Lara Briden's Forum

I have been trying to seek out answers about an event that happened. I understand you cannot offer facts without knowing background/medical history, but I'm hoping you can at least offer some hypothetical explanations based on a situation that's been emotionally trying for someone I love--my cousin who has been suffering from anorexia for well over a decade (and lost her period).

My cousin is a long-time sufferer of an eating disorder and has had hyperthalamic amenorrhea for many years. Well, last week, out of the blue, she got a period. It was only a light one that lasted three days and didn't even drip out (hardly more than spotting). All the same, she is torn up by what happened. Let me explain that my cousin is NOT recovered (no where near recovered, in fact). Since she has severe body dysmorphia, her missing period was the only thing that assured her she was underweight. She has neither gained weight nor reduced exercise/or done anything else these "recovery from eating disorders" websites claim to be the silver bullet reasons for why menses would resume. In fact, the fact that these websites keep brow-beating the idea of weight gain as being the ONLY viable reason for a period to resume is very damaging to my already vulnerable cousin. If anything her BMI is even less than it was when she first lost her period!

She is so upset and wants to know if there is another reason for this sudden erratic bleed NOT related to weight gain or less exercise. Note, she is almost 39, and in our family menopause typically begins early (40ish). So this begs the question on whether an estrogen surge or other hormonal imbalance related to possibly being in perimenopause could be the reason. I am working with her on going to the doctor to get tested for answers, but she is too upset right now trying to come to terms with all this. Can you weigh in (no pun intended) and possibly confirm whether my cousin's sudden period reemergence can be related to perimenopausal hormone wackiness? If so, that would probably reassure her somewhat that she did NOT gain weight at least.

Sorry to hear about your cousin's situation. Eating disorders are so complex, and there's a common misconception that periods can only return with weight gain.

There are a few things that could explain what happened - none of which is tied to weight-gain:

1) The body's hormonal system is complex and dynamic, and even in chronic anorexia, there can be sporadic and unpredictable fluctuations in hormone levels. These fluctuations can sometimes be enough to trigger menstruation, even in the absence of significant weight gain or changes in exercise patterns.

2) Your suggestion of it being related to perimenopause, is also a plausible hypothesis, especially given the family history of early menopause. Perimenopause is characterized by fluctuating hormone levels, particularly estrogen, which can be erratic and unpredictable. These fluctuations can lead to irregular menstrual cycles and unexpected bleeding, even in the context of a pre-existing condition like anorexia-induced hypothalamic amenorrhea. It's not uncommon for women in the perimenopausal age range to experience changes in their menstrual patterns, including the return of menstruation after a period of amenorrhea.

3) Additionally, other factors can contribute to the return of menstruation or cause spotting, including stress, minor changes in body composition or diet that may not be from weight gain, or underlying medical conditions unrelated to the eating disorder. Thyroid dysfunction, for example, is common in individuals with chronic anorexia and can impact menstrual cycles.

I hope that that can help ease her mind, and that she can get the help that she needs.