A woman with primary amenorrhea attributable to prepubertal anorexia nervosa has restored her weight at age 23 years. What is the likelihood of her developing pubertal changes (i.e., breast development, bone restoration)? — Robin F. Maestripieri, RN, APN, Princeton, N.J.
This sounds like a case of functional hypothalamic amenorrhea, which by definition excludes pathologic disease. Assuming that she does not have another underlying disorder causing the amenorrhea, her chances of developing pubertal changes are excellent once her weight is sufficient for these changes to occur. A study suggests an 83% recovery of menses with appropriate weight gain (Hum Reprod. 2001;16:2198-2205). Consider prescribing 1,500 mg of calcium daily until her periods resume. — Sharon Demeter, MSN, CNM, WHNP, assistant clinical professor, department of family health care nursing, University of California, San Francisco (150-5)