Estrogen Eased Anxiety in Anorexia

Anorexia patients scored lower on anxiety scales after estrogen replacement therapy

/ Author:  / Reviewed by: Chris Galloway, M.D. Beth Bolt, RPh

(RxWiki News) People with the eating disorder anorexia nervosa may also experience symptoms of anxiety. Hormone replacement therapy may, in some ways, ease certain anxieties in anorexia patients.

A recent study tested the use of an estrogen patch to treat anxiety symptoms in a group of girls with anorexia nervosa.

The results of the study showed that, after 18 months, girls with anorexia who had been using estrogen patches scored lower on an anxiety test than those who had not used estrogen patches.

"Seek treatment for an eating disorder."

Madhusmita Misra, MD, MPH, from the Department of Pediatrics at Massachusetts General Hospital and Harvard Medical School, led an investigation into using hormone replacement therapy to treat anxiety in adolescent girls with anorexia nervosa.

Anorexia nervosa is an eating disorder classified by low body weight due to behaviors, such as over-exercising and restricting calories.

Low body weight can affect whether or not the body’s sex organs produce normal hormone levels.

Therapeutic treatments for anorexia nervosa run the risk for drawing attention to body image in a negative and unproductive way for the patient.

The researchers in this study suggested that the use of estrogen replacement therapy might help reduce anxiety and improve eating behavior without drawing attention to body image issues for the patients.

For this small study, the researchers tested the use of estrogen replacement therapy on 72 girls, 13 to 18 years of age, for 18 months.

Of the 72 girls, 38 were given a 100 mcg transdermal (through the skin) estradiol patch twice per week and 34 girls were given a placebo, or fake patch, twice a week.

Only 37 of the original 72 girls stuck with the trial for the full 18 months, 20 in the hormone patch group and 17 in the placebo patch group.

The researchers used an anxiety questionnaire, an eating disorders questionnaire and a body shape questionnaire to take inventory of symptoms at the start and end of the study.

The anxiety questionnaire included 40 questions, comprised of 20 trait and 20 state questions on a four-point scale. Trait anxiety has to do with longer-term personality traits, such as the trait to worry. State anxiety relates to short-term reactive anxiety, such as the state of nervousness.

The eating disorders questionnaire included 91 questions on a six-point scale. The body shape questionnaire included 34 questions on a six-point scale.

After 18 months, girls in the hormone group had a significant reduction of 3.05 points in trait anxiety scores compared to girls in the placebo group, which experienced a 2.07 point increase.

Little difference was found between groups with the state anxiety scores. Girls in the hormone group scored 1.11 fewer points, while the girls in the placebo group scored 0.20 points higher, than their original scores after 18 months.

The researchers found that eating disorder symptoms and body mass index were unchanged by the estrogen therapy.

"This is an important finding that confirms what we have long recognized clinically that estrogen replacement therapy may have an important role in mood and anxiety disorders as well as in conditions such as eating disorders, e.g, anorexia nervosa with associated anxiety," Dr. David Rosenberg, the Chief of Psychiatry and Psychology on staff at Children's Hospital of Michigan told dailyRx News. "The target here appears to be trait anxiety rather than body shape perception and eating attitudes. More information would also be needed about whether or not any of the patients were on any other psychotropic medications or CNS-active medications that might confound results."

"Estrogen replacement led to a reduction in trait anxiety (the tendency to experience anxiety) in adolescent girls with anorexia nervosa independent of weight changes, but did not impact eating attitudes and behaviors or body shape perception," the authors concluded.

"More information on medical and psychiatric comorbidity would also be informative. Nonetheless, this is quite intriguing for conditions other than just anorexia nervosa and merits further investigation as well as a more complete review of this dataset," said Dr. Rosenberg.

These research results were presented at the annual conference of The Endocrine Society in San Francisco, CA, from June 15-18. This study has not yet been published in a peer-reviewed journal.

The National Institutes of Health (NIH) provided funding for this study. The authors declared no conflicts of interest.

Review Date: 
June 20, 2013
Last Updated:
December 30, 2013