Eating Disorders and Long-Acting Reversible Contraception Side Effects: A Matched Retrospective Cohort Analysis

Fear of weight gain is a feature of many eating disorders (EDs). We examined patient-reported side effects and the need for menstrual management after long-acting reversible contraception (LARC) insertion among a matched cohort of adolescent and young adults (AYAs) with and without EDs.

Patients with EDs were matched with patients without EDs based on factors including age, device type, LARC indication, and weight status. We examined associations between EDs and reported side effects, and the need for medication-based menstrual management (any medication or hormonal-only) using mixed-effects logistic regression models, accounting for clustering within matched groups.

We included 313 patients (mean age = 18.5, age range = 13.4-24.7), of whom 58 (18.5%) had EDs, and 255 (81.5%) did not. There was no difference between patients with and without EDs in the likelihood of reporting LARC concerns, either any side effect (OR = 1.39; 95% CI: 0.72, 2.69), or pelvic pain specifically (OR = 0.83; 95% CI: 0.35, 1.97). However, in adjusted models, patients with EDs had 1.96 times the odds of reporting unsatisfactory bleeding compared to those without (95% CI: 1.04, 3.69). There was no difference in the receipt of medication-based menstrual management between patients with and without EDs.

Patients with EDs reported a higher prevalence of unsatisfactory bleeding with LARC use, though we saw no between-group differences in the receipt of medication-based menstrual management. These findings highlight the importance of proactively counseling AYAs with EDs about potential bleeding changes after LARC insertion.