Eating disorders, such as anorexia nervosa, bulimia nervosa, binge eating disorder, and other types of disordered eating, are more common in younger women than in any other group, despite the fact that they can affect people of any age and gender. And while a gynecologist may not be the first type of doctor who comes to mind when you think of eating disorder treatment, they actually can play a major role due to potential effects these conditions can have on your reproductive health.
How a gynecologist can help identify eating disorders
In younger women (those who have not gone through menopause), certain gynecological signs and symptoms rooted in disordered eating may lead them to seek the care of a gynecologist, according to the American College of Obstetricians and Gynecologists (ACOG).
No matter what takes you to see your gynecologist, they may also be looking for other signs of an eating disorder. For example, they may look for calluses on your knuckles or dental decay, which may indicate purging related to bulimia, or dry skin or fine body hair, like lanugo, in the case of anorexia, according to ACOG.
A gynecologist may also do lab work, including a complete blood count, serum pregnancy test, and others. Some may also do an electrocardiogram and a bone mineral density test for thoroughness. In some cases, if your eating disorder is severely impacting your health, you may even need hospitalization, and your gynecologist would refer you to someone who specializes in this care to lead the treatment beyond the gynecologic symptoms.
While a gynecologist is not trained to diagnose or treat an eating disorder, they can screen you for a disorder and help you seek care, as well as be a part of the team that will help treat you.
Eating disorder symptoms related to your reproductive health
Again, many of the symptoms of eating disorders in women are related to reproductive health, such as:
- Irregular periods
- Lack of periods (amenorrhea)
- Vaginal dryness: The drop in estrogen that eating disorders can cause can lead to vaginal dryness. Vaginal dryness may result in painful intercourse, urinary tract issues, and general vaginal soreness. This condition can be treated by efforts to restore weight, which leads to regulation of estrogen levels. Hormonal methods of treatment may also be considered, depending on the severity of the symptoms.
- Pelvic pain
- Painful intercourse
- Shrinking breasts (atrophy)
If these symptoms are paired with an eating disorder, they may be treated differently than they would be if they presented on their own.
The connection between eating disorders and irregular periods
Problems with periods are so common with eating disorders that, in a past edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), problems with the menstrual cycle were required for diagnosis of certain eating disorders. While this is not the case in the fifth edition of DSM, published in 2013, it’s still common to see issues with both the timing and frequency of periods in women who are experiencing disordered eating.
Women with disordered eating can experience delayed puberty, a lack of menstrual cycles for more than three months (called amenorrhea), or very few cycles (called oligomenorrhea). These issues occur with disordered eating because it can cause your hormone levels and even fat mass to be low, preventing your body from cycling as normal. It’s also important to remember that binge eating is associated with period irregularities, even though you may not be underweight with this disorder.
Research has shown that 66-84 of women with anorexia nervosa also have amenorrhea, and 6-11 percent have oligomenorrhea. For those who have bulimia, 7-40 percent have amenorrhea and 33-64 have oligomenorrhea. These numbers show that the number of women with eating disorders and problems related to their cycles can be quite high.
Treating menstrual irregularities when you have an eating disorder
Treatment for period irregularities is different in someone with an eating disorder than it is someone with normal eating patterns. This is because the cause of the irregularities are related to your nutritional status. The good news for women with eating disorders and either a lack of periods or infrequent cycles is that increasing their BMI toward a healthy number will usually result in the return to normal cycles and a decrease in gynecologic symptoms.
It used to be common practice to treat period irregularities with birth control pills, even in a woman with an eating disorder. However, ACOG and other physician groups no longer recommend this. One reason for this change is that using birth control pills makes it hard to see if a woman’s regular period has returned, which is a signal of health, because birth control pills usually cause people to have “withdrawal bleeds.” The use of birth control pills also doesn’t result in higher bone mineral density.
Eating disorders and pregnancy: Understanding fertility and birth control
Eating disorders, particularly anorexia, may lead to an increased risk of an unintended pregnancy. This risk may be partially due to the fact that women with anorexia who experience irregular periods or absence of periods mistakenly believe that they cannot become pregnant.
While severe cases of eating disorders can lead to infertility, many people with eating disorders can get pregnant. Additionally, pregnancies in women with eating disorders are often higher risk. Therefore, it’s important to discuss the use of birth control methods with your doctor if you don't want to become pregnant. A thorough medical history and understanding of your reproductive life plan can be helpful in making birth control decisions.
While not all methods of birth control may be right for you, most women will have effective options available to them, ACOG says. Long-acting reversible contraceptive options, like an intrauterine device (IUD) or implants, may be ideal because of their “set-it-and-forget-it” nature.
If you do want to get pregnant, it's important to know that fertility issues following a diagnosis of an eating disorder are not uncommon. This is one reason why getting a gynecologist’s treatment is helpful. When infertility is an issue without the presence of menstrual irregularities, treatments remain the same, with the addition of psychological support and support for proper nutrition and weight gain.
Women with eating disorders who get pregnant may not learn of their pregnancy early on because of the period irregularities they may be experiencing. Therefore, you may also have a delay in receiving prenatal care. Depending on the stage and type of eating disorder you have, your pregnancy may be at added risk. For example, someone with an active diagnosis of bulimia may be at a higher risk of miscarriage, preterm labor, and postpartum depression. A diagnosis of binge eating disorder also increases the risk of miscarriage.
Polycystic ovary syndrome and eating disorders
Some women with bulimia or binge eating disorder may have a condition called polycystic ovary syndrome (PCOS). In fact, in one study, 75 percent of people with bulimia had polycystic ovaries, and 33 percent of people with PCOS reported bulimia-like eating patterns. While this potential link is not completely understood, when PCOS is present, using medications like Metformin and dietary changes have been shown to help periods return.
Your reproductive life plan
In the end, it’s important to remember that women with disordered eating should seek the care of a gynecologist to assist with issues with their periods and to discuss birth control options. While a gynecologist won’t be the only specialist who is helping you through your treatment, they can be a key part of your recovery and reproductive life plan.