growth retardation. Gynecologists have an important role in the secondary prevention of eating disorders because many patients first seek medical attention for menstrual abnormalities. An eating disorder should be ruled out before initiating tr eatment for infertility.