title: Irregular menses linked to vomiting in a nonclinical sample: findings from the National Eating Disorders Screening Program in high schools.
abstract: OBJECTIVE
  Using data from an eating disorders screening initiative conducted in high schools across the United States, we examined the relationship between vomiting frequency and irregular menses in a nonclinical sample of adolescent females.
  
  
  METHODS
  A self-report questionnaire was administered to students from U.S. high schools participating in the National Eating Disorders Screening Program in 2000. The questionnaire included items on frequency of vomiting for weight control in the past 3 months, other eating disorder symptoms, frequency of menses, height, and weight. Multivariable regression analyses were conducted using data from 2791 girls to estimate the risk of irregular menses (defined as menses less often than monthly) associated with vomiting frequency, adjusting for other eating disorder symptoms, weight status, age, race/ethnicity, and school clusters.
  
  
  RESULTS
  Girls who vomited to control their weight one to three times per month were one and a half times more likely (risk ratio [RR] = 1.6; 95% confidence interval [CI] = 1.2-2.2), and girls who vomited once per week or more often were more than three times more likely (RR = 3.2; 95% CI = 2.3-4.4), to experience irregular menses than were girls who did not report vomiting for weight control. Vomiting for weight control remained a strong predictor of irregular menses even when overweight and underweight participants were excluded.
  
  
  CONCLUSIONS
  Our study adds to the evidence that vomiting may have a direct effect on hormonal function in adolescent girls, and that vomiting for weight control may be a particularly deleterious component of eating disorders.
authors.affiliation: Division of Adolescent and Young Adult Medicine, Children's Hospital, Boston, Massachusetts 02115, USA. bryn.austin@childrens.harvard.edu
authors.forename: S Bryn
authors.initials: SB
authors.lastname: Austin
authors.forename: Najat J
authors.initials: NJ
authors.lastname: Ziyadeh
authors.forename: Sameer
authors.initials: S
authors.lastname: Vohra
authors.forename: Sara
authors.initials: S
authors.lastname: Forman
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Gordon
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prokop
authors.forename: Anne
authors.initials: A
authors.lastname: Keliher
authors.forename: Douglas
authors.initials: D
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D017195:Adolescent Nutritional Physiological Phenomena; D000328:Adult; D015992:Body Mass Index; D004700:Endocrine System Diseases / Q000209:etiology; D001068:Feeding and Eating Disorders / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008599:Menstruation Disturbances / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology; D014839:Vomiting / Q000150:complications* / Q000453:epidemiology; D015431:Weight Loss / Q000502:physiology