Amenorrhoea and loss of weight

Amenorrhoea due to loss of weight was diagnosed in 39 of 170 consecutively investigated patients with amenorrhoea: 24 patients had anorexia nervosa but in the remainder this diagnosis could not be made with certainty. The only difference detected between the two groups was in their lowest weights. Endocrine tests revealed subnormal oestrogen production, low serum LH levels and a failure to ovulate in response to clomiphene. All patients were encouraged to put on weight and 14 resumed ovulatory menstrual cycles. In these patients the mean weight at resumption of ovulation exceeded the mean weight at presentation by 3.6 kg; in contrast, in the patients who remained amenorrhoeic, there was no significant increase of weight by the time of the last visit. Of 8 patients who complained of infertility, 5 ovulated and conceived. Thus dietary treatment of patients with amenorrhoea and loss of weight may replace gonadotrophin therapy for induction of ovulation in a significant proportion of patients with anovulatory infertility.