2026 Volume 6 Pages 28-36
Amenorrhea associated with anorexia nervosa represents only one phenotypic manifestation of the underlying condition. The fundamental pathophysiology involves a hypoestrogenic state and its associated health consequences. In particular, prolonged undernutrition during adolescence may impair the acquisition of height and bone mass during this critical period of growth and development. Missing this critical window for bone accrual may have irreversible consequences that affect health throughout later life. Therefore, from the perspective of women’s health, the therapeutic goal should not be merely to restore menstrual bleeding but rather to support patients’ physical and psychological health both now and throughout their future lives.
Current guidelines prioritize weight restoration, and a cautious approach to hormone replacement therapy (HRT) is generally recommended in patients with markedly low body weight. However, once eating behaviors become disrupted, patients may lose their sense of what constitutes appropriate eating, and recovery can be prolonged and challenging. From the perspectives of women’s health and Women’s Bone Health, this review discusses the potential role and practical considerations of HRT in patients with eating disorders, as well as the role that obstetricians and gynecologists can play in supporting their long-term health.
