Journal of Psychosomatic Obstetrics & Gynecology

ISSN: 0167-482X (Print) 1743-8942 (Online) Journal homepage: http://www.tandfonline.com/loi/ipob20

Assessment of the menstrual cycle, eating

disorders and self-esteem of Polish adolescents

Agnieszka Drosdzol-Cop, Monika Bąk-Sosnowska, Dominika Sajdak,

Agnieszka Białka, Agnieszka Kobiołka, Grzegorz Franik & Violetta Skrzypulec-
Plinta

To cite this article: Agnieszka Drosdzol-Cop, Monika Bąk-Sosnowska, Dominika Sajdak,

Agnieszka Białka, Agnieszka Kobiołka, Grzegorz Franik & Violetta Skrzypulec-Plinta (2016):
Assessment of the menstrual cycle, eating disorders and self-esteem of Polish adolescents,
Journal of Psychosomatic Obstetrics & Gynecology, DOI: 10.1080/0167482X.2016.1216959

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JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY, 2016
http://dx.doi.org/10.1080/0167482X.2016.1216959

ORIGINAL ARTICLE

Assessment of the menstrual cycle, eating disorders and self-esteem of

Polish adolescents
Agnieszka Drosdzol-Copa, Monika Ba˛k-Sosnowskab, Dominika Sajdaka, Agnieszka Białkaa,
Agnieszka Kobiołkaa, Grzegorz Franikc and Violetta Skrzypulec-Plintaa
a
School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland; bSchool of Health Sciences in Katowice,
Medical University of Silesia, Katowice, Poland; cDepartment of Endocrinological Gynecology, Medical University of Silesia, Katowice,
Poland

ABSTRACT ARTICLE HISTORY

Introduction: Eating disorders are an important factor in menstrual cycle disorders in girls. Received 4 September 2015
Moreover, low self-esteem among adolescent girls may be a risk factor for eating disorders. The Revised 25 May 2016
aim of the study was to assess the menstrual cycle, eating habits and self-esteem of Polish Accepted 13 July 2016
adolescents. Published online 22 August
2016
Methods: The study was conducted from January 2014 to March 2015 and included 623 girls,
aged 15–19, from randomly selected junior high schools in Silesia, Poland, in which their men- KEYWORDS
strual cycle, risk of eating disorders and self-esteem were evaluated. A five-part questionnaire Adolescent; eating
was used to assess basic demographic data, lifestyle and physical activity, gynecological history, disorders; self-esteem;
as well as Rosenberg Self-Esteem Scale (SES) and Eating Attitude Test (EAT-26). irregular menstrual cycle
Results: Irregular menstrual cycles were observed in 236 (37.88%) girls; 5.20% presented second-
ary amenorrhea. Based on the EAT-26 test, 101 (16.21%) girls were indicated being at risk for an
eating disorder. Low self-esteem was observed in 340 (54.57%) study girls on the base of SES.
Discussion: Girls with irregular menses had higher scores on the EAT-26 test in subscales: EAT-
overall score, EAT-diet and EAT–bulimia, while lower scores on the SES. In our study, we did not
observe a significant relationship between exercise intensity, body mass, BMI and menstrual
cycle regularity. Low self-esteem among adolescent girls may be a risk factor for eating disorders
which could interrupt the menstrual cycle.

