Estrogen Replacement Therapy Reduces Anxiety in Anorexics

woman weighing herself

Anorexia nervosa is an eating disorder characterized by such things as a severely distorted body image, a dysfunctional obsession with staying thin, and excessive restrictions on food and calorie intake. Teenagers and adults recovering from the disorder often experience a spike in their levels of anxiety that coincide with a healthy increase in their body weight. According to the results of a new study presented in June 2013 to the Endocrine Society, use of a treatment called estrogen replacement therapy can reduce the anxiety levels in recovering anorexics and significantly boost their chances of avoiding a symptom relapse.

Anorexia Basics

Most of the people who develop anorexia are teenage girls; however, the condition also appears in women, teenage boys and men. The classic driving factors behind the establishment of anorexic eating behaviors are an irrational perception of the self as being overweight, regardless of actual body weight; an outsized fear of putting on weight; and a fixation on thinness that leaves the affected individual with a deeply ingrained aversion to maintaining a body weight that supports general health and well-being.

As a rule, doctors only diagnose anorexia in people who consistently fail to keep their body weight within 15 percent of the expected range for a given height, age and gender. In addition to a steep decline in weight, common physical consequences of the food/calorie restrictions associated with disorder include an abnormal heartbeat, an unusual sensitivity to cold, unusually brittle hair and nails, loss of vital mineral content in the bones, constipation, and dehydration. Girls and women with anorexia also frequently experience a decline in normal estrogen production that, in combination with excessive weight loss, leads to erratic or absent menstruation.

Estrogen Replacement Therapy Basics

Estrogen replacement therapy (ERT) is a specific form of hormone replacement therapy (HRT), also known simply as hormone therapy. The majority of women receive this treatment as part of a short-term effort to relieve the unpleasant, disruptive symptoms associated with the onset of menopause, or to reduce the risks for developing the bone disease osteoporosis in the aftermath of menopause. During ERT, the individual receives doses of synthetic estrogen in any one of a number of forms, including gels, pills, skin sprays, vaginal rings and skin patches. Some women receive treatment every day, while others only receive treatment once or twice a week. In most cases, the estrogen used in ERT achieves its effects by circulating in the bloodstream and traveling to various parts of the body. In addition, some women receive a more localized form of the therapy that’s applied directly to the vaginal area.

Role in Anorexia Treatment

In the report presented to the Endocrine Society, researchers affiliated with Harvard Medical School studied the effects of estrogen replacement therapy in a group of 38 teenagers ranging in age from 13 to 18, all of whom had a previous diagnosis for anorexia and were in the process of recovering from the disorder’s symptoms. The researchers also compared the effects of ERT in these teenagers to the treatment outcomes of another 38 recovering anorexics in the same age group who didn’t receive ERT. At the beginning of the study, all participants went through testing designed to measure their levels of anxiety, as well as their personal perspectives on their body appearance and eating habits.

After 18 months of treatment, the authors of the study retested all of the participants and compared their levels of anxiety and body dissatisfaction to the levels reported at the beginning of the study. After reviewing their findings, they concluded that an increase in body estrogen was directly related to a significant drop in the anxiety symptoms of the participants who received estrogen replacement therapy. They also concluded that use of ERT helps offset the rise in body dissatisfaction that often occurs when recovering anorexics put on weight as part of the treatment process.


Anxiety and rising body dissatisfaction play critical roles in increasing the likelihood that a person recovering from anorexia will relapse and return to the restrictive eating behaviors that characterize the condition. The authors of the study presented to the Endocrine Society believe that targeted use of estrogen replacement therapy can steeply reduce the risks for anorexia-related relapse and significantly diminish the disorder’s potential to trigger ongoing illness and life disruption. The therapy will only benefit girls and women with clear estrogen deficiencies, and appears to produce its greatest benefits when it’s begun in the earliest stages of anorexia treatment.


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