Eating Disorders in Perimenopause

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Eating Disorders in Perimenopause

We often think of eating disorders as an issue in adolescence and young adulthood, yet they affect more women in mid-life than previously realized. Just like puberty, the hormonal fluctuations and transition of perimenopause affect mental health, creating a window of vulnerability for developing an eating disorder.

Eating disorders are diagnosable conditions with specific criteria, including anorexia, bulimia, and binge-eating disorder. These are severe conditions associated with disease risk and death. For women who don’t fall into this category, the risk of disordered eating behaviors, such as restriction, overeating, and disordered thoughts about food and body, can also increase in perimenopause.

Like most topics in women’s health, we need more funding and research for a better understanding. Today’s article will walk through some of what we do know. Keep reading as we explore:

• How prevalent are eating disorders in perimenopause?
• The connection between hormones and eating behaviors and disorders
• Resources and support

Prevalence of Perimenopausal Eating Disorders

Eating disorders can occur at any age, and across the lifespan, will affect 13% of women. While diagnoses occur most often in adolescence and young adulthood, rates are increasing during perimenopause. The rates of midlife women seeking outpatient or inpatient eating disorder treatment are trending up.

Although the data is mixed, some research suggests that eating disorder rates are higher during perimenopause compared to the pre-menopause and post-menopause years. Some researchers even argue that the eating disorder peak is in midlife, correlating with perimenopause.

Approximately 3.5% of midlife women (over the age of 40) experience an eating disorder. One study suggests rates of 9% during perimenopause compared to 2% before menopause.

The rates are even higher when considering disordered eating behaviors compared to a diagnosable eating disorder. Disordered eating behaviors include a range of behaviors and attitudes towards food and body that negatively influence mental health and well-being.

As many as 29.3% of women over 40 experience some symptoms, most notably dissatisfaction with body weight, body shape, and eating patterns that involve restriction and control. Some data suggest that binge eating behaviors are one of the most common symptoms during perimenopause.

Hormones and the Window of Vulnerability 

Eating disorders are multi-factorial conditions and don’t have a single cause. We must consider diet culture, genetics, mental health, and more. One piece that is gaining more attention is the association between female hormones and eating disorder risk.

It’s important to note that most eating disorders, up to 90%, occur in women. When eating disorders develop in adolescence, they often coincide with puberty, where hormone levels fluctuate and rise as the menstrual cycle becomes established.

Hormone fluctuations across the menstrual cycle and lifespan make women more susceptible to mood changes and mental health conditions, so it makes sense that eating disorder risk would increase as well. Some of these connections have been established in the research. For example, women with PMS are more likely to have bulimia.

Perimenopause is considered a window of vulnerability for eating disorders. Women may experience:

• New onset of an eating disorder
• Exacerbation of disordered behaviors
• Eating disorder relapse after recovering from a disorder earlier in life

The hormonal changes of perimenopause, especially the estrogen fluctuations, are associated with an increased risk of mood and mental health symptoms, including mood swings, anxiety, depression, and others. It’s also a time when women can experience serious mental health challenges.

During perimenopause, women may experience physical and mental changes that make this period of time particularly stressful, potentially contributing to eating behaviors and eating disorder risk. Some examples include:

• Changes in body composition, such as increased fat around the midsection and decreased muscle mass
• Menopausal symptoms, including, hot flashes, vaginal dryness, skin aging, and others
• Mood changes, including increased anxiety, depression, and irritability
• Insomnia and difficulty sleeping
• Overall, not feeling well or like themselves

While those with a difficult perimenopausal transition may be at a higher risk for eating disorders, those at risk for eating disorders may have more challenges with perimenopause.

How to Get Support

The first step is awareness. When your hormones change in perimenopause, you may feel less stable and grounded, like so many things are out of control. Your body may be changing, and you may experience new symptoms, making you feel not like you’re not yourself. If you find yourself coping in unhealthy ways, like exerting control around food or binging, it’s time to get support.

Since disordered eating exists on a spectrum from mild and moderate symptoms to diagnosable disease requiring treatment, it’s good to check in with your healthcare provider early. At TārāMD, we can screen you for eating disorders and refer you to specialists, including mental health professionals and dietitians, for the support you need.

We also take a more holistic and integrative approach to women’s health in midlife. We understand the connection between your hormones and symptoms, and that supporting a healthy midlife transition can lower your risk for eating disorders. This approach often means using all the appropriate tools in our toolkit, including:

• Nutrition – Our TārāMD nutritionist can help you develop a personalized perimenopausal eating plan that prioritizes nutrient density, blood sugar control, and a healthy relationship with food. Read more about perimenopause nutrition here.

• Lifestyle – Now is the time to build the habits required to optimize sleep, stress management, and exercise. Perimenopause will likely require new approaches in these areas.

• Mindset – Research suggests that positive perceptions about aging increase resilience to eating disorders in perimenopause.

• Supplements – Supplemental nutrients and herbs can address various perimenopausal symptoms, help meet nutrient goals, and support mental health. We have numerous tools in this area and can tailor a plan specifically for you. Read about supplements for perimenopause here.

• Bioidentical hormone replacement therapy – Not only can BHRT help prevent osteoporosis while reducing hot flashes and other symptoms, it may serve as essential brain health support during these vulnerable years.

When you understand the role that hormones play in eating disorders, you won’t be caught off guard or afraid to seek help should disordered eating or an eating disorder arise or reappear in perimenopause.

Perimenopause is a time of vulnerability for many symptoms and chronic health challenges, including eating disorders. But it’s also an incredible opportunity to prioritize your health, address needs that have gone unmet, and collect new habits and tools that will serve you during this transition and beyond. If you don’t know where to start or need guidance on next steps, we are here to help.

References

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