Examining the benefits of estrogen therapy for girls with anorexia


Estrogen replacement therapy may significantly reduce anxiety symptoms among girls diagnosed with anorexia, according to findings presented this week at the Endocrine Society annual meeting.

The clinical trial involved a group of girls ages 13 to 18 who met DSM-IV criteria for anorexia nervosa and had been part of a previously published cohort examining the effects of estrogen replacement on bone density over 18 months. During the study, researchers randomly assigned participants to estradiol patch with cyclic progesterone or a placebo and evaluated their anxiety levels, eating behaviors and body image perception. As a recent MedPage Today story reports, researchers found that the girls’ anxiety decreased as estrogen levels increased.

Interested to know more about the potential use of estrogen therapy for treating anxiety among anorexia patients, I contacted James Lock, MD, PhD, a Stanford professor and psychiatric director of the Comprehensive Eating Disorders Program at Lucile Children’s Packard Hospital, about the significance of the findings. He told me:

Patients with anorexia commonly have anxiety disorders, including obsessive compulsive disorder. Anxiety can interfere with treatment. There are many ways to treat anxiety in patients with anorexia such as reassurance, cognitive behavior therapy and low dose atypical antipsychotics. This article implies that treating bone loss secondary to anorexia using estrogen is an effective treatment for bone loss, which studies have not shown. It seems to me using estrogen to treat anxiety in anorexia would be a treatment that would be deferred until other options of treatments that have been shown to be useful for anxiety had failed. These data on estrogen are quite preliminary.

Seeking additional information on study authors’ assertion estrogen therapy can improve bone accrual in girls with anorexia, I reached out to Neville Golden, MD, a professor of pediatrics and expert in bone health in anorexia. He said:

Estrogen treatment is not standard treatment to treat bone loss in anorexia nervosa.  Estrogen is usually administered to adolescent girls orally in a combination estrogen-progestin preparation such as that found in oral contraceptive pills.  Multiple studies, including one of our own studies, have shown that oral estrogen-progestin preparations do not increase bone mass in adolescent girls. [Madhusmita Misra, MD, the study’s lead author] and her colleagues studied the use of an estrogen patch and found a positive effect on bone mass in 31 girls with anorexia nervosa compared with 30 control subjects. Transdermal administration of estrogen bypasses the liver and has the theoretical advantage that it does not suppress  important growth factors that promote bone formation.  In contrast, the oral contraceptive pills suppress production of these factors.  However this is a single study with a small number of patients and use of an estrogen patch is very much in the experimental stage.  The study has to be replicated in larger number of patients and is by no means standard treatment for low bone mass in patients with anorexia nervosa.

Previously: Eating-disorder hospitalizations decline, How anorexia is striking what many consider to be an unlikely group: boys and young men, What a teenager wishes her parents knew about eating disorders and Stanford’s eating disorder program owes its success to holistic treatment
Photo by Charlotte Astrid