How bulimia affects your period

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Bulimia nervosa (BN) may cause changes in your menstrual cycle, or period. It has been known to shorten cycles, stop the period for a short period of time, give you more periods, and cause a light flow during the cycle. All of these changes indicate that there are hormonal disruptions that are occurring with bulimia. (1)

Any condition that affects your nutritional intake has the potential to affect your menstrual period. When asking yourself, “can bulimia cause irregular periods,” there are a few things to consider, starting with your eating habits. Individuals with bulimia nervosa, like other eating disorders, can often become malnourished. Malnutrition, regardless of a persons’ weight, can potentially affect an individual's period. (1)

Purging can cause electrolyte imbalances leading to dehydration. Malnutrition can also affect hormonal production or response which can alter menstrual periods. 

In one study, all 14 patients with bulimia had pathologically low follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Pathologically low means it’s altered enough to cause a distinct state of disease. 

In the study, two thirds of those with bulimia nervosa had polycystic ovarian syndrome (PCOS), which is known to affect periods. The malnutrition associated with BN results in hormonal dysfunction, menstrual disturbances and infertility. 

Many doctors say that hormone treatment is the solution. However, doctors in Hungary concluded that estrogen replacement is not the best treatment. Early treatment of the eating disorder is more appropriate. The doctors also stated that it is questionable to prescribe excessive hormonal contraceptives. (2)

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What about foods affecting hormone production?

Some people might suggest adding foods, herbs, and spices that are high in phytoestrogens and phyto progestins. Soy milk increases estradiol levels. Herbs such as black cohosh, yam, licorice, red clover, thyme, turmeric, hops, damiana, oregano, and verbena have the capacity to raise or lower hormonal levels in the body. (3) Of course it is always best to consult with your treatment team first.

What about the effects of nutrients on the periods?

One study published in 2020 in a journal on nutrition and diet tested the effects of riboflavin (vitamin B2), vitamin B6, and vitamin B12 on ovarian cycle function. They tested 259 healthy people who menstruate from 18 to 44 years old with menstrual cycles that were between 21 and 35 days and were not using contraceptive hormones during the previous three months. The researchers measured hormone levels four times during the menstrual cycle and did this for two cycles. (4)

Higher levels of riboflavin caused a decrease in estradiol levels. Small increases in testosterone were found with vitamin B12 intake. Higher vitamin B6 intakes were found to cause higher levels of follicle-stimulating hormone (FSH).

Another study found that vitamin B2 and B6 have estrogen-like effects and act synergistically with estradiol. Vitamin B1 and vitamin B5 (pantothenic acid) enhance the action of estradiol but do not have any estrogenic action themselves. Vitamin B12 did not have an estrogenic effect and did not influence the action of estradiol. (5)

Boron is a mineral and can be used to support estrogen production in the body. Taking 5 to 10 mg boron during the menstrual cycle from two days before it starts to three days into the flow has been found to be helpful for pain severity and duration during the period by researchers in Iran. (6) 

About half of adolescents with bulimia nervosa have been found to have a dysfunction in their hypothalamus as well as irregular menses.

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How does bulimia affect your periods?

With hormonal disruptions your period may: 

  • Stop for several months and then starting up again
  • Be irregular
  • Be very light 

What to Expect After Treatment for Bulimia

Treatment for bulimia should be multidisciplinary. You will especially need a dietician who specializes in eating disorders who can assess your nutritional status and create a meal plan which may contain supplements that are appropriate for your body.

It can take up to six months after starting your protocol for your period to return, however, keep in mind that everyone’s body as well as their recovery is different and it could take longer. Working on reducing and eliminating binging and purging behaviors can help your periods to resume.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Gendall, K. A., Bulik, C. M., Joyce, P. R., McIntosh, V. V., & Carter, F. A. (2000). Menstrual cycle irregularity in bulimia nervosa. Journal of Psychosomatic Research, 49(6), 409–415. https://doi.org/10.1016/s0022-3999(00)00188-4 
  2. Resch M, Szendei G, Haasz P. Bulimia from a gynecological view: hormonal changes. J Obstet Gynaecol. 2004 Nov;24(8):907-10. https://pubmed.ncbi.nlm.nih.gov/16147649/
  3. Zava DT, Dollbaum CM, and Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med. 1998 Mar;217(3):369-78. https://pubmed.ncbi.nlm.nih.gov/9492350/ 
  4. Kim K, Mills JL, Michels KA, Chaljub EN, Wactawski-Wende J, Plowden TC, and Mumford SL. Dietary intakes of vitamin B-2 (riboflavin), vitamin B-6, and vitamin B-12 and ovarian cycle function among premenopausal women. J Acad Nutr Diet. 2020 May;120(5):885-892. https://pubmed.ncbi.nlm.nih.gov/31879178/
  5. Sharaf A and Gomaa N. Interrelationship between vitamins of the B-complex group and oestradiol. J Endocrinol. 1974 Aug;62(2):241-4. https://pubmed.ncbi.nlm.nih.gov/4413948/
  6. Nikkhah S, Dolatian M, Naghii MR, Taheri F, Taheri SM. Effects of boron supplementation on the severity and duration of pain in primary dysmenorrhea. Complement Ther Clin Pract. 2015 May;21(2):79-83. 
  7. Seidenfeld ME and Rickert VI. Impact of anorexia, bulimia and obesity on the gynecologic health of adolescents. Am Fam Physician. 2001 Aug 1;64(3):445-50. https://pubmed.ncbi.nlm.nih.gov/11515833/

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