Introduction all eating disorders. Furthermore, within the same

Eating disorders are psychological illnesses character-
ized by abnormal eating habits and specific psycho-
pathological symptoms. The latest classification of
eating disorders (DSM-V) includes: anorexia nervosa,
bulimia, and other feeding and eating disorders con-
nected with avoidant or restrictive food intake [1].
Eating disorders are chronic conditions and,
depending on the severity of the illness, can be devas-
tating. It is estimated that approximately 90% of the
patients with eating disorders are women, and the
onset of the illness most frequently coincides with
adolescence [2,3]. The prevalence of eating disorders
among adolescents and young adults in the USA is
0.5–1% for anorexia, 1–2% for bulimia and approxi-
mately 5% for other eating disorders [4]. In a
Portuguese study, involving a group of young people
aged 12–23, EDNOS (eating disorder not otherwise
specified – according to DSM- IV) constituted 77.4% of
study, it was found that the prevalence indices for
anorexia and bulimia were 0.3–2.2% and 0.1–2%,
respectively [5].
According to the Agency for Healthcare Research
and Quality, hospitalizations for eating disorders
increased most sharply for children younger than
12 years. This is particularly alarming, due to the pos-
sible future disorders of physical, psychological and
social development [6].
Many teenagers implement restrictive or starvation
diets, the use of slimming or laxative drugs, or induce
vomiting. Research into the etiopathogenesis of eating
disorders stresses the role of family relationships.
A particularly difficult life event, such as death of a
family member, or parents’ divorce is often a trigger
for the manifestation of the disease. The socio-cultural
aspect is another significant risk factor – the wide-
spread media-driven canon of female beauty promotes

CONTACT Dominika Sajdak ds.sajdak@gmail.com Chair of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia,
Katowice, ul. Medyk

ow 12; 40-752 Katowice, Poland
ß 2016 Informa UK Limited, trading as Taylor & Francis Group
2 A. DROSDZOL-COP ET AL.
slimness as a synonym of beauty and attractiveness, as
well as acceptance by society, peers and family [2,7].
Self-esteem, especially during adolescence, can be
strongly associated with building of one’s own body
image and perfectionism. When the level of self-
esteem is low, it affects body satisfaction and corre-
lates with a higher level of unhealthy weight-control
behaviors, which in turn lead to more often binge-eat-
ing, due to self-doubt in the ability to lose weight [8].
Eating disorders may be associated with various
somatic disorders which may lead to permanent func-
tional changes – cardiac, gastroenterological, neuro-
logical, orthopedic and gynecological. Teenage girls
with menstrual disorders, such as primary or secondary
amenorrhea, or even oligomenorrhoea, are among the
most frequent reasons resulting in a visit to a specialist
at the gynecological outpatient clinic [2]. The men-
strual cycles in the first two or three years after menar-
che may be irregular. This phenomenon is fully
physiological and it is connected with the maturation
of correct feedbacks within the hypothalamic–pituitar-
y–gonadal system. Menstrual disorders occurring in
young girls after this period may indicate significant
abnormalities within the hypothalamic–pituitary–gona-
dal system [9,10].
Studies have shown a relationship between the age
at menarche and body mass: malnutrition and eating
disorders (e.g. anorexia, bulimia), as well as a high
level of physical activity correlation with older age at
menarche. Functional hypothalamic amenorrhea (FHA)
is the most frequent reason for secondary amenorrhea
in adolescent girls (50–75%); FHA also causes primary
amenorrhea in approximately 15% of cases [11,12].
Menstrual dysfunctions in teenagers based on the eti-
ology of functional hypothalamic disorders may be
classified as follows [12]:

