Weight-Related Amenorrhea: A Comprehensive Review

Introduction:

A normal menstrual cycle must be between 21 and 34 days. However, a menstrual flow lasting over seven days or requiring frequent sanitary pad changes is considered heavy. Blood loss of over 80 mL in a menstrual cycle is also considered a heavy period.

Being overweight or underweight can alter the menstrual cycle and the menstrual flow because the menstrual cycle is a complex interaction between the ovaries and the brain. Also, ovulation results from changes in certain hormone levels, which can also result in periods. Anything interfering with these hormonal changes can stop a woman from ovulating, resulting in skipping a menstrual period.

The amount of fat in the body and the body weight can affect hormonal levels. Being underweight with too little body fat can lead to skipping periods. Too much fat and body weight can lead to heavy or missed periods. Also, rapid fluctuations in weight can interfere with the menstrual cycle.

What Is Amenorrhea?

Amenorrhea is a medical term used for missing one or more periods during the reproductive years between puberty and menopause. It may occur due to some problem with any part of the female reproductive system or a change in the reproductive system's function. Amenorrhea can be temporary or permanent. It is not a disease and does not affect fertility, but it can indicate any underlying health issues requiring medical attention. It is of two types:

• Primary Amenorrhea - Absence of menstruation in girls by the age of 15. Primary amenorrhea's common causes are related to hormone levels. However, anatomical problems also can cause amenorrhea.

• Secondary Amenorrhea - If there is no period for continuous three or more months in someone who has had periods in the past is called secondary amenorrhea. The leading cause of secondary amenorrhea may be hormonal-related issues. Pregnancy is also the most common cause of secondary amenorrhea.

How Does Weight Loss Cause Menstrual Disturbance?

In a normal-weight woman, a 10 % to 15 % weight reduction from ideal body weight (IBW) is said to cause amenorrhea. The menstrual cycle variations associated with low body weight can change according to the individual. Amenorrhea due to weight loss is often caused due to eating disorders or stress.

Chronic stress leading to food restriction plays a significant role in amenorrhea. Excessive exercise to change the personality style is also an additive to low body weight-related amenorrhea. These changes lead to elevated cortisol and corticotropin-releasing factor (CRF) and chronic activation of the adrenocorticotropic axis leading to functional hypothalamic amenorrhea (FHA). Women who undergo intense, rapid exercise training and dietary restriction experience a luteal phase defect cycle and a lengthening of the menstrual cycle.

How Does Being Overweight Cause Menstrual Disturbance?

Various reasons, such as thyroid problems, mental health issues such as depression, eating disorders like binge eating disorder, or genetics, can cause obesity or being overweight.

The American Psychological Association states that genetic factors are rare for causing obesity, whereas overeating or leading a sedentary lifestyle is the important cause. Increased weight gain can result in irregular periods or no periods. This can be due to increased estrogen levels in the body.

Estrogen is stored in the body's fat, and obese people, their body produces more amount of hormones, which is known as hyperestrogenism (a condition characterized by an increased amount of estrogenic activity in the body). This accumulated estrogen can result in menstrual disorders and bleeding. This can result in women not ovulating for months, but the uterine lining will still get to the extent that it becomes unstable.

Balanced hormone levels are crucial to maintaining a healthy menstrual cycle. Being overweight or obese leads to a hormonal imbalance resulting in irregular periods or no periods. It is necessary to consult a doctor and check whether the menstrual changes are due to being overweight. If so, lifestyle changes such as exercising and following a healthy diet are required.

What Are the Weight-Related Menstrual Issues?

Weight changes can cause the following menstrual issues:

1. Heavy Periods: Being overweight can result in heavy periods due to increased body fat stores leading to hormonal imbalance that can stop ovulation. Obese women are more likely to experience abnormal uterine bleeding and heavy periods. Untreated heavy menstrual bleeding can lead to severe issues like iron deficiency anemia, fatigue, and weakness.

2. Light and Infrequent Periods: Losing weight too fast can cause irregular periods. Losing weight due to strenuous exercise and calorie restriction may cause a stress response that alters hormone levels, leading to lighter and less frequent periods.

3. Amenorrhea: Losing too much weight or gaining excess weight can cause amenorrhea. It can also cause harm to the bone, infertility, and lower estrogen levels.

What Is the Treatment for Weight-Related Amenorrhea?

Maintaining a regular menstrual cycle requires a healthy body with optimal body weight and a good indicator of hormonal balance. Suppose a person has a high BMI (body mass index) and experiences heavy periods, irregular periods, or no periods. It is necessary to consult a gynecologist.

If the menstrual cycle has stopped due to excess weight, the normal menstrual cycle can be regained by reducing weight as well as by making lifestyle changes will be helpful.

• Following a healthy diet.

• Limit snacks.

• Maintain a journal to keep a watch on your eating habits.

• Monitor weight regularly so many variations in weight can be checked and corrected.

• Perform exercise regularly, preferably weight training.

• Try to include low glycemic index foods, promoting weight loss in obese populations.

• Yoga and appropriate nutritious food will also help to correct menstrual irregularities.

Conclusion:

Having a regular period indicates the optimal hormonal balance in the body. However, variations in weight, such as increased weight gain or excess weight loss, can result in hormonal imbalances leading to irregular periods, heavy periods, or no periods for a long time. In most cases, it is necessary to achieve optimal body weight to correct hormonal imbalances. If you are experiencing menstrual cycle issues, consult a gynecologist to know whether it is related to weight and make necessary diet and lifestyle changes.