- Veronica Bridget Ward, GP registrar
- 110 Nicholson Road, Oxford OX3 0HW
Eating disorders are more common than is realised in women of reproductive age. Anorexia nervosa has a prevalence of up to seven per 1000 in the UK population and is especially common in adolescent girls and young women.1 Bulimia nervosa is more common and affects a slightly older age group, with a prevalence of 0.5-1% in women of reproductive age.1 Atypical eating disorders (eating disorder not otherwise specified) are probably even more common, but little is known about their prevalence. People in the atypical group have abnormal eating behaviour but do not meet the diagnostic criteria for anorexia nervosa or bulimia nervosa.1 A retrospective questionnaire study of 454 women, three to seven months postpartum, reported an 11.5% prevalence of some type of eating disorder, with a predominance of younger women affected.2
Pregnancy can complicate an eating disorder as changes in body shape may increase anxiety about weight gain. Women with a history of eating disorder should be monitored frequently during pregnancy and postpartum; they also need enhanced support with breast feeding (see Scenario box).
How do eating disorders affect fertility?
Most women with bulimia nervosa (even those with a normal body mass index) have menstrual irregularities, and 5% of these women report secondary amenorrhoea. Women with eating disorders may therefore present to their general practitioner with infertility. However, an 11.5 year follow-up study of 173 women with bulimia nervosa found that 75% became pregnant, which indicates that fertility problems are not more common in these women.3 Women with active anorexia nervosa have more difficulty conceiving. Menstruation and return of normal fertility can be delayed in up to 30% of women with anorexia nervosa …