amenorrhea related to body mass loss,

amenorrhea related to excessive exercise,

amenorrhea related to stress, and

amenorrhea related to: anorexia nervosa, bulimia
nervosa, eating disorders not otherwise specified
(EDNOS).
The main cause of menstrual disorders among teen-
agers are disorders of the pulsatile GnRH secretion,
leading to secondary decrease of FSH and LH secre-
tion, and resulting in abnormal ovarian steroidogenesis
[13,14]. Hypoleptinemia has been reported to play a
role in hypothalamic–pituitary–gonadal axis inhibition
[15]. Statistically, 68% of the patients suffering from
eating disorders experience amenorrhea. Research
shows that menstruation ceases in more than 90% of
anorexic girls, and in 20%, menstruation stops before
considerable weight loss [16–18]. Some teenagers
experience the “female athlete triad syndrome”: amen-
orrhea, an eating disorder, and osteoporosis resulting
from severe hypoestrogenism [19–22].
The aim of the study was to assess the menstrual
cycle, eating habits and self-esteem of Polish adoles-
cents, by means of evaluating eating related menstrual
disturbances with additional correlations of self-
esteem. Eating disorders might be a risk factor for
menstrual cycle disturbances among adolescent girls.
However, low self-esteem may also contribute to the
development of the risk for eating disorders among
female teenagers.
Methods
The study was conducted from January 2014 to March
2015, and encompassed 623 girls. Study inclusion cri-
teria were: age between 15 and 19 years, absence of
systemic diseases, and the girls’ or their legal
custodians’ consent to participate in the study.
Furthermore, study exclusion criteria encompassed:
pharmacotherapy in the last 6 months (hormone ther-
apy, contraceptives, NSAIDs), additional systemic dis-
eases (such as hypothyroidism, hyperthyroidism,
cardiovascular diseases, diabetes, ulcer disease, auto-
immune diseases, other endocrinological disorders,
epilepsy). All the participants were pupils from ran-
domly chosen junior high schools in Silesia, Poland.
The girls were asked to complete a five-part ques-
tionnaire related to:

Basic demographic data: age, place of living, paren-
ts’ education, family’s economic status, type of
school, scholastic performance, height, weight;

Lifestyle and physical activity: participation in phys-
ical activity classes, additional forms of exercise out-
side school, intensity of exercise, use of diets;

Gynecological history, including assessment of the
menstrual cycle (length, regularity, presence of sec-
ondary amenorrhea as well as duration and volume
of menstrual flow) and medical history (systemic
diseases, medications, surgery, analgesics). This part
of the questionnaire was completed in the pres-
ence of a physician.
According to the American College of Obstetricians
and Gynecologists, a normal menstrual cycle in a young
woman lasts between 21 and 45 days, with flow dur-
ation of 7 days. Menstrual flow >80 ml is considered
heavy (soaking more than 3 sanitary pads or 5–6 regu-
lar-size tampons a day for a minimum of 3 days).

