Experiences of menstrual health and amenorrhoea in eating disorder inpatient units in England: a subgroup analysis from a lived experience led, qualitative study.

Background: Although no longer specified within the diagnostic criteria for anorexia nervosa, the prevalence of menstrual disturbances among patients with eating disorders is well-documented. However, there is limited research examining patient experiences of amenorrhoea and eating disorders, or addressing how the topic is approached by eating disorder services. This article presents a subgroup analysis of a survivor-led qualitative study, which examined experiences of menstrual health in psychiatric inpatient settings. The study's main findings remain relevant to eating disorder services, however, this article presents an additional subgroup analysis which identified two themes from participants with experience of inpatient eating disorder services.

Methods: Thematic analysis was used to analyse qualitative data generated through questionnaires with staff and people with lived experience of inpatient settings and interviews with people with lived experience. An additional subgroup analysis was conducted to further explore the experiences which were specific to the eating disorder context.

Results: Three interviewees, 13 lived experience and two staff questionnaire respondents had experience related to eating disorder services. Eating disorder services were reported to place significant emphasis on the menstrual cycle as a marker of health, informing patient meal plans and weight targets. However, the emotional impact of managing the return of menstruation, and its significance within the context of their eating disorder, was not adequately addressed. Invasive practices of forcing patients to display used menstrual products to staff, as evidence of their menstruation, were reported.

Conclusions: The menstrual cycle is an important consideration in the treatment of patients with eating disorders, however, this should extend beyond monitoring the presence or absence of menstrual cycles to consider a more holistic perspective of menstrual health. This should include provision of information; how menstrual and gynaecological conditions may interact with someone's eating disorder; and addressing psychological and emotional needs related to menstruation in eating disorder treatment and recovery. Further research is needed to understand these experiences in greater depth.