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While full recovery restores many aspects of physical health, certain reproductive and metabolic changes can linger. Hormones, bones, and even the brain's hunger-satiety signals may take time to rebalance. The good news? With early, personalised, and non-judgmental care, most people with a history of eating disorders go on to have healthy pregnancies. The key lies in recognising the risks and working proactively with your care team.
How Eating Disorders Affect Reproductive Health
Even long after symptoms resolve, eating disorders can leave behind subtle physiological effects.- Hormonal disruption: Anorexia, bulimia, and binge-eating disorder can all suppress the hypothalamic-pituitary-ovarian (HPO) axis, reducing levels of luteinising hormone (LH) and follicle-stimulating hormone (FSH). This impacts ovulation and menstrual regularity.
- Amenorrhoea and ovulation problems: Functional hypothalamic amenorrhoea (FHA) is common in restrictive disorders. It may persist for months or years, even after weight normalisation, especially if body fat remains low or stress is high.
- Low oestrogen and bone health: Chronically low oestrogen can reduce bone density, affect uterine lining development, and increase miscarriage risk.
- Polycystic Ovary Syndrome (PCOS): In some cases of bulimia or binge eating, insulin resistance may lead to PCOS, complicating ovulation and fertility.
How It May Impact Pregnancy
Pregnancy places high metabolic, hormonal, and emotional demands on the body. If your system is still recalibrating from past restrictions or binge cycles, the effects may show up in these ways:- Increased risk of miscarriage or preterm birth: Some studies show higher rates of pregnancy loss and early delivery in people with past anorexia or bulimia.
- Nutrient deficiencies: Prior deficiencies in iron, folate, calcium, or vitamin D can affect fetal development and maternal well-being, even if labs look normal now.
- Gestational complications: There's a higher incidence of anaemia, intrauterine growth restriction (IUGR), and small-for-gestational-age (SGA) infants in those with a history of restrictive eating.
- Mental health risks: Pregnancy can resurface body image distress or fears about weight gain, raising the risk of relapse or antenatal anxiety.
Conception and IVF Outcomes
If you're trying to conceive, naturally or with assistance, your history matters.- Delayed return of fertility: Even after weight restoration and menstrual return, ovulation may remain irregular. You may still need ovulation tracking or medical assistance.
- IVF considerations:
- Lower ovarian reserve and fewer follicles may be seen in people with past eating disorders.
- Thin endometrial lining, affected by years of low oestrogen, can reduce embryo implantation rates.
- Hormonal stimulation may be poorly tolerated if there's lingering endocrine sensitivity.
When to Seek Testing or Support
You don’t need to wait until something feels wrong. If you’ve had an eating disorder and are planning pregnancy, it’s worth checking:- Hormonal panels: FSH, LH, oestradiol, prolactin, and AMH (anti-Müllerian hormone)
- Thyroid function: Hypothyroidism is more common post-restriction
- Bone density scan: Especially if amenorrhoea lasted more than a year
- Nutrient levels: Iron, B12, folate, vitamin D, calcium
Management and Protective Strategies
You’ve done the hard work of recovery. Now it’s about supporting your body in a new chapter.- Nutrition support: A prenatal dietitian can help ensure you're meeting energy and micronutrient needs without triggering old behaviours.
- Mental health therapy: Pregnancy and fertility journeys can surface unresolved body image fears. Regular check-ins with a therapist trained in perinatal mental health can prevent relapse.
- Gentle exercise: Avoid high-intensity regimens if they were part of past disordered behaviours. Choose intuitive, low-impact movement that prioritises connection over control.
- Build a collaborative team: OB-GYNs, fertility doctors, mental health professionals, and nutritionists should work together, not in silos, especially if you're undergoing assisted reproduction or monitoring for relapse.
Emotional and Practical Support
You are not your diagnosis. You are not your past weight or lab results. You are someone with insight, strength, and the right to pursue motherhood (or not) without fear or guilt.- Ask your care team to focus on function, not numbers. Healthy pregnancy isn't about BMI alone.
- Lean on support groups. Many exist for pregnant people in recovery or post-recovery.
- Let your partner or close friends know how to support you: affirm body neutrality, offer meal support, and help with doctor visits.
FAQs on How Past Eating Disorders Affect Fertility and Pregnancy Outcomes
- Can I get pregnant after recovering from an eating disorder?
Yes. Many do. It depends on how long you’ve been in stable recovery, your ovulatory function, and whether nutrient levels have stabilised. - Do I need IVF if I have had amenorrhoea for years?
Not always. Some people resume natural ovulation after recovery. But if cycles remain irregular, your doctor may recommend ovulation induction or ART. - How can I protect my mental health during pregnancy?
Build a care team that understands your history. Prioritise therapy, request weight-blind care if triggering, and stay connected to recovery-minded spaces.