Irregular menstrual cycles are defined as cycles lasting
less than 21 days or more than 45 days. Secondary
amenorrhea is diagnosed in the absence of menses for
a period of 6 months in a girl with previously normal
menstruation [2,23].
The Rosenberg Self-Esteem Scale (SES) is a one-
dimensional tool used for the assessment of self-
esteem or the conscious attitude (positive or negative)
towards oneself. This scale is composed of 10 diagnos-
tic statements answered on a four-point scale: 1 –
strongly agree, 2 – agree, 3 – disagree, 4 – strongly
disagree. The final SES score is a total of points
obtained for all the items, with a range of 10 to 40
points, which in turn may be transformed into a 10-
point sten scale. Stens 1–5 correspond to low scores,
while stens 6–10 correspond to high scores. Scores
below 15 points, suggest the presence of a clinically
significant disorder of self-esteem [24]. Cronbach a val-
ues for the Polish version of SES range from 0.81 to
0.83 and test-retest reliability demonstrates a good
correlation (0.83; p < .001) [25]. Cronbach a value of
SES for our results was estimated at the level of 0.82,
showing high reliability.
The Eating Attitude Test (EAT-26) is a screening tool
widely used to identify respondents at risk of eating
disorders. It is a 26-item test concerning beliefs and
behaviors towards food. The respondents state the
extent with which they agree with the statements: 1 –
always; 2 – usually, 3 – often, 4 – sometimes, 5 –
rarely, 6 – never. The range of score is between 0 and
78 points. The interpretation of the EAT-26 test results,
takes into consideration the overall score, as well as
scores for questions regarding behaviors associated
with eating disorders, body mass loss and BMI. A total
score of 20 or more indicates only being at risk for an
eating disorder but not yet the clinical diagnosis of it.
EAT-26 subscales include: diet (the respondents’ focus
on calories present in food, their appearance, physical
activity in order to reduce body mass, feeling of guilt
after eating), bulimia (persistent thoughts focused on
food, uncontrollable binge eating, induction of vomit-
ing to compensate after eating), restrictive diets (lim-
ited food intake, starvation diet) [26]. Cronbach a
value for the Polish version of EAT-26 is 0.84, showing
high reliability. Cronbach a values for EAT-26 subscales
range from 0.65–0.82 [27]. Cronbach a value of EAT-26
for our results was estimated at the level of 0.83,
showing high reliability.
The study was anonymous and all the girls and
their parents/custodians gave informed consent for
participation. The study was approved by the Bioethics
Committee of the Medical University of Silesia in
Katowice, Poland.
JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY 3
All statistical analyses were made with STATISTICA
software (StatSoft Polska v.10, Krakow, Poland). The
accepted level of statistical significance was a ¼ 0.05.
Normality of distribution was assessed with the
Shapiro–Wilk test. Since most data had non-normal
distribution, hypotheses were verified with non-para-
metric tests. The significance of differences was
assessed by means of the Mann–Whitney U-test and
the Chi-squared test of independence. Spearman’s
rank correlation coefficient was used to assess the
monotonic relationship between the studied variables.
Results
General characteristics of the study population
The study population encompassed 623 girls aged
15–19 (mean age: 17.31 ± 1.08). The girls’ mean body
mass was 56.62 ± 9.38 kg and mean body mass index
(BMI) was 20.63 ± 2.99 kg/m2. Sexual activity was
declared by 68 girls (10.91%), of whom 8.82% started
sexual life at the age of 14, 29.47% at 15, 39.71% at
16, and 11.76% at 17. A significant majority of girls
(82.18%) took an active participation in physical activ-
ity classes and 11.72% declared partial exemption of
participation. Taking part in physical activity outside
school was found among 58.10% of the respondents.
The girls’ eating habits
Based on the EAT-26 test, 101 (16.21%) girls were indi-
cated being at risk for an eating disorder, whereas the
use of various diets was reported by 15.09%. Body
mass loss in the previous six months was observed in
33.71% of girls, while body mass gain in 24.56%. The
mean score on EAT-26 test (overall score) was
11.98 ± 8.74, with the mean scores in subscales: EAT-
diet 8.38 ± 6.34, EAT-bulimia 1.33 ± 2.43 and EAT-
restrictions 2.30 ± 2.88.
Assessment of the menstrual cycle
All of the girls from the study group menstruated. The
age of menarche was 11 in 11.88%, 12 in 31.30%, 13
in 33.39% and 14 in 14.77% of the girls, with the
mean age of menarche – 12.62 ± 1.12 years. The mean
length of the menstrual cycle was 28.50 ± 5.81 days,
while the mean duration of menses was: 5.41 ± 1.31
days.
Regular menstrual cycles were observed among 387
of the studied girls (62.12%), while the remaining 236
girls (37.88%) had irregular menstrual cycles.
Oligomenorrhea was diagnosed in 250 girls (40.13%);
4 A. DROSDZOL-COP ET AL.

