For about a year, all 20-year-old Erin Konheim Mandras could think about was food — the half muffin she’d pick at in the morning, the turkey and lettuce wrap she’d take a few bites of for lunch, the lettuce leaves she’d dip in fat-free dressing for dinner.
“I felt so preoccupied in my head that I was unable to focus on anything else other than food — even though food wasn’t what I was going to be eating,” says Mandras, who played Division 1 varsity soccer for Michigan State University during the height of her restrictive eating. Even free samples at the Cheesecake Factory — her favorite restaurant — wouldn’t pass her lips.
She thought about the scale too, stepping on at every opportunity. “It didn’t matter if I’d weighed myself 30 seconds earlier,” recalls Mandras, who lost 30 pounds in six months — a devastating amount for her 5-foot-1-inch frame.
What she didn’t think about: the long-term damage her “out of control” behavior — then diagnosed as eating-related obsessive compulsive disorder, but today would likely be considered anorexia nervosa — could have on her body. Namely, her fertility.
“When you have an eating disorder, you’re so focused on having a low body weight that you just can’t think past any issues like osteoporosis or bone damage or fertility because they’re not realistic in your life. They’re not relevant,” says Mandras, now a 31-year-old speaker, blogger and soccer coach in Baltimore.
But about five years ago, when Mandras and her husband began trying to start a family, these issues became crushingly relevant. Despite undergoing medical and psychiatric treatment for her eating disorder throughout college and maintaining a healthy weight for the prior six years, Mandras was terrified that the couple’s inability to conceive immediately was linked to her medical history.
“Is it because I had an eating disorder? Is it because there’s something wrong with my body? Is it because I just can’t do it?” she worried. “If it’s going to take nine months, I just want to know it’s going to take nine months. But to not know if it’s going to happen, it was very painful; it was very traumatic.”
[See: The Eating Disorder Spectrum — From Pregorexia to Drunkorexia.]
Twenty million women and 10 million men have an eating disorder at some point in their lives, according to the National Eating Disorder Association. Fertility problems, though they can be overcome, are among the potential long-term consequences of such conditions, with some studies suggesting that eating disorders account for about 18 percent of patients seen in infertility clinics, says Dr. Leslie A. Appiah, associate professor in the University of Kentucky College of Medicine’s Department of Obstetrics and Gynecology. Men who’ve had or have eating disorders, or whose weight has fluctuated dramatically, can also experience fertility problems, adds Dr. Isaac Sasson, a fertility specialist at Shady Grove Fertility’s practice in Chesterbrook, Philadelphia.
But for women with histories of eating disorders, getting pregnant is only half the battle — if it’s a battle at all. They can also struggle with re-emerging body image issues during and after pregnancy, says Claire Mysko, NEDA’s CEO who’s also an eating disorder survivor and mother. “This is, in fact, a major issue for women,” she says, but few are open about it, she found while interviewing women for her 2009 book, “Does This Pregnancy Make Me Look Fat?: The Essential Guide to Loving Your Body Before and After Baby.” “There’s a tremendous amount of shame and silence around these issues.”
It makes sense that women with eating disorders like anorexia can have trouble getting pregnant. Their periods are usually irregular — if not absent — which often means they’re not ovulating, or releasing an egg, each month. It’s all a defense mechanism on the part of the brain, which reverts back to a prepubertal hormonal state, Sasson explains.
“The combination of the brain being aware that there’s not enough food resources, plus a huge rise in the stress hormones, are all telling the body it’s not the right time to be pregnant,” he says.
However, some research finds that’s not always the case. In fact, one Norwegian study found that women with eating disorders are among the most likely to have unintended pregnancies, perhaps because they’re less aware that they can ovulate without getting a period, speculates Cynthia Bulik, a psychologist and founding director of the University of North Carolina’s Center of Excellence for Eating Disorders.
“For regularly menstruating women, the absence of a period is one of the first signs of pregnancy, and it can signal you to do all of the things that you should do to ensure a healthy pregnancy,” such as stopping drinking and starting prenatal vitamins, she says. Women who aren’t used to getting normal, if any, periods (a common side effect of anorexia, bulimia and sometimes binge eating disorder), on the other hand, can continue longer into their pregnancy without proper care.
[Read: Everything You Need to Know About Prenatal Vitamins.]
While women in the throes of eating disorders should seek mental health treatment for the condition before trying to get pregnant, experts say, once they’ve recovered, fertility problems can linger, though uncommon, Sasson says. “The overwhelming majority of women, when they resolve the eating disorder piece, their periods will become regular again and they should not have trouble getting pregnant,” he says.
