From the Guidelines
It is generally safe for individuals with a history of eating disorders to use birth control, but this decision should be made in consultation with healthcare providers who understand both reproductive health and eating disorder history. When considering birth control options, it's essential to weigh the potential benefits and risks, particularly in the context of eating disorders. The American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1 emphasizes the importance of a comprehensive evaluation, including assessing co-occurring health conditions and psychosocial impairment.
Key Considerations
- Most hormonal contraceptives, including combination pills, progestin-only pills, patches, rings, injections, implants, and hormonal IUDs, are options to consider for individuals with a history of eating disorders.
- For those concerned about weight fluctuations, low-dose hormonal options or non-hormonal methods like copper IUDs might be preferable, as suggested by the U.S. Medical Eligibility Criteria for Contraceptive Use 1.
- Transparency about eating disorder history, current recovery status, and any concerns about body image or weight is crucial when discussing birth control with a doctor.
- Healthcare providers should monitor for any changes in eating disorder symptoms or behaviors after starting contraception, as some individuals may experience minor side effects like nausea, breast tenderness, or slight weight changes when beginning hormonal birth control.
Recommendations
- Regular follow-up appointments are important to ensure the chosen method remains appropriate and doesn't negatively impact recovery from the eating disorder.
- The decision to use birth control should be based on individual circumstances, taking into account the potential benefits and risks, as well as the patient's overall health and well-being, in line with guidelines from reputable sources such as the American Psychiatric Association 1 and the U.S. Medical Eligibility Criteria for Contraceptive Use 1.
From the Research
Safety of Birth Control with a History of Eating Disorders
- The use of birth control pills in individuals with a history of eating disorders, particularly anorexia nervosa, is a topic of concern due to potential effects on bone mineral density and the risk of creating a false picture of skeletal protection 2.
- There is no evidence to support the benefits of hormone therapy, including birth control pills, in patients with anorexia nervosa, and such treatments may reduce motivation to regain weight and adhere to eating disorder treatment 2.
- Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, are complex mental illnesses that require comprehensive treatment approaches, including medical, psychological, and dietetic interventions 3, 4, 5.
- The quality of evidence for dietetic interventions in adult outpatients with eating disorders is generally low, and more research is needed to inform treatment guidelines 4.
- A history of eating disorders, particularly if currently active, can increase the risk of adverse birth outcomes, such as preterm birth, small-for-gestational-age infants, and low birth weight 6.
Considerations for Birth Control Use
- Individuals with a history of eating disorders should discuss their medical history and current health status with their healthcare provider to determine the safest and most appropriate birth control options 2, 6.
- The decision to use birth control pills or other forms of hormonal contraception should be made on a case-by-case basis, taking into account the individual's overall health, nutritional status, and risk of adverse effects 2, 5.
- It is essential to prioritize comprehensive treatment of eating disorders, including psychological and dietetic interventions, to promote recovery and reduce the risk of adverse health outcomes 3, 4, 5.