in 76.00% of these girls, the interval of menstrual Table 1. Regularity of the menstrual cycle and EAT-26 test
absence was shorter than 3 months, in 18.80% scores.
between 3 and 6 months, while secondary amenorrhea Regular men- Irregular men-
strual cycle strual cycle Mann–Whitney
was observed in 5.20%. In 56.80% of girls, it was a (n ¼ 387) (n ¼ 236) U test
once-off episode, while in 37.60%, menstruation was Mean SD Mean SD p U-value
irregular since menarche. According to the girls’ sub- EAT-overall score 11.16 8.15 13.34 9.50 .004 2.82
jective opinion, the interval was not associated with EAT-diet 7.82 5.97 9.30 6.80 .009 2.59
EAT-bulimia 1.19 2.30 1.58 2.60 .035 2.10
any specific triggering factor (56.00%), was associated EAT-restrictions 2.19 2.74 2.47 3.09 .354 0.93
with stress (22.80%), connected with hormonal disor- p < .05.
ders (4.40%) or resulted due to weight loss (4.80%).
Within the entire study group, pain-free menstru- also investigated using the Mann–Whitney U test. The
ation was declared by 119 (19.10%) girls, pain at the analysis showed that irregular menstrual cycles
beginning of menses by 439 (70.47%), while pain were more frequent in case of shorter time since
throughout the entire duration of menses by 65 menarche compared with regular cycles (median: 4
(10.43%) girls. Pain was assessed as mild by 13.16% of years versus 5 years, respectively) (Mann–Whitney
the girls, moderate by 25.84%, severe by 21.19%, very U test; U ¼ 4.86, p < .000).
severe by 21.19% and unbearable by 9.15% of the Finally, we also analyzed combinations of risk fac-
girls. Additional menstrual conditions (headache, faint- tors in logistic regression analysis (age, BMI, risk for
ing, fatigue, back pain, nausea, vomiting, breast ten- eating disorders), to determine the profile of girls with
derness, diarrhea) were declared by 165 (26.48%) girls. irregular menstrual cycles. It was revealed that the like-
The regularity of the menstrual cycle was correlated lihood of irregular menstrual cycles was 1.85 times
with the EAT-26 test scores using the Mann–Whitney higher in girls at risk for eating disorders (OR ¼1.85;
U test (Table 1). Significant differences were noticed p ¼ .005) (Table 2).
for EAT-overall score, EAT-diet and EAT-bulimia. In all
cases, girls with irregular menstrual cycles had higher
Self-esteem in the study girls
EAT-26 total test scores, indicating a stronger tendency
towards eating disorders. Furthermore, the relationship Based on the results of the conducted analysis (SES),
between irregular and regular cycles in girls at risk for low self-esteem was observed in 340 (54.57%) of the
eating disorders and girls not at risk for eating disor- study girls, while high self-esteem was observed in
ders was analyzed. The results of statistical analysis 283 (45.42%) girls.
showed that girls at risk for eating disorders had Among the studied girls, 30.66% were not satisfied
irregular cycles significantly more frequently. This dif- with their body mass, 35.96% were moderately satis-
ference appeared to be statistically significant (50.50% fied, while 33.39% were dissatisfied. Furthermore,
versus 35.00%). 25.04% of the girls did not accept themselves fully,
The relationship between the intensity of exercise 62.44% accepted themselves to a certain degree, while
and regularity of the menstrual cycle was also ana- 12.52% did not accept themselves.
lyzed using the Mann–Whitney U test. Mean duration The EAT-26 test results were analyzed with regard
of weekly physical activity in the study population was to the girls’ self-esteem using the Mann–Whitney
5.15 ± 3.47 h. The mean duration of weekly physical U test. Significant differences were observed for EAT-
activity among girls with regular menstrual cycles was general score, EAT-diet and EAT-restrictions. In all
5.29 ± 3.83 h, while in girls with irregular cycles the three domains, girls with high self-esteem had lower
duration was 4.93 ± 2.80 h (p ¼ .828). EAT-26 scores (Table 3). The relationship between the
No significant correlation was found between body risk for eating disorders and self-esteem within the
mass and regularity of the menstrual cycle using the study population was also analyzed. Among girls at
Mann–Whitney U test. Mean body mass of girls with risk for eating disorders, 34.00% had high self-esteem
regular cycles was 56.91 ± 9.38 kg versus 56.14 ± 9.37 kg and 66.00% low self-esteem. Among girls with normal
in girls with irregular cycles (p ¼ .221). Moreover, no eating habits, high self-esteem was confirmed by
significant differences were found between the BMI of 48.00% and low by 52.00% (Chi-squared test: 6.73;
girls with regular and irregular cycles: 20.79 ± 3.04 ver- p ¼ .010, df ¼ 1).
sus 20.37 ± 2.89 kg/m2 (Mann–Whitney U test; Finally, the relationship between SES scores and
p ¼ .062). cycle regularity was assessed. Significantly higher SES
The correlation between time since menarche (con- scores were observed in girls with regular
founding factor) and menstrual cycle disturbances was menstrual cycles than in girls with irregular cycles
 JOURNAL OF PSYCHOSOMATIC OBSTETRICS & GYNECOLOGY 5