Fortunately, Mandras was among them. After about four months of trying, she found out she was pregnant. Allison Kreiger Walsh, a 32-year-old in Orlando, Florida, wasn’t so lucky. Despite having been recovered from anorexia and bulimia for about 10 years, she and her husband couldn’t get pregnant. A fertility specialist told them it was because parts of Walsh’s brain still weren’t properly communicating to release the hormones needed for ovulation and pregnancy.
“How could this be possible?” Walsh remembers thinking. “I’m healthy now. I haven’t struggled for a decade.”
Still, learning the root of the problem — and that treatments were available — was a relief for Walsh, who now serves as the vice president of business development for Advanced Recovery Systems, a health care management company focused on the treatment of mental health conditions, including eating disorders. While Sasson says a specific combination of drugs that stimulates the growth and release of an egg are often the best treatment option for women with histories of eating disorders, three cycles of Clomid, a drug that just stimulates ovulation, worked for Walsh.
“I just cried,” she remembers of the moment she discovered she was pregnant. “It was just such a relief, and [I] just prayed. [I was] very grateful and thankful to have that opportunity.”
Coping With a Changing Body
For women who’ve struggled with eating disorders, gaining weight during pregnancy and pressure to lose it afterward can be just as — if not more — anxiety-provoking than trying to get pregnant in the first place. Mandras, for one, felt her worries about weight gain come soaring back the moment she learned she was pregnant. Not helping was the fact that she’d gone off her antidepressants for the first time since her OCD diagnosis to better support her future baby.
“I felt the constant urge to exercise because I felt so big, and my only response to that is to work out,” Mandras remembers, noting that she’d sometimes exercise three times a day. “And no matter how much I was working out, my stomach was growing and the numbers were going up — but not much.” Her baby was born three weeks early but is now a healthy 4-year-old. She also has a 2-year-old son. While the outcome of a family was worth every second, getting there was “psychologically challenging — to say the least,” she says.
[See: How to Know If You’re Exercising Too Much.]
These concerns are common among pregnant women in general, and particularly among those who’ve had body image and disordered eating problems in the past, Mysko found while reporting her book. After all, pregnancy can cause a lot of eating disorders’ underlying problems — such as depression, anxiety and the need for control — to “bubble up” again, she says. What’s more, “the scale and discussions about weight gain are pretty much the centerpiece of every [doctor] visit,” she points out.
To make matters worse, women clam up about their pregnancy-related emotions because they know their feelings aren’t rational. “They felt like they should be focused on the baby and the health of the baby, and they were very ashamed that they have these concerns — they felt they should know better,” Mysko says. “It was this double layer of shame.” As a result, only one-third of women who’ve struggled with disordered eating disclose it to their OB-GYN or midwife, Mysko found. “A lot of women would say, ‘It was in my past, I didn’t think it was relevant,'” she says. “Others were afraid — they didn’t know how to approach it.”
But being open with your health care provider is one of the most important ways to cope with these feelings, experts say. If you’re seeing one who’s judgmental or brushes it off, find a new provider, Mysko suggests. “Find someone who you connect with and who gets it,” she says. For her, shielding herself (but not her doctor) from the scale during and after pregnancy was a big help. “Taking weight out of the equation can be very empowering,” Mysko says. So can banning yourself from magazines and other media reports that glamorize “getting your body back” after baby, she adds.
Recruiting a strong support system — including a mental health professional, if necessary — is also key to getting through a healthy pregnancy and postpartum period. ( The National Eating Disorder Association, which has resources on how and where to find support, is a good place to start.) “The more support, the better — not just for women with histories of eating disorders, but for all moms,” Bulik says.
For Walsh, who just gave birth to a baby girl this week — this child also conceived with the help of Clomid — keeping the focus on what would make her baby healthy helped prevent body image concerns from consuming her. “I really tried not to focus on that weight” during the first pregnancy, she says. “I tried to focus on, ‘I need to be healthy for my baby; I need to be healthy for myself.'”
That’s the right idea, says Mysko, noting that for some eating disorder survivors, pregnancy can be the road that teaches women to appreciate, not criticize, their bodies. “For a lot of women we talked to, it was really awe-inspiring and a way to shift from the weight piece of it to, ‘Wow — this is pretty impressive,'” she says. “‘I’m strong and I’m doing this, and this is really incredible.”
More from U.S. News
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The Fertility Preservation Diet: How to Eat if You Want to Get Pregnant
The Eating Disorder Spectrum — From Pregorexia to Drunkorexia
The Lasting Toll of an Eating Disorder: Fertility Issues originally appeared on usnews.com
