Washington, DC—Young people face numerous pressures to conform their identity and body to perceived standards of acceptability. In some instances, these perceptions and other stressors associated with growing up may manifest in eating disorders. In “Gynecologic Care for Adolescents and Young Women With Eating Disorders,” the American College of Obstetricians and Gynecologists’ (ACOG) Committee for Adolescent Health Care issues guidance on the ob-gyns role in identification and treatment.
Ob-gyns may be one of the first health care providers an adolescent or young woman encounters with warning signs or symptoms of an eating disorder and the new Committee Opinion aims to equip ob-gyns with appropriate knowledge to ensure patients receive comprehensive care.
While historically eating disorders have been associated with young, white, affluent women, research demonstrates these diseases afflict women and men across all racial, ethnic and socioeconomic categories. Adolescents and young adults who identify as LGBTQIA may also have increased risk of an eating disorder. The diversity of people affected underscores the need to be aware of potential warning signs and symptoms in every patient, not just a select few.
“Eating disorders are complicated and difficult diseases to diagnose and treat,” said Committee Opinion author, Nancy Sokkary, M.D. “We must proceed cautiously and deliberately with any patient who presents with potential symptoms of an eating disorder. A person’s appearance is not enough to rule out an eating disorder. Thorough examination and compassionate conversation with every patient are essential to ensuring we meet every patient’s needs.”
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. Because eating disorders are complex and affect psychologic and physical health, a multidisciplinary approach is imperative.
Due to the effect of eating disorders on reproductive health, ob-gyns are likely to play an important role on a multi-disciplinary care team. Adult and adolescent women with eating disorders may come to an ob-gyn with gynecologic concerns or symptoms, including irregular menses; amenorrhea, or lack of a period; pelvic pain; atrophic vaginitis and breast atrophy.
Some confusion persists about fertility in patients with eating disorders. However, studies confirm that patients can become pregnant. As such, ob-gyns should offer these patients individualized counseling about contraception and pregnancy that includes review of the unique concerns about effectiveness and safety of contraception use and/or pregnancy for those with the eating disorder.
Committee Opinion #740, “Gynecologic Care for Adolescents and Young Women With Eating Disorders," is available online and in the June 2018 issue of Obstetrics and Gynecology.
The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. www.acog.org