Table 2. Odds ratios, their 95% confidence intervals and the result of Wald’s significance test obtained from logistic regression
of irregular menstrual cycles and low self-esteem occurrence in connection with age, BMI and risk for eating disorders among
girls.
Variable Age BMI At risk for eating disorders
Irregular menstrual cycles 0.86 [0.74; 1.00] (p ¼ .058) 0.95 [0.90; 1.00] (p ¼ .072) 1.85 [1.20; 2.85] (p 5 .005)
Low self-esteem 0.97 [0.83; 1.12] (p ¼ .642) 1.03 [0.98; 1.09] (p ¼ .237) 1.78 [1.14; 2.79] (p 5 .011)
p < .05.

Table 3. EAT-26 test scores in girls with low and high self- frequently [28]. According to Vale et al., who assessed
esteem (SES). the menstrual cycle of girls with eating disorders,
Low self- High self- irregular menses occurred in one-third of the studied
esteem esteem Mann–Whitney U girls (mainly secondary amenorrhea: two-thirds of the
(n ¼ 340) (n ¼ 283) test
cases) [18]. Vyver and Pinheiro demonstrated that
Mean SD Mean SD p U-value
menstruation ceased in over 90% of the anorexic girls
EAT-overall score 13.62 9.53 10.02 7.23 <.000 5.27
EAT-diet 9.67 7.08 6.83 4.88 <.000 5.25 and in almost 50% of the girls with bulimia and other
EAT-bulimia 1.43 2.47 1.22 2.37 .367 0.90 specific eating disorders [15,16].
EAT-restrictions 2.53 3.09 2.02 2.58 .031 2.15
p < .05.
In our study, we did not observe a significant rela-
tionship between exercise intensity, body mass, BMI
and menstrual cycle regularity. However, Vinkers et al.
(5.41 ± 2.30 versus 4.72 ± 2.11 respectively; showed a relationship between low self-esteem in
Mann–Whitney U-test; p < .001). teenage girls and exercise intensity; the desire to
In the next step, the correlation between time since change one’s own body through intensive exercise
menarche (confounding factor) and self-esteem was may eventually lead to the development of eating dis-
investigated using the Mann–Whitney U test. No sig- orders and menstrual cycle disorders [29].
nificant differences were found in this analysis The absence of menses related to excessive physical
(Mann–Whitney U test; U ¼ 0.24, p ¼ .813). exercise is a part of the female athlete triad (menstrual
Moreover, based on the logistic regression model of disorders, eating disorders, low bone density). Our
low self-esteem occurrence conducted for selected var- study did not reveal any girls showing the symptoms
iables: age, BMI, risk for eating disorders, the odds of athlete triad, there were no adolescents practicing
ratio (OR) and their 95% confidence intervals were competitive sports; whereas Nichols et al. assessed the
determined. Self-esteem in teenagers was significantly menstrual disorders in 170 teenage athletes and found
correlated with the risk for eating disorders; the risk that 17% had irregular menses, 5.3% secondary amen-
for eating disorders increased up to nearly 2-fold the orrhea and 1.2% primary amenorrhea [30]. The
odd ratio of low self-esteem (OR ¼ 1.78; p ¼ .011) absence of menses related to body mass loss is an
(Table 2). adaptive mechanism, whose main aim is to save
energy for the basic physiological functions, excluding
the reproductive system. Payne et al. showed that
Discussion
body mass and BMI have a significant impact on men-
The study compared the EAT-26 and SES scores in girls strual cycle disorders; nevertheless, irregular menses
with regular and irregular menses. The Eating Attitude may occur also in girls with correct body mass or over-
Test (EAT-26) is a screening tool widely used to indi- weight [31].
cate being at risk for an eating disorder but not yet In our study, we observed a significant relationship
the clinical diagnosis of it. Girls with irregular menses between the girls’ self-esteem and the risk of develop-
had higher scores on the EAT-26 test in subscales: ing eating disorders. Girls with high self-esteem had
EAT-overall score, EAT-diet and EAT–bulimia, and lower lower scores on the EAT-26 test (EAT – overall score,
scores on the SES. Further analysis showed that irregu- EAT – diet, EAT – restrictions). A similar relationship
