How Binge Eating Disorder Could Ultimately Affect Fertility
Eating disorders can substantially impact a person's reproductive health, from inhibiting ovulation to increasing the risk of miscarriage, and it's not just anorexia and bulimia that have this effect.
Binge eating disorder (BED), the most common eating disorder in the United States, can have similar implications.
Up to 27.5 percent of women seeking fertility treatments have a history of an eating disorder, while up to 16.7 percent have a current eating disorder, according to a 2022 review published in the Archives of Women's Mental Health. Of those with a history of disordered eating, approximately 18.5 percent had BED.
Most people can restore their fertility after recovering from an eating disorder. As anyone with a history of these conditions may know, however, recovery is not linear, and some effects persist for years, or even a lifetime.
Understanding BED and the complications it can cause with fertility can empower you to make informed decisions about your health and reproductive future.
What is binge eating disorder?
It's normal to experience intense hunger and cravings during pregnancy. Binge eating is different. When a person binges, they rapidly eat a large amount of food within a short period, feel out of control and may be unable to stop eating despite feeling full, or even ill, according to the National Eating Disorders Association (NEDA).
Many people binge when they aren't hungry and do so in secret due to feelings of shame and guilt. After a binge, they may feel disgusted or depressed.
The occasional binge doesn't constitute a disorder. Many people occasionally binge, especially during times of intense stress or while on a restrictive diet. People with bulimia nervosa binge as well but purge afterward by vomiting, exercising or using laxatives. Those with anorexia nervosa also tend to binge and purge, but not as frequently, and exhibit other characteristics, including an obsession with weight loss and thinness.
According to NEDA, a person might be diagnosed with BED if they have the following signs and symptoms:
- Have recurrent binges
- Experience notable distress about binge eating
- They've binged at least once a week, on average, for at least three months
- The bingeing doesn't occur exclusively within the context of another eating disorder, such as bulimia nervosa or anorexia nervosa
Although people can binge on anything, most people tend to select highly processed, high-sugar, high-fat foods that are calorically dense and nutritionally lacking. Such foods have a much stronger influence on the brain's reward center than their healthier counterparts and stimulate surges of dopamine—the "happy hormone"—to a similar degree as opiates, such as heroin and morphine.
The swell in dopamine can temporarily assuage physical and psychological distress, including stress, anxiety and depression, which is one reason bingeing can become so addictive.
Causes and risk factors
As with most eating disorders, scientists believe a combination of factors contributes to a person's risk of developing BED, according to Mayo Clinic. These factors include a history of dieting, a family history of disordered eating and biological and psychological factors.
Many people with BED have low self-esteem and self-image and are under significant stress. Other psychiatric conditions, such as depression, anxiety, bipolar disorder and attention-deficit/hyperactivity disorder (ADHD), often co-occur with eating disorders, including BED.
How BED affects fertility
Psychological stress, nutritional deficiencies, hormonal fluctuations and weight changes associated with BED can all affect a person's menstrual cycles, ovulation and egg quality, according to Sam Najmabadi, M.D., a fertility doctor at the Center for Reproductive Health & Gynecology in Los Angeles, and Natalia Llarena, M.D., a reproductive endocrinologist at HRC Fertility in Pasadena, California.
Experts say these factors can impede a person's ability to conceive naturally or with assisted reproductive technology (ART), such as in vitro fertilization (IVF).
One of BED's most prominent fertility-related symptoms is irregular menstruation, where periods are unpredictable, unusually short or long, or more painful. Some people experience worse premenstrual symptoms. In extreme cases, periods stop altogether, which is known as amenorrhea.
Although amenorrhea is most prevalent in people with anorexia and orthorexia due to severe malnutrition and low body fat, it also occurs in people with other eating disorders.
This occurs because periods of intense stress cause neurological and hormonal changes that affect ovulation and menstruation, Llarena explained.
