Predictors of recovery of ovarian function after weight gain in subjects with amenorrhea related to restrictive eating disorders.

OBJECTIVE: The aim of the present study was to investigate the anthropometric and endocrine characteristics of subjects with amenorrhea related to eating disorders after weight recovery, in order to identify factors connected with the resumption of menses. METHODS: Clinical data, body composition parameters and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, cortisol, leptin and insulin were assessed in two groups of young women classified according to menstrual status after weight rehabilitation: 43 subjects who displayed persistent amenorrhea and 34 who resumed menses. Univariate and multivariate logistic regression analyses were used to examine the relationships between the different parameters and menstrual recovery. RESULTS: The patients who resumed menses had low initial weight and BMI, and a greater difference between current and initial BMI (DeltaBMI), than those with amenorrhea. No differences were observed in lean mass, body fat or bone density between the two groups. Moreover, the reduction in FSH and the increase in LH, insulin and leptin emerged as significant predictors of menstrual recovery. Increased DeltaBMI and insulin continued to be positive predictors in the multivariate analysis. CONCLUSION: Following weight rehabilitation, the individual's metabolic set point before weight loss and the current insulin levels appear significant in predicting the reactivation of reproductive function.

The management of polycystic ovary syndrome.

It is well known that subjects with polycystic ovary syndrome (PCOS) show very variable clinical and biochemical aspects. Considering long-term repercussions, two main disturbances, not always strictly related, need to be countered: hyperandrogenism and insulin resistance, with compensatory hyperinsulinemia. The aim of this review is to summarize therapeutic perspectives for PCOS, starting from basic approach, such as weight reduction and changes in lifestyle. The benefits of long-term use of oral contraceptives and the criteria of choice of the estro-progestin combinations are discussed. With severe hyperandrogenism, a pure antiandrogen should be added. The experiences with insulin-sensitizing drugs, especially metformin, are reviewed; while their beneficial role as an adjuvant to treatment of ovulatory infertility has been well established, the effects of a long-term treatment, especially in very young patients, are still under debate. Current studies are testing the results of combinations of different treatments at low dosage; randomized comparative trials on the long-term efficacy of these approaches have yet to be scheduled.