lar menses occurred in 50.50% of the girls at risk for was observed by Stice et al. [32]. Based on an analysis
an eating disorder and in 35.00% of the girls with cor- of risk factors for eating disorders in a group of 496
rect eating habits. teenage girls, the authors concluded that low self-
In their studies, Algars et al. assessed menstrual esteem is the most important risk factor for eating dis-
cycle irregularity in binge-eating women and women orders. Indeed, in girls who are dissatisfied with their
with no history of eating disorders. Similarly, women body, the risk of developing such disorders is four-fold
with eating disorders suffered from oligomenorrhea higher than in girls with higher self-esteem (24% ver-
and secondary amenorrhea statistically more sus 6%) [32].
6 A. DROSDZOL-COP ET AL.
The hypothesis was further confirmed by Brechan
et al. in a study of 320 Norwegian university students
(65% female). Self-esteem and depression were shown
to have a significant impact on the students’ satisfac-
tion with their body image. Furthermore, Brechan
observed that low self-esteem and distorted image of
one’s own body conditioned unhealthy behaviors,
such as restrictive food intake or compensatory behav-
iors. Depression was directly connected with both
restrictive food intake and binge eating [33]. Similar
conclusions were drawn by Courtney et al., who
showed that teenagers with low self-esteem are at risk
of developing eating disorders; depressive symptoms
were seen as mediating factors between low self-
esteem and eating [34].
Teenage girls are susceptible to the development
of eating disorders caused by genetic, environmental,
familial, social, cultural and personality factors. The
chronic and frequently devastating course of the dis-
ease, results in a high ratio of complications and
mortality. Menstrual disorders may often be the first
symptom occurring before a significant body mass
loss, and may have serious consequences not only
on the girls’ reproductive health but may also lead
to other complications, such as loss of bone density.
Effective treatment should be based on the cooper-
ation of an interdisciplinary medical team and the
patient’s family in order to restore correct body mass
and correct nutrition, as well as to reduce the pos-
sible health complications of eating disorders.
Our study was an extensive and pioneering
report of the numerous groups of Polish teenage
girls. The evaluation of correlations between self-
esteem, risk for eating disorders and menstruation
was performed.
Conclusions
The risk of developing eating disorders and low self-
esteem are frequently observed among Polish teenage
girls. Low self-esteem among adolescent girls may be
a risk factor for eating disorders which could interrupt
the menstrual cycle. Therefore, an interdisciplinary
medical team including gynecologists, psychiatrists
and even nutritionists should take care of the girls at
risk of menstrual disorders.
Disclosure statement
No competing financial interests exist. The authors report no
financial, personal, political, intellectual or religious conflicts
of interest. The authors alone are responsible for the content
and writing of the paper.
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ä Current knowledge on the subjects:

Irregular menses occurs in one-third of the girls at the risk for eating disorders.

Girls, with low self-esteem are at risk of developing eating disorders four-fold higher than in those with
higher self-esteem.

Low self-esteem and distorted image of one’s own body conditions unhealthy behaviors, such as restrictive
food intake or compensatory behaviors. Depression is directly connected with both restrictive food intake
and binge eating.

ä What this study adds:

Eating disorders are an important factor in menstrual cycle disorders in girls.

Risk for eating disorders are frequently observed among Polish teenage girls.

Low self-esteem among adolescent girls may be a risk factor for eating disorders.