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Gynecologic Care for Adolescents and Young Women With Eating Disorders

ACOG Committee Opinion Summary, Number 740

doi: 10.1097/AOG.0000000000002653
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ABSTRACT: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines eating disorders as a “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 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. 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 health care 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. Simply asking the patient how she feels about her weight, what she is eating, how much she is eating, and how much she is exercising can help identify at-risk patients. A physical examination and laboratory tests are valuable in the diagnosis of an eating disorder. 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.

Number 740, June 2018

For a comprehensive overview of these recommendations, the full-text version of this Committee Opinion is available at http://dx.doi.org/10.1097/AOG.0000000000002652.

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Committee on Adolescent Health Care

The North American Society for Pediatric and Adolescent Gynecology endorses this document. This Committee Opinion was developed by the American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care in collaboration with committee members Nancy Sokkary, MD and Anne-Marie E. Amies Oelschlager, MD, and committee liaison Laurie L. Hornberger, MD, MPH.

This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.

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Recommendations and Conclusions

The American College of Obstetricians and Gynecologists makes the following 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 health care 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.

Copyright June 2018 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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Official Citation

Gynecologic care for adolescents and young women with eating disorders. ACOG Committee Opinion No. 740. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e205–13.

© 2018 by American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.