Etenevässä tutkimuksessa «Golden NH, Jacobson MS, Schebendach J ym. Resumpti...»1 paino kuukautisten palautuessa oli keskimäärin 2,05 kilogrammaa korkeampi kuin paino kuukautisten loppuessa (100 potilasta osallistui tutkimukseen, ja näistä 69 potilasta seurattiin vuoden ajan ja 59 potilasta 2 vuotta). Ei kuitenkaan todettu eroa painon, paino-indeksin tai rasvaprosentin suhteen niiden potilaiden välillä, joiden kuukautiset palautuivat vuoden sisällä (n = 47) tai eivät palautuneet (n = 22). Koska luteinisoivan hormonin ja estradiolin tasot olivat matalampia vuoden kuluttua potilailla, joilla kuukautiset eivät olleet palautuneet vuoden sisällä, hypotalamisen tai aivolisäkkeen tason häiriön korjautumista pidettiin tärkeimpänä ennustetekijänä.
Takautuvassa tutkimuksessa «Shomento SH, Kreipe RE. Menstruation and fertility...»2 selvitettiin 83 nuoren laihuushäiriöpotilaan (haastatteluhetkellä keskimääräinen ikä 22 vuotta) kuukautisten palautumista suhteessa painoon. Kuukautiset olivat palanneet 83 %:lla haastatelluista. Kuukautiset palautuivat painon ollessa keskimäärin 92 % (SD 7) pituuden mukaisesta ihannepainosta.
The aim of this German study «Dempfle A, Herpertz-Dahlmann B, Timmesfeld N ym. P...»3 was to investigate the impact of several clinical parameters on the resumption of menses in first-onset adolescent AN in a large, well-characterized, homogenous sample that was followed-up for 12 months. A total of 172 female adolescent patients with first-onset AN according to DSM-IV criteria were recruited for inclusion in a randomized, multi-center, German clinical trial. Menstrual status and clinical variables (i.e., premorbid body mass index (BMI, menstruating 20.2 ± 2.8kg/m2 vs amenorrheic group 19.9 ± 2.8 kg/m2), age at onset (menstruating 14.5 ± 1.4 yrs vs amenorrheic group 14.1 ± 1.4 yrs, duration of illness (menstruating 11.5 ± 9.4 mths vs amenorrheic group 9.9 ± 7.2 mths), duration of hospital treatment (menstruating 14.7 ± 5.4 mths vs amenorrheic group 16.8 ± 7.2 mths) and BMI at discharge (menstruating 18.2 ± 0.9kg/m2 vs amenorrheic group 17.8 ± 1.1kg/m2) were assessed at the time of admission to or discharge from hospital treatment and at a 12-month follow-up. Based on German reference data, the percentage of expected body weight (%EBW), BMI percentile, and BMI standard deviation score (BMI-SDS) for all time points to investigate the relationship between different weight measurements and resumption of menses were calculated. Forty-seven percent of the patients spontaneously began menstruating during the follow-up period. %EBW at the 12-month follow-up was strongly correlated with the resumption of menses. The absence of menarche before admission, a higher premorbid BMI, discharge below target weight, and a longer duration of hospital treatment were the most relevant prognostic factors for continued amenorrhea.
The recovery of menstrual function in adolescent patients with AN should be a major treatment goal to prevent severe long-term physical and psychological sequelae. Patients with premenarchal onset of AN are at particular risk for protracted amenorrhea despite weight rehabilitation. Reaching and maintaining a target weight between the 15th and 20th BMI percentile is favourable for the resumption of menses within 12 months. Whether patients with a higher premorbid BMI may benefit from a higher target weight needs to be investigated in further studies.