I just lost weight, why did the “big aunt” run away from home?

This is the 4018 article

of Medical Care

Xiaoxiao is 22 years old this year, 1.62m tall, and weighed 50kg in the past. Xiaoxiao always felt that she was too fat. He also followed the trend of losing weight and pursued a skinny, dieting and exercise, and the weight dropped to 45kg in less than 2 months. Seeing her “slim” figure, Xiaoxiao was secretly happy. However, Xiaoxiao has an unexpected trouble, “Auntie” is not coming! When I first started losing weight, my menstrual flow decreased, and Xiaoxiao didn’t care too much. When Xiaoxiao went to the outpatient clinic, it had been 4 months that her “aunt” had not come! The examination revealed not only a small uterus, a thin endometrium, but also abnormal hormone levels. Looking at the thin Xiaoxiao, Dr. Wu said: If you want “Auntie” to go home, you must first regain her weight!

How does losing weight affect the “big aunt”?

First, let’s take a look at the “hypothalamic-pituitary-ovarian” gonadal axis that is closely related to our female reproductive function. The hypothalamus is the “big brother”, the command, and regulates the pituitary “second brother” by secreting GnRH (gonadotropin-releasing hormone). The pituitary “second brother” regulates the “third brother” ovarian secretion of sex hormones (including estrogen E, progesterone P) by secreting Gn (gonadotropins, including follicle-stimulating hormone FSH and luteinizing hormone LH). The sex hormones secreted by the ovaries of the “third brother” can in turn act as a feedback to the “elder brother” hypothalamus and the “second brother” pituitary. The three brothers (hypothalamus-pituitary-ovary) adjust and influence each other to form a complete and coordinated combination, which controls the periodic changes of the ovary and the uterus over and over again, and forms a regular “aunt” , which is called the “hypothalamus-pituitary-ovarian” gonadal axis, which is also known as the HPO axis.

Excessive dieting

“Big brother” also has a feeding center and a satiety center in the hypothalamus. During the process of dieting, the cerebral cortex suppresses appetite and also causes the “second brother” pituitary secreted FSH and LH Therefore, the function of the “third brother” ovary is affected, and these hormones play a very important role in maintaining the “big aunt”. Therefore, in the case of Xiaoxiao, after a period of dieting and weight loss, menstrual reduction or prolonged menstrual cycle first occurs, followed by amenorrhea.

Strong exercise

Many young ladies and sisters always have some misconceptions when they first start exercising to lose weight. For example, the greater the amount of exercise and the more intense the exercise, the better the weight loss effect. In fact, this is not the case. On the contrary, strenuous exercise will affect the function of the “big brother” hypothalamus, which is also called “exercise amenorrhea”. Therefore, the amount of exercise should also be moderate.

Low body fat

Low body fat will also affect the “big aunt”. Body fat content also affects endocrine regulation in women. Studies have shown that a normal “big aunt” cramp can be maintained when the body fat rate is at least 17%; when the body fat rate is at least 22%, a regular “big aunt” can be maintained. When the body weight is lower than 5% to 10% of the standard body weight, the “big aunt” cycle can change; when it is less than 15% of the standard body weight, it may lead to the dysfunction of the “third brother” ovarian function. Therefore, excessive weight loss and rapid reduction of body fat can also cause endocrine disorders, menstrual disorders and even amenorrhea, which is also called “weight loss amenorrhea”.

When should I lose weight?

According to WHO, the standard body mass index BMI=weight kg/(height*height m), normal BMI is 18.5-23.9, <18.5 is underweight, 24-27 is overweight, 28 -32 is obese, >32 is very obese. Only people who are overweight, obese, or very obese need to lose weight, but weight loss also needs to follow scientific laws, control diet, and strengthen physical exercise. It is not recommended to lose more than 2-2.5kg in one month. Gradually, until it reaches a normal body mass index, it is absolutely necessary. Excessive dieting and strenuous exercise.

We see that Xiaoxiao is 1.62m tall, weighs 50kg, and has a BMI=50/(1.62*1.62)=19.05, which is actually a very standard weight. For women with normal body mass index, blind weight loss is not recommended, but appropriate exercises targeting local tissues can be performed to improve body curves. For women with a low body mass index, it is recommended to strengthen dietary nutrition appropriately to avoid menstrual disorders caused by low body weight. It is because of inappropriate weight loss that Xiaoxiao has the adverse consequences of amenorrhea.

Of course, we can’t just look at BMI. Because the distribution of fat is also related to health, abdominal fat is more harmful to health than the accumulation of fat in the limbs. However, this point cannot be reflected by BMI. At the same time, weight is also divided into fat, muscle and water. Some people have a high BMI because of a high proportion of muscle, which is not harmful to the body. Therefore, we also need to understand the body fat rate. Generally, the recommended body fat rate for adult women is 21%-31% (this data does not apply to pregnant women).

What if “Auntie” ran away from home?

If you want “Auntie” to go home, you must first restore your normal weight. Misses and sisters who have been dieting too much need to resume a nutritionally balanced diet, and comprehensively supplement cereals, meat, poultry, fish, eggs, milk, vegetables and fruits. , gradually return to normal weight and body fat percentage.

Secondly, those who are exercising excessively need to reduce the amount of exercise, or change the way of vigorous exercise, and change to aerobic exercise such as yoga and swimming, and pause the exercise if necessary. Usually when the weight returns to normal weightThe “big aunt” will slowly recover on its own when it is more than 85% of the time, but the recovery time varies from person to person, and it may take 1 to 2 years, or even longer. Therefore, the weight can be reduced all at once, and the “big aunt” who has run away from home may not go home so easily!

Third, before menstruation resumes, we need to adhere to the treatment of artificial cycles of estrogen and progesterone to maintain the basic reproductive function of our women, so as to prevent the uterus, ovaries and other reproductive organs from shrinking due to long-term amenorrhea, even premature aging. If amenorrhea lasts for a long time, it is also necessary to monitor bone density and supplement calcium and vitamin D appropriately to prevent bone loss.

Fourth, also pay attention to mental health, try to relax, and stay away from anxiety and stress. On the one hand, due to the influence of declining hormone levels, many young ladies and sisters will experience anxiety, depression, and even anorexia nervosa. On the other hand, looking at the weight that I have finally lost, I have to regain it, and it is necessary to recover, it will be very tangled, and the psychological pressure will be even greater. At the same time, the bad mood itself will also affect the “big aunt”.

Although everyone has a love for beauty, the pursuit of beauty is an innate instinct of human beings. But it’s not that the thinner you are, the more beautiful you are. Beauty can only come from health. The reason why the human body is beautiful, health is the primary condition. “Beauty” at the expense of physical health is like a castle in the sky, like Xiaoxiao, who loses weight, has ovarian dysfunction, and has amenorrhea. I believe that this kind of “beauty” will not be appreciated by anyone. Scientific and reasonable weight loss, comprehensive and reasonable nutrition, avoiding menstrual disorders caused by weight loss, and maintaining women’s health are the sincere hope of gynecologists to the ladies and sisters.

Author: Shanghai First Maternity and Infant Health Hospital

Wu Shengnan Attending Physician