Estrogen decreased anxiety in girls with anorexia nervosa

SAN FRANCISCO — Girls with anorexia nervosa experienced significant improvements in anxiety symptoms after estrogen replacement therapy, according to data presented here.

“[Anorexia nervosa] is a condition that can be very difficult to treat,” study researcher Madhusmita Misra, MD, MPH, pediatric endocrinologist and associate professor of pediatrics at Massachusetts General Hospital and Harvard Medical School in Boston, said during a press conference at ENDO 2013. “Anxiety is commonly seen with anorexia nervosa, and increasing anxiety and body dissatisfaction with increasing weight during recovery can impede the chances of successful recovery.”

Madhusmita Misra

Misra, who presented the data, also noted that estrogen replacement in ovariectomized rats reduces anxiety related behavior in these animals, and variations in food intake across the menstrual cycle may be related to cyclic changes in gonadal hormones, including estrogen. However, the impact of estrogen replacement on anxiety, eating attitudes and body image perception has not been studied in adolescents with anorexia nervosa — a condition associated with low estrogen levels.

To evaluate the effects of estrogen therapy on these endpoints in girls with the disorder, Misra and colleagues randomly assigned girls aged 13 to 18 years with anorexia nervosa and a bone age of at least 15 years to estrogen replacement (n= 38) or placebo (n=34) for 18 months. Estrogen replacement included twice weekly transdermal estradiol 100 mcg with cyclic progesterone. The researchers evaluated anxiety, eating attitudes and behavior, and body image using the Spielberger’s State-Trait Anxiety Inventory for Children (STAIC), the Eating Disorders Inventory II questionnaire (EDI II) and the Body Shape Questionnaire (BSQ-34), respectively. At 18 months, 20 girls in the estrogen group and 17 in the placebo group completed both baseline and follow-up questionnaires.

Results linked estrogen replacement to a significant decrease in STAIC trait scores, which indicate the tendency for anxiety (–3.05 vs. 2.07; P=.01), but not STAIC state scores, which indicate transitory anxiety (–1.11 vs. 0.2; P=.64). The researchers also found that change in estradiol was inversely associated with change in STAIC trait scores over the study duration (P=.001).

“We found that, in girls randomized to placebo, as BMI increased, state anxiety and body dissatisfaction increased. Giving estrogen seemed to prevent this effect,” Misra said.

EDI II and BSQ-34 scores, however, appeared to be unaffected by treatment. The researchers observed no differences between study arms in BMI change during the course of the study and also found that the effects of treatment on STAIC trait scores persisted at 18 months after controlling for changes in weight (P=.02) and BMI (P=.03).

“We know that anorexia nervosa can be difficult to treat,” Misra said. “Physiologic replacement of estrogen may reduce trait anxiety and reduce the risk for increased anxiety with weight gain. More studies are necessary to confirm these findings. – by Melissa Foster

For more information:

Misra M. #FP37-1. Presented at: The Endocrine Society Annual Meeting and Expo; June 15-18, 2013; San Francisco.

Disclosure: Misra reports no relevant financial disclosures.