A sudden menstrual return

I have already posted this to two forums and received zero responses. My cousin is really beside her self and nagging me for answers, so any response that can shed light on this matter would be appreciated:

My cousin is a long-time sufferer of an eating disorder and has had hyperthalamic amenorrhea for many years. Well, last week, out of the blue, she got a period. It was only a light one that lasted three days and didn't even drip out (hardly more than spotting). All the same, she is torn up by what happened. Let me explain that my cousin is NOT recovered (no where near recovered, in fact). Since she has severe body dysmorphia, her missing period was the only thing that assured her she was underweight. She has neither gained weight nor reduced exercise/or done anything else these "recovery from eating disorders" websites claim to be the silver bullet reasons for why menses would resume. In fact, the fact that these websites keep brow-beating the idea of weight gain as being the ONLY viable reason for a period to resume is very damaging to my already vulnerable cousin. If anything her BMI is even less than it was when she first lost her period!

She is so upset and wants to know if there is another reason for this sudden erratic bleed NOT related to weight gain or less exercise. Note, she is almost 39, and in our family menopause typically begins early (40ish). So this begs the question on whether an estrogen surge or other hormonal imbalance related to possibly being in perimenopause could be the reason. I am working with her on going to the doctor to get tested for answers, but she is too upset right now trying to come to terms with all this. Can someone weigh in (no pun intended) and possibly confirm whether my cousin's sudden period reemergence can be related to perimenopausal hormone wackiness? If so, that would probably reassure her somewhat that she did NOT gain weight at least.

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