“My periods have stopped and I’m cold all the time — can I just go on the pill to bring them back?”

Amenorrhoea, dizziness and cold intolerance in a young woman with rapid weight loss should prompt sensitive questions about eating, exercise, body image and compensatory behaviours (vomiting, laxatives, diuretics, diet pills, insulin omission). The GP’s key task is risk assessment using MEED (Medical Emergencies in Eating Disorders, 2022): BMI and rate of weight loss, heart rate, lying and standing BP, temperature, SUSS test, bloods (potassium, phosphate, magnesium, glucose, LFT, FBC) and ECG (QTc). Several amber features plus active purging with hypokalaemia, symptomatic postural hypotension and bradycardia justify same-day medical assessment; any red feature means admission. Refer urgently to the eating disorder service and do not use a single measure such as BMI to decide whether to refer (NICE). FREED offers rapid early intervention for 16–25 year olds within three years of onset. The combined pill is not a treatment for amenorrhoea in anorexia: it masks the sign and does not protect bone density. Screen for self-harm and suicide (eating disorders carry high mortality), advise against driving while dizzy, and address fears about compulsion and confidentiality; encourage her to involve family.