Bulimic eating patterns should be stabilised in polycystic ovarian syndrome

EDITOR—Hopkinson et al have reviewed the polycystic ovarian syndrome and emphasised that it represents more than a purely gynaecological disorder.1 They also emphasised the link between insulin resistance and obesity in its pathogenesis. They made no mention, however, of the role of bulimia nervosa. McCluskey et al found that three quarters of 34 patients with bulimia nervosa had polycystic ovaries2 and roughly one third of 153 patients with the polycystic ovarian syndrome attending an endocrinology clinic had scores on a self rating scale for bulimia indicating disordered eating.3 It was stated that fluctuations in carbohydrate intake associated with bulimia may facilitate the phenotypic expression of the polycystic ovarian syndrome via altered insulin resistance.

Hopkinson et al have highlighted the multiple benefits of weight reduction in the management of women with the polycystic ovarian syndrome. This, however, may simply amount to unsupervised dieting, which runs the risk of escalating cycles of binge eating and purging, potentially contributing to the pathogenesis of the syndrome and certainly contributing to the patient's distress.

More work is needed to examine the causal relations between bulimia nervosa and the polycystic ovarian syndrome. On the available evidence, women with the syndrome should be routinely screened for abnormal eating behaviour; where appropriate, bulimic eating patterns should be stabilised by cognitive behavioural therapy before dieting is recommended. Such treatment can lead to a reduction in the frequency of purging and bingeing of over 70%.4 Cycles of feast and famine have always modulated reproductive cycles, and an appreciation of this is crucial.