Contraception in adolescents with anorexia nervosa. Is there evidence for a negative impact of combined hormonal contraceptives on bone mineral density and the course of the disease?

Abstract

Objective: Adolescents with anorexia nervosa (AN) are at increased risk of unplanned pregnancies and bone loss, due to low oestrogen levels and low use of efficient contraception. The negative impact of combined hormonal contraceptives (CHC) on peak bone mass during adolescence might limit wider use in anorexic women. Another issue limiting CHC use is the concern, that CHC-induced cyclic bleeding reduces the motivation for further weight gain and thus exerts a negative impact on recovery. We wanted to find evidence based answers about the impact of CHC use on bone health and course of the disease in adolescents with AN.

Methods: We performed a narrative review of the current literature investigating the effect of CHC or progestin-only contraceptives on bone density, body shape and course of disease in young women with anorexia.

Results: There is no evidence that CHC use aggravates the bone loss associated with AN. In long-term users CHC exert a protective effect. Anorexic women using CHC showed at least the same or a greater weight gain in comparison with controls. Eating disorder attitudes did not worsen.

Conclusion: We conclude, that at present there is no evidence, that use of CHC by AN patients has a negative impact on bone density or the course of disease.

摘要

目的：患有神经性厌食症（AN）的青少年由于低雌激素水平和采用低效避孕措施, 意外妊娠和骨质丢失的风险增加。复方激素避孕药（CHC）对青春期骨峰值的负面影响可能会限制厌食症女性的更广泛采用。另一个限制CHC采用的问题是担心CHC引起的周期性出血会刺激体重进一步的增加, 从而对康复产生负面影响。关于CHC的采用对患有AN的青少年骨骼健康和病程的影响, 我们希望找到证据为基础的答案。

方法：我们对目前的文献进行了叙述性回顾, 调查CHC或单纯孕激素的避孕药对患有厌食症的年轻女性的骨密度、体型和病程的影响。

结果：没有证据表明采用CHC会加剧与AN相关的骨丢失。在长期采用中, CHC起到保护作用。与对照组相比, 服用CHC的厌食症女性至少显示出相同或更大的体重增加。进食障碍的态度并没有恶化。

结论：我们的结论是, 目前没有证据表明患者服用CHC对骨密度或病程有负面影响。

Keywords:

• Combined hormonal contraception
• anorexia nervosa
• bone density
• menstrual bleeding
• body shape
• progestin-only contraception
• peak bone mass

Disclosure statement

G. Merki-Feld has received funding for studies and/or been lecturer/adviser for MSD, Bayer, Exeltis, HRA. J. Bitzer received honoraria for lectures and participation in advisory boards from Bayer AG, Merck, Exeltis, HRA, Gedeon Richter, Mithra.