The American College of Obstetricians and Gynecologists (ACOG) has released recommendations for gynecologic care of young women and adolescents with eating disorders. The guidelines have been published in the journal Obstetrics & Gynecology.
This Committee Opinion was developed by the ACOG’s Committee on Adolescent Health Care in collaboration with committee members Nancy Sokkary and Anne-Marie E. Amies Oelschlager, and committee liaison Laurie L. Hornberger.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), eating disorders can be defined as “persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.”
The correct diagnosis of and a distinction between eating disorders are important because the course, prognosis, and treatment may be vastly different. Although the age at peak incidence can vary depending on the eating disorder, these disorders commonly arise during adolescence.
Key Recommendations and Conclusions:
- Adult and adolescent females with eating disorders may present with gynecologic concerns or symptoms, including irregular menses, amenorrhea, pelvic pain, atrophic vaginitis, and breast atrophy.
- Although formal diagnosis and treatment of eating disorders in adolescents are complex and outside the scope of practice for most general obstetrician-gynecologists, it is important that healthcare providers be comfortable with recognizing and screening at-risk patients.
- Recognizing risk factors for eating disorders can help to identify patients who should be further evaluated.
- Because eating disorders are complex and affect psychologic and physical health, a multidisciplinary approach is imperative.
- Although obstetrician-gynecologists are not expected to treat eating disorders, they should be familiar with the criteria that warrant immediate hospitalization for medical stabilization.
- Weight restoration is the best treatment for low bone mineral density (BMD) caused by disordered eating.
- Further research is needed to define best practices, including management of low BMD, menstrual irregularities, and pregnancy prevention.
- The American College of Obstetricians and Gynecologists recommends against the use of combined oral contraceptive pills (OCPs) solely for the treatment of amenorrhea associated with eating disorders.
Obstetrician-gynecologists can provide an important aspect of care for adolescents with eating disorders from recognition to work-up for amenorrhea and contraception. Further research is needed to define best practices, including management of low BMD, menstrual irregularities, and pregnancy prevention.
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