Estrogen therapy can ameliorate disordered eating in exercise-induced amenorrhea

Madhusmita Misra

CHICAGO — Young female athletes with normal weight and no or irregular menstrual periods reported fewer disordered eating behaviors, diminished drive for thinness and less body dissatisfaction after receiving 12 months of estrogen therapy, according to findings of a cross-sectional study and a randomized controlled trial reported here.

“Disordered eating is known to increase the risk of menstrual dysfunction. This is typically believed to be a unidirectional relationship, and while there are some data that cyclic changes in gonadal steroid levels during a menstrual cycle may impact food intake, estrogen status is usually not thought of as impacting chronic eating behavior,” presenter Madhusmita Misra, MD, MPH, Fritz Bradley Talbot and Nathan Bill Talbot Professor of Pediatrics at Harvard Medical School, chief of the division of pediatric endocrinology at MassGeneral Hospital for Children, and director of the pediatric endocrine-sports endocrine-neuroendocrine laboratory at Massachusetts General Hospital, told Endocrine Today. “Our findings are, thus, interesting and suggest a bidirectional relationship between estrogen status and chronic eating behavior.”

In the cross-sectional study, Misra and colleagues administered the Eating Disorder Inventory-2 (EDI-2) and Three-Factor Eating Questionnaire (TFEQ) to 109 athletes with oligomenorrhea, 50 athletes with normal menstruation and 39 nonathletes; all participants were females aged 14 to 25 years with mean age 19.9 years.

Compared with the nonathletes and the athletes with normal menstruation, the athletes with oligomenorrhea had scores indicating greater drive for thinness, cognitive restraint in eating and body dissatisfaction.

Researchers randomly assigned the athletes with oligomenorrhea, none of whom had been diagnosed with an active eating disorder at baseline, to 12 months’ therapy with a hormonal patch of 100-µg transdermal 17-beta-estradiol with cyclic progesterone (patch group), an oral contraceptive pill with 30 µg ethinyl estradiol and 0.15 mg desogestrel (pill group), or no estrogen. In the patch group, 25 of the participants completed the EDI-2 and 19 completed the TFEQ at baseline and 12 months. In the pill group, 19 women completed the EDI-2 and 16 completed the TFEQ at both time points. In the no-estrogen group, 26 participants completed the EDI-2 and 21 completed the TFEQ at baseline and 12 months.

At 12 months, drive for thinness decreased from baseline in the groups receiving estrogen vs. the non-estrogen group (change in EDI-2 score, –0.6 vs. 1.25; P = .04), as did body dissatisfaction (change in EDI-2 score, –0.81 vs. 2.18; P = .002) and uncontrolled eating (change in TFEQ score, –4.03 vs. 4.07; P = .046), with statistically significant improvements for body dissatisfaction and uncontrolled eating in the patch group compared with the other two groups; improvements in the pill group vs. the non-estrogen group did not reach statistical significance.

“These results highlight the importance of normalizing estrogen levels in female athletes with irregular menstrual periods, not only because of the beneficial effects of normal estrogen levels on bone health (as we have previously reported), but also because normalizing estrogen status may have positive effects on underlying disordered eating behavior,” Misra said. “More studies are necessary to confirm these findings.” – by Jill Rollet

Reference:

Misra M, et al. SAT-290. Presented at: The Endocrine Society Annual Meeting; March 17-20, 2018; Chicago.

Disclosures: The authors report no relevant financial disclosures.