Contraceptive Pearl: Contraception for Patients With a Current or Prior History of Eating Disorders
Written by Sadia
Contraception for patients with a current or prior history of eating disorders is similar to contraception for people without a history of eating disorders. Clinicians should first establish the extent of a patient’s eating disorder since there are several eating disorders with varying clinical manifestations. Commonly known eating disorders and their special considerations include:
- Anorexia nervosa – a condition involving a distorted body image, weight gain concerns, and malnutrition
- Clinicians should assess for severe electrolyte imbalances, organ function, bone density, mental health, and weight changes.
- Recent studies have shown that estrogen-containing contraception might offer some bone protection to patients with a history of anorexia nervosa.
- Bulimia nervosa – a condition involving a distorted body image, periods of binge eating, and attempts at weight loss, such as exercise or induced vomiting
- Clinicians should assess for trouble swallowing pills, organ function, mental health, and weight changes
- Binge eating disorder – a condition involving a psychological urges to consume large amounts of food in one sitting
- Clinicians should assess for weight changes, metabolic shifts, and mental health
- Pica – a condition involving the compulsion of consumption of non-food items, such as plastics or paper
- Clinicians should assess for throat damage, electrolyte imbalances, and mental health
When counseling for patients with a current or prior history of eating disorders, it is important to note that weight gain can be a possible trigger for relapse. Injected progestin (DMPA) may cause weight gain, but there is little evidence that other hormonal methods affect weight. Even so, some patients may prefer to avoid hormonal methods due to concerns about possible weight gain. Clinicians should recognize that patients’ experiences and priorities play an important role in contraceptive decision-making. Non-hormonal contraception, such as withdrawal, condoms, diaphragm, and the cervical cap, are safe to use and cost-effective for many patients with a current or prior history of eating disorders.
Possible counseling points to consider are:
- How comfortable are you possibly gaining weight while using contraception?
- Do you have a preference for hormonal vs non-hormonal methods?
- How comfortable are you relying on a partner for contraceptive needs (if considering withdrawal and condom use)?
- What are your goals for pregnancy prevention in the next year or longer?
While eating disorders are not a condition in the US Medical Eligibility Criteria for Contraceptive Use, this clinical reference can help identify various conditions and co-morbidities associated with eating disorders, such as headaches, thyroid dysfunction, and anemia.
Given the complexity of eating disorders and their systemic and chronic effects on the body, approaching contraceptive needs from a whole-person perspective and considering the patient’s needs and preferences are essential. Eating disorders carry stigma that can impair patients’ trust in health care providers. For this reason, clinicians should pay special attention to continuity of care, active listening, and other measures that enhance trust.
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Paslakis, G., Maas, S., Gebhardt, B. et al. Prospective, randomized, double-blind, placebo-controlled phase IIa clinical trial on the effects of an estrogen-progestin combination as add-on to inpatient psychotherapy in adult female patients suffering from anorexia nervosa. BMC Psychiatry 18, 93 (2018). https://doi.org/10.1186/s12888
Laurent M, et al. Oral contraceptives partially protect from bone loss in young women with anorexia nervosa. Fertility and Sterility 111, 5 (2019). https://doi.org/10.1016/j.fert
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.