Menstrual distress in women with eating disorders: insights from the Menstrual Distress Questionnaire (MEDI-Q).

Purpose: Despite the well-established association between Eating Disorders (EDs) and menstrual disorders, menstrual distress in women with EDs has not been thoroughly investigated. This study aimed to compare menstrual distress between patients with EDs and healthy controls (HCs), explore correlations between menstrual distress and ED psychopathology, and examine the differential impact of hormonal contraception on perceived menstruation-related distress in patients compared to HCs.

Methods: A total of 132 patients with EDs and 105 HCs were recruited. Socio-demographic, anthropometric, and menstrual cycle data were collected. Self-administered questionnaires were used to evaluate premenstrual symptoms, ED psychopathology, and general psychopathology. The Menstrual Distress Questionnaire (MEDI-Q) was adopted for the assessment of menstrual distress.

Results: Patients with EDs had higher scores in all menstrual distress subscales of MEDI-Q and higher premenstrual symptoms as compared to HCs, without differences between different ED diagnoses. Approximately 65% of distress was specific of the menstrual phase in both groups. Patients experienced particular symptoms as more distressful: muscle and osteoarticular pain, breast tenderness and widespread swelling sensation, headache, constipation, feeling of being impure, impulsiveness, anxiety, insomnia, and fatigue. Greater menstrual distress correlated with higher ED psychopathology. Hormonal contraceptive use predicted reduced menstrual distress in individuals with low ED psychopathology, but not in those with high ED psychopathology.

Conclusion: These results highlighted the profound interplay between menstrual distress and psychopathology in women with EDs, with important clinical implications for both the therapeutic path of patients with EDs and the gynecological assessment of women experiencing menstrual distress.

Article Highlights: • Patients with eating disorders had higher MEDI-Q menstrual distress than controls. • 65% of menstrual distress was specific to the menstrual phase. • Patients found swelling, constipation and anxiety particularly distressful. • Greater menstrual distress correlated with higher eating disorder psychopathology. • Hormones did not reduce distress in presence of high eating psychopathology.