For individuals who are struggling or have struggled with an eating disorder, the uncertainty surrounding infertility and the ability to carry a baby can be worrisome. Eating disorders, particularly those that are characterized by severe food restriction, involve behaviors that can disrupt normal hormonal and reproductive function. While fertility is dependent on many factors, malnutrition, overexercise, and chronic stress can be major contributors to reproductive health.
By: Mary Matone
Eating disorders can develop at any time in a person’s life; however, it is not uncommon for an eating disorder to develop or “come to light” during a woman’s reproductive years.[1] While it’s well understood that eating disorders developed in adolescence can hinder the physical growth and stature of an individual, the effect of restrictive eating disorders on hormonal development and reproductive health requires more attention.[2]
The actual effect of restrictive eating on a woman’s reproductive health is individualized and may vary from person to person. However, there are some basic impacts restrictive eating may have on reproductive health at various stages throughout eating disorder recovery.
In Periods of Restriction
During periods of restricted energy intake, the body seeks to conserve energy by performing only processes that are absolutely vital for the maintenance of life. As a result, many women who restrict food intake may experience changes to their menstrual cycle. In particular, some women may experience infrequent periods (a condition known as oligomenorrhea), or lose their periods altogether (a condition known as amenorrhea).[1]
In some cases, this change in menstruation may be a result of hormonal interruptions, which can also alter the size and function of the uterus and ovaries.[1] For these reasons, conceiving a baby and supporting a healthy pregnancy may be difficult for someone who is restricting their energy intake. However, this is not true for all women, and the absence or presence of a monthly period should not be the sole basis for determining when or if someone is fertile.
In fact, studies have shown that women with oligomenorrhea or amenorrhea may be at increased risk for unplanned pregnancy compared to the general population, despite their interrupted menstruation.[1] Therefore, if you are not planning to become pregnant, interruption in menstruation should not be interpreted as a form of contraceptive.
In Recovery
Once recovery begins, many women have an initial goal of resumed monthly periods, and often interpret this as an indication of weight restoration. However, as discussed above, the presence or absence of a menstrual period is not directly indicative of fertility status.
While some women may have difficulty getting pregnant before resuming their monthly period, other women may be able to become pregnant even with oligomenorrhea or amenorrhea. Therefore, as mentioned above, it is important to use alternate forms of contraception during eating disorder recovery if you are not planning to become pregnant.
After Recovery
Similar to the time period during recovery, conception appears possible in women who have previously experienced an eating disorder. In fact, studies show no statistically significant difference in fertility rates among those with previous eating disorders compared with the general population.[1]
Other Considerations
While there is promising research to suggest that eating disorders likely do not generally have long term effects on fertility, there are a few additional considerations to keep in mind when it comes to eating disorder recovery and pregnancy.
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Pregnant women have increased energy needs in order to keep themselves safe and provide their baby with the nutrients required for growth and development.[1] Therefore, it is recommended that pregnancy occur only after full eating disorder recovery; any plans to become pregnant should be discussed with a doctor, dietitian and therapist.
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Pregnancy changes the body in many ways, and may have an impact on one’s body image. If you have recently recovered from an eating disorder, it is important to ensure you have a strong treatment and support team to help navigate any residual feelings that may arise throughout your pregnancy.[1]
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Be prepared for the postpartum period. This period is commonly associated with relapse in eating disorder behaviors, so it is important to have a plan in place and a support system prepared to help navigate these thoughts.[1]
This information is considered a general overview for the average population and is not intended as individualized advice. For specific health concerns, it is important to consult your doctor and treatment team.
Early recognition and treatment intervention are paramount for avoiding the dangerous reproductive complications associated with eating disorders. At BALANCE eating disorder treatment center, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues.
Our admissions team would be happy to answer any questions you may have about our programs and services. Book a free consultation call with our admissions team below or read more about our philosophy here.
This post was written by BALANCE Dietetic Intern, Mary Matone.
Mary is a graduate student at New York University, where she is completing her Dietetic Internship and pursuing a Master’s Degree in Clinical Nutrition. Prior to her education in nutrition, Mary studied Geology and Geological Engineering at the University of Wisconsin-Madison and later worked as a Geotechnical Engineer in NYC. While traveling across the city for her engineering work, Mary’s interest in food and nutrition continued to grow as she continued to meet many people from varied backgrounds. Ultimately, Mary hopes to help others of all backgrounds develop healthy lifestyles while enjoying great foods from around the world.
Resources
1. Hoffman ER, Zerwas SC, Bulik CM. Reproductive issues in anorexia nervosa. Expert review of obstetrics & gynecology. 2014;6(4):403-414. https://search.datacite.org/works/10.1586/eog.11.31. doi: 10.1586/eog.11.31.
2. Gaudiani JL. Sick enough. New York, NY: Routledge; 2019.
