Abnormal Uterine Bleeding in Underweight Women

Relationship Between Low Body Weight and Menstrual Dysfunction

Low body weight can lead to hypothalamic amenorrhea, affecting approximately 12% of women with a specific medical condition, compared to 1.5% of the general population 1
Hypothalamic amenorrhea is associated with disturbed secretion of pituitary gonadotropins and low hormone levels, causing amenorrhea or oligomenorrhea 1
Rapid fat mass reduction can compromise menstrual function 2
Low energy availability alters levels of metabolic hormones, disrupting normal menstrual cycles 2

When evaluating abnormal uterine bleeding in underweight women, consider hormonal measurements, including hormone tests, and assessment of energy availability and nutritional status 2, 4, 5
Pelvic ultrasonography can rule out structural causes of abnormal bleeding 3, 4

The American Academy of Family Physicians recommends increasing caloric intake to improve energy availability, weight gain, and reducing excessive exercise for underweight women 2
Medical management of abnormal bleeding may include progestin-only contraception or combined hormonal contraception to regulate menstrual cycles 3, 6

Abnormal uterine bleeding in adolescents with low body weight should prompt consideration of eating disorders 2
Endometrial sampling is necessary in patients with risk factors for endometrial cancer, as recommended by the American College of Obstetricians and Gynecologists 3