From the Guidelines
The dose of estrogen in oral contraceptive pills does impact the treatment of amenorrhea related to anorexia nervosa in adolescents, and lower-dose estrogen formulations are generally preferred, typically containing 20-30 mcg of ethinyl estradiol combined with a progestin such as norethindrone or levonorgestrel 1. When treating teenagers with amenorrhea related to anorexia, it is essential to consider the dose of estrogen in birth control pills.
- The primary goal of therapy should be weight restoration and normal nutritional status, with hormonal therapy serving as an adjunct to comprehensive eating disorder treatment.
- Lower-dose estrogen formulations are preferred to minimize the risk of thromboembolic events and other adverse effects.
- Common options for lower-dose estrogen formulations include pills like Loestrin 1/20, Alesse, or Yaz.
- Regular monitoring of bone density is recommended, as these patients are at high risk for osteoporosis.
- Hormonal therapy should not be considered a replacement for comprehensive eating disorder treatment, which should focus on nutritional rehabilitation and weight gain, with psychological support and eating disorder treatment 1. It is crucial to note that while hormonal therapy can help protect bone health and prevent further bone loss in these patients, it does not address the underlying cause of amenorrhea in anorexia, which is primarily nutritional deficiency and low body weight.
- The most recent and highest quality study suggests that lower-dose estrogen formulations are safer and more effective in treating amenorrhea related to anorexia nervosa in adolescents 1.
- The study also highlights the importance of considering the type and dose of estrogen, as well as the route of administration, when selecting a hormonal therapy for these patients.
From the Research
Estrogen Dose in Oral Contraceptives and Amenorrhea Treatment
- The dose of estrogen in oral contraceptive pills may impact the treatment of amenorrhea related to anorexia nervosa in adolescents, as studies suggest that hormone therapy, including oral contraceptives, should not be prescribed for young women with amenorrhea and concurrent eating disorders 2.
- However, other studies indicate that physiologic estrogen replacement can increase bone density in adolescent girls with anorexia nervosa, suggesting a potential benefit of estrogen therapy in this population 3.
- The impact of estrogen administration on eating disorder pathology in normal-weight young women with exercise-induced amenorrhea has also been studied, with results showing that 12 months of estrogen replacement can improve symptoms of eating disorders 4.
Considerations for Estrogen Dose and Amenorrhea Treatment
- The choice of estrogen dose and type of progesterone in oral contraceptives can affect the treatment of amenorrhea, with low-dose pills containing minimal doses of progesterones and estrogens ensuring good control of the menstrual cycle 5.
- In cases of hypomenorrhea and/or amenorrhea, a dose of at least 30 microg of ethinyl estradiol (EE) plus drospirenone may be used, while women with hypermenorrhea may require a different approach to avoid spotting 5.
- Estrogen replacement therapy, including estrogen and progestins, can be administered to avoid hypoestrogenism in adolescents with amenorrhea, and a contraceptive pill can be considered when contraception is needed and/or when hyperandrogenism needs to be treated 6.
Key Findings and Implications
- The current evidence suggests that the dose of estrogen in oral contraceptive pills can impact the treatment of amenorrhea related to anorexia nervosa in adolescents, and that physiologic estrogen replacement can have benefits for bone density and eating disorder pathology 3, 4.
- However, the use of hormone therapy, including oral contraceptives, should be approached with caution in young women with amenorrhea and concurrent eating disorders, and individualized treatment plans should be developed based on the specific needs and circumstances of each patient 2, 5, 6.