Menstruation during and after caloric restriction: The 1944–1945 Dutch famine

ObjectiveTo investigate the relation between exposure to the 1944–45 Dutch famine and concurrent and subsequent menstrual disturbances.DesignCohort study.SettingDoorlopend 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.