Amenorrhea during obesity
Amenorrhea during obesity could be noted pretty often. Let’s try to understand why and how it is happening.
General definition of obesity is an excess proportion of total body fat. Woman is considered obese when her weight is 20% or more above normal weight. Body Mass Index (BMI) is usually used for objective obesity measures. Women could be considered overweight if their BMI is between 25 and 29.9 and women could be considered obese if their BMI is over 30.
Amenorrhea during obesity
Nowadays every woman knows that overweight and obesity are not healthy and associated with several health risk factors including menstrual dysfunctions such as amenorrhea and oligomenorrhea. It is also well known that the infertility rates are increased in obese women because of anovulation, irregular periods and amenorrhea. At the same time the amenorrhea rate is high in women with obesity.
Woman with obesity and amenorrhea
Scientists discovered that the risk for irregular periods and/or amenorrhea is depending on the degree of obesity – the frequency of irregular periods and amenorrhea is doubling with each increase in obesity grade. It was also noted that amenorrhea is highly associated with type 2 diabetes and other blood sugar abnormalities. At the same time the severity of menstrual dysfunction (mainly hormonal dysfunctions and ovulation disturbances) depends on the severity of obesity.
Obesity – Menstrual Dysfunction – Hormones – Amenorrhea
Obesity effects are usually mediated primarily through hormonal changes (changes in sex hormones).
Main reason of amenorrhea during obesity is menstrual dysfunction developed because of body excess fat cells which are interfering with the process of ovulation.
Hyperandrogenemia (increased levels of androgens in women body) could be a part of mechanism for amenorrhea development in women with obesity.
Insulin resistance is a well known consequence of obesity. Insulin resistance provokes increased levels of insulin in the blood and increased concentrations of insulin elevate androgen production (increased levels of male hormones) in women body.
During obesity fat cells could be responsible for reduced concentration and/or reduced activity of sex-hormone-binding globulin – another reason for increased concentration of free androgens in women body.
The relationship between insulin and androgens in women body is thought to be important trigger of Polycystic Ovarian Syndrome (PCOS) which is known as functional ovarian hyperandrogenism-ovarian dysfunction. Polycystic Ovarian Syndrome is a frequent cause of menstrual dysfunctions including oligomenorrhea (rare periods) and amenorrhea (absence of periods).
Anovulation and amenorrhea in obesity results from excess androgens and decreased estrogens causing progesterone reduction.
During obesity and amenorrhea the typical LH pulse amplitude and rhythm is also diminished.
During obesity the dysfunction of sex hormones has been noted. As a result during obesity different types of menstrual dysfunctions were observed because of extended follicular phase of the menstrual cycle, anovulation (absence of ovulation) and shortened (almost absent) of luteal phase of the menstrual cycle.
Metabolic changes during obesity and amenorrhea include decreased sex-hormone binding globulin, FSH, prolactin and cortisol. Estrone is significantly increased by peripheral conversion in adipocytes.
Adipose tissue is highly metabolically active during obesity and amenorrhea and could produce about 30% of testosterone (male hormone).
Amenorrhea during obesity – solutions
During obesity and amenorrhea and followed infertility medical professional usually start treatment from weight loss and weight control. It was well reported that thousand of obese women could restore normal menstrual cycles just thanks to weight loss and reasonable weight control. Modest weight loss of 10-15% of body weight does increase ovulation rates. Bariatric surgery has also been successful in improving ovulation in women with obesity and amenorrhea.
Second step of treatment of amenorrhea during obesity usually include hormonal medicine.
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