"An area of the brain called the hypothalamus plays an important role in normal menstrual patterns and fertility," Llarena explained in an email interview. "Under normal circumstances, the hypothalamus releases a hormone called gonadotropin-releasing hormone [GnRH] that helps stimulate the ovary to grow eggs. This allows for regular menstrual cycles, ovulation and fertility.
"In cases of extreme stress—nutritional, emotional or physical—such as an eating disorder, the release of GnRH from the hypothalamus is disrupted, and the brain shuts down reproduction," she continued. "The person often stops having regular periods, or may stop having periods altogether, stops ovulating and stops being able to conceive until regular cycles are restored. This is called hypothalamic amenorrhea."
Carrying excess body fat can diminish a person's fertility as it can prompt an increase in androgens, or "male" hormones, further impeding ovulation. Not everyone with BED is overweight, and most people who are overweight do not have BED.
However, people with BED are more likely to be overweight compared to the general population, according to Emily Osman, M.D., a reproductive endocrinologist with Reproductive Medicine Associates of New Jersey in Princeton.
According to NEDA, up to two-thirds of people with BED have clinical obesity.
BED's affect on pregnancy
Some people with BED find their symptoms subside with pregnancy. However, if a person with BED becomes pregnant before managing their disorder, they and their baby may be at risk, according to Osman. Some of the most pronounced dangers come from excess body fat, she noted.
"Women with obesity have been demonstrated to have increased rates of miscarriage after both unassisted conception and pregnancy after infertility treatment," Osman wrote in an email interview.
Being overweight can make it difficult for a doctor to monitor fetal growth and development with an ultrasound. More significantly, it increases the chances of high blood pressure (preeclampsia) and gestational diabetes, according to Osman.
Additionally, people with BED are likely to have unusually large babies, according to Najmabadi and Osman. This can raise the chances of a cesarean section and the risk of miscarriage late in pregnancy.
Babies born to people with excess body fat are more susceptible to health problems such as congenital disabilities, growth problems, asthma, obesity and cognitive challenges, Mayo Clinic states.
Frequently losing and gaining considerable amounts of weight—known as "yo-yo dieting," a common phenomenon among people with BED—can pose additional challenges during pregnancy due to the resulting physical and psychological stress, hormonal fluctuations and nutritional deficiencies.
Being underweight at the time of conception and failing to gain a healthy amount of weight during pregnancy can be hazardous as well, because it can increase the chances of preterm birth and low birth weight, Llarena noted.
Coping with BED while pregnant or trying to conceive
Most people with BED can restore fertility upon managing their disorder and regaining overall health, Najmabadi and Llarena said.
However, it can be a long and difficult journey, and some effects may persist after recovery, according to Najmabadi.
"Studies show that women with hypothalamic amenorrhea—loss of periods due to physiologic, nutritional or emotional stress—regain regular periods about 70 percent of the time, but it can take months or even years," Llarena said. "Fortunately, fertility treatments can help these women conceive even if regular periods have not returned. Prior to undergoing fertility treatment, the eating disorder should be well controlled."
"The doctors need to be alert and aware so they can step in and shepherd the patient through the fertility process and pregnancy," Najmabadi said, noting that it takes teamwork to achieve the best results.
BED treatment resembles that of other eating disorders and usually involves a multidisciplinary approach with a physician, mental health professional and nutritionist, according to the National Eating Disorders Collaboration (NEDC). Together, these professionals address an eating disorder's physical, emotional and psychological facets.
For example, a physician may help to monitor and prevent any potential complications associated with BED and support you in restoring physical well-being, while a nutritionist can assist you in developing a healthier relationship with food.
In terms of counseling and therapy, research indicates cognitive behavioral therapy (CBT) can be effective in helping people with eating disorders change negative thought patterns. Psychotherapy, or talk therapy, can address the root of a person's emotional distress while providing coping tools.
Many people with eating disorders find online or in-person support groups beneficial, too.
