Die bedeutung von ess-störungen in der gynäkologischen praxis

We review the epidemiology, etiology, diagnosis, medical complications, and treatment of patients with eating disorders. The gynecologic aspects of anorexia and bulimia nervosa are discussed. Osteopenia due to hypoestrogenemia, malnutrition, hypercortisolism and low IGF-1 levels are frequent complications of anorexia. Treatment frequently includes estrogen replacement. Nearly all patients with eating disorders have menstrual abnormalities such as anovulation, oligomenorrhea and amenorrhea. Hypothalamic amenorrhea caused by impaired pulsatile GnRH secretion is one of the four diagnostic criteria for anorexia nervosa and an early sign of the disorder. Patients with bulimia frequently have inadequate follicular maturation or a disturbed luteal phase. Nonetheless pregnancies can occur and often have an unfavorable effect on the eating disorder. Pregnancies are at increased risk for spontaneous pregnancy loss, premature delivery, and intrauterine growth retardation. Gynecologists have an important role in the secondary prevention of eating disorders because many patients first seek medical attention for menstrual abnormalities. An eating disorder should be ruled out before initiating treatment for infertility.