Objectives These findings are part of a wider study designed to assess clinicians’ contraceptive provision for patients with eating disorders. Contraception provision for patients is a vital role of sexual health clinics across the country. Certain patient groups may have additional factors, symptoms or behaviours that make different contraceptive choices safer or preferable. Adolescents with eating disorders are one such group. Research shows that behaviours such as laxative use or the induction of vomiting alongside pre-existing risk factors can affect contraceptive choice efficacy and safety. Patients with eating disorders have been demonstrated to have a greater number of new sexual partners and decreased condom use.¹ Eating disorders most commonly start in adolescence, with studies estimating the mean age of incidence for anorexia nervosa as 14.6 years² and have a much higher prevalence in females.³ Current advice from the FRSH⁴ is for clinicians to ask about eating disorders when providing contraception and the recommended contraception for this group is long-acting-reversible contraception (IUS/implants).

Methods 25 females aged 15-18 were randomly selected who had come to a regional sexual health centre from October 2021 - May 2022 seeking contraception. Patient records were reviewed to assess the use of the box for history of eating disorders on the ‘new family planning’ history form (this box was not mandatory for clinicians to complete but they were advised to). If an eating disorder was identified, information was then collected on what further history was documented (e.g. classification of eating disorder, relevant behaviours and risk factors). Data was collected on what contraceptive was then given to each patient with/without the eating disorder box completed. Data was collected on recorded BMIs.

Results In the age group 15-18 only 76% of the patients were asked about eating disorders. Of these patients, 5 had notes detailing problems relating to eating. The average number of words in the notes on eating disorders was 10.4, with the least being 5. The contraceptive choices given were varied (figure 1). Only 10 of the patients had their BMIs measured, of these 3 were low (<18.5). Only 1 of these 3 had notes detailing eating problems.

Conclusion To conclude, there is more research to be done in this field. This study may serve as a prompt to clinicians, including paediatricians, to ask about eating issues/disorders when prescribing contraception. The study assisted with the production of a proforma for clinicians to use when an eating disorder history is elicited.

References

1. Fergus KB, Copp HL, Tabler JL, Nagata JM. Eating disorders and disordered eating behaviors among women: associations with sexual risk. International Journal of Eating Disorders 2019;52(11):1310–1315.

2. Petkova H, et al. Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study. (2019).

3. Eating disorders in children at crisis point, as waiting lists for routine care reach record levels. [online].

4. Contraception for Women with Eating Disorders 2021. Faculty of Sexual & Reproductive Healthcare.