A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute

Summer, 2019 | Number 3, Volume 33

Case study indicates that oral contraceptives may help reduce pica in some females with ASD

Oral contraceptives may help to reduce pica (the eating of non-food items) in some females with autism spectrum disorders (ASD), according to a new case report by Harris Wild and Russell Tobe. 

The authors’ patient, a 17-year-old female with ASD and a near-normal IQ, had exhibited pica since the age of 6 months. Her pica included eating sand, rocks, clothing, electrical insulation, and the metal eraser holders on pencils. Evaluation indicated that the pica did not result from discomfort, and the girl’s lab tests were normal.

Due to her pica, the girl required a one-on-one school aide. She began taking sertraline for anxiety when she was 11 years of age, but while this reduced her anxiety, it did not affect her pica. 

When the girl began having menstrual periods, the frequency of her pica incidents increased immediately before her periods, returning to baseline when they ended.  When she began taking an oral contraceptive at the age of 16, the rise in pica incidents prior to her periods no longer occurred, and her levels of pica across all menstrual phases dropped below her pre-puberty levels. 

Women on oral contraceptives typically take placebo pills for one week during each menstrual cycle. In this case, Wild and Tobe say, the switch from the contraceptive pills to the placebo pills resulted in a recurrence of pica within 24 to 48 hours. 

“At age 17 years,” the authors say, “the frequency of the placebo week was reduced from monthly to quarterly, with near remission of pica behavior. The school-based aide was discontinued.” 

Wild and Tobe say that while oral contraceptives may have reduced menstrual discomfort, this would not explain the reduction in pica at other times of the month. Alternatively, they say, the improvements may have stemmed from the effects of estrogen on serotonin levels in the central nervous system.


“Oral contraceptives reduced pica behavior in a female with autism spectrum disorder,” Harris Wild and Russell H. Tobe, Journal of Child and Adolescent Psychopharmacology, July 24, 2019. Address: Russell H. Tobe, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Office N 106, Orangeburg, NY 10962,  [email protected].