Menstruation during and after caloric restriction: the 1944-1945 Dutch famine

Abstract

Objective: To investigate the relation between exposure to the 1944-45 Dutch famine and concurrent and subsequent menstrual disturbances.

Design: Cohort study.

Setting: Doorlopend Onderzoek Mammacarcinoom breast cancer screening project, Utrecht, the Netherlands.

Patient(s): Between 1983 and 1986, approximately 12,500 women (born 1911-41) reported their individual famine experiences.

Main outcome measure(s): Irregular menstruation during the famine; time to regular menses after menarche, and menstrual patterns in adulthood after childhood famine.

Result(s): The famine had a direct impact on menstruation. The odds ratio (OR) of concurrent irregular menses in severely versus unexposed women was 8.85 (95% confidence interval [CI], 7.31-10.70). Women exposed to severe famine before menarche were 1.51 (95% CI, 1.15-1.98) times more likely to experience irregular menses for a prolonged time after menarche compared with the unexposed. This association was stronger in women with an early menarche. When the menstrual pattern was assessed in adulthood by menstrual diaries, a nonsignificant tendency of increased irregularity (OR, 1.13; 95% CI, 0.82-1.54) and regular but long menstrual cycles (OR, 1.41; 95% CI, 0.89-2.23) was observed in women exposed to severe famine.

Conclusion(s): Famine relates to concurrent menstrual irregularity, and exposure in childhood seems to affect the subsequent menstrual pattern.