The Female Reproductive System and the Systems that Regulate Appetite are Closely Related
A group of medical doctors out of the University of Carolina summarized existing literature on obstetric and gynecologic complications associated with eating disorders in women. The most common complications of the reproductive system for women with eating disorders were:
- Amenorrhea (absence of menstruation for >3 months) occurs in approximately 66-84% of women with anorexia nervosa (AN). The strongest predictors of amenorrhea in women with eating disorders are low BMI and higher levels of exercise. In cases of anorexia nervosa weight restoration is the main treatment for amenorrhea although menstruation does not always resume. There is promising literature on using hormone levels (follicle stimulation hormone, inhibin B, anti-mullerian hormone, estradiol, serum cortisol and leptin), to predict recovery but more studies are necessary.
Infertility and Miscarriage
- There seem to be conflicting studies on determining whether women with a history of AN experience infertility and miscarriage at a greater rate than the general population. A study (Brinch et al) appears to have sampled only women who had a history of inpatient hospitalization for AN – which means the test group included only women with the severest cases of AN. Broader test group results did not indicate any difference in rates of pregnancy, reported infertility or infertility treatment for women with histories of AN compared to the general population.
- Women with BN and BED are associated with greater risks of miscarriage and infertility.
- In contrast to the studies on infertility and AN – many large cohort studies have concluded that women with histories of AN are actually at a significantly greater risk (nearly twice as likely) of unplanned pregnancy than women in the general population. Ovulation can still occur in the absence of menstruation. This holds true for women with BN as well. The risks associated with unplanned pregnancy in all women include unpreparedness for pregnancy, engaging in risky behaviors (drinking alcohol), and failure to nourish herself appropriately.
- “Sexual dysfunction is common across AN and BN eating disorder subtypes. While most individuals with eating disorders report having had some physical intimacy with a partner, women with AN report sexual dysfunction across a variety of domains including decreased libido, higher sexual anxiety, and decreased self-focused sexual activity.52 An increase in sexual drive has been found to accompany weight restoration for those with AN.”
Complications in the Treatment for Gynecologic Cancers
- Women with AN do not appear to differ from the general population in terms of having higher rates of breast or female genital cancers, however, their risk of death as a result of gynecologic cancers is twice as high. One hypothesis is that this is due to delay in diagnosis and treatment and the ineffectiveness of treatment due to malnutrition.
- Women with BED may also have an increased risk of developing endometrial cancer as BED is associated with obesity and obese women are at risk of endometrial cancers.
Poor Nutrition During Pregnancy
Having a Baby with Small Head Circumference
There were further complications that were unique to different eating disorders. For example:
- Anorexia nervosa saw an earlier cessation of breastfeeding.
- Bulimia nervosa saw an increased change of polycystic ovarian syndrome.
- Binge eating disorder saw an increase in the chances of obesity.
Multi-Disciplinary Teams are Important in the Comprehensive Care of Women with Eating Disorders
It’s important for medical providers who treat women to understand the associations between eating disorders and gynecologic problems. Women with eating disorders are more likely to seek psychiatric care for co-morbid psychiatric illnesses like generalized anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. Therefore, it’s important for specialized psychiatrists to consider working on a collaborative multidisciplinary team that include obstetrical and gynecologic providers as well. Furthermore, women with eating disorders should be encouraged by their psychiatric providers to seek routine gynecologic care as neglecting to do so as demonstrated to be linked to the development of many of the conditions above.