We Need to Talk About Perimenopause and Eating Disorders

There are some stereotypes about eating disorders that have been stuck in the public mind forever—namely, they only affect people who are female, white, and in their teens or 20s. The reality, however, looks a lot different: People of all ages, racial and ethnic backgrounds, and sexes can and do develop them. And while eating disorder risk indeed spikes after puberty, there may be a second wave years later, during perimenopause, the transitional period (typically starting in your 40s) when estrogen levels decline and your reproductive system prepares for menopause.

Studies estimate that between 2% and 7.7% of women aged 40 and above meet the criteria to be diagnosed with an eating disorder, including anorexia, bulimia, and binge-eating disorder; and up to 13% of women 50 and older experience at least one eating disorder symptom. Many others contend with poor body image and disordered eating, resorting to weight-control tactics like skipping meals, obsessively exercising, or misusing laxatives.

“Menopause and perimenopause are times when people are experiencing their bodies differently, and also dealing with the stress of midlife,” Doreen Marshall, PhD, a psychologist and CEO of the nonprofit National Eating Disorders Association (NEDA), tells SELF. “That can increase your vulnerability to eating disorders.”

Here’s a look at the reasons that eating disorders can and do occur during perimenopause, and some ways you can navigate this challenging period.

An eating disorder in midlife can be a relapse or an entirely new thing for you.When people develop an eating disorder during perimenopause, it’s often a relapse of a condition they had earlier in life, Cynthia Bulik, PhD, a professor of eating disorders at the University of North Carolina at Chapel Hill, tells SELF. In other cases, she says, people have had some “smouldering” symptoms for years, and perimenopause is the tipping point. But for some people, Dr. Bulik says, this is the first time they’re facing serious issues around body image and food. In other words: It can happen to anyone.

On a side note, your body does not need to look a certain way for you to have an eating disorder. Only around 6% of people with these conditions are actually medically underweight, Dr. Marshall says.

The emotional rollercoaster of perimenopause can fuel disordered eating.Perimenopause typically begins in your mid 40s and lasts four to eight years. As Dr. Bulik points out, that’s also a time when women can be juggling many roles (career, kids, aging parents who need support) and/or dealing with major life changes (the “empty nest,” divorce, loss of a parent). Those kinds of stressors can gang up to trigger or worsen body image issues or eating disorder symptoms.

At the same time, the hormonal upheaval of perimenopause can have a big impact on mental health—with “mood changes,” including depression, being common during this period. Eating disorders, Dr. Marshall says, often coexist with depression or other mental health conditions. So for some people, an episode of depression, for example, might fuel the development (or relapse) of an eating disorder.

Researchers also theorize that the drop-off in estrogen during perimenopause, and the body’s response to it, can help spur eating disorders specifically. That’s partly based on the knowledge that eating disorder risk soars after puberty, and estrogen changes have long been suspected as one explanation (of many).

Your shifting body shape may contribute to body image issues.Dr. Bulik says many women are blindsided by one super-common change during perimenopause: Your body will start to store more fat around your middle. That, too, is at least partly thanks to plummeting estrogen levels—and it can happen even if you’re eating and exercising just like you always have, Mary Rosser, MD, PhD, an assistant professor of women’s health at Columbia University Irving Medical Center, in New York City, tells SELF.

Many women feel disheartened by this particular fact. “It’s one of the things I hear all the time,” Dr. Bulik says. “‘I had no idea my waist was going to change so much. Now I have to throw all my pants out and get new stuff.’” That can be “triggering” for some people, she adds, especially when they’re not prepared. In fact, according to research, as many as 73% of women experience dissatisfaction with their weight in midlife—and it’s a significant risk factor for an eating disorder.

Dr. Rosser agrees, noting that she’s had many patients come to her distressed by this new belly shape. “It can really knock into people’s self-confidence,” she says.

Then there’s the hot flashes and sleep loss…As you move through perimenopause, you may be hit with a slew of symptoms, like hot flashes, night sweats, poor sleep, vaginal dryness, and/or joint and muscle pain. In short, you might be feeling pretty lousy, physically and mentally—and drained of the energy you need to exercise, Dr. Rosser points out. That can trap some people in a cycle of fatigue, additional body shape changes, and increasingly negative feelings toward themselves.

Studies do suggest there’s a link between the severity of perimenopause/menopause symptoms and eating disorder risk: Women with more (or worse) symptoms are more prone to having a negative body image or at least some symptoms of an eating disorder.

To make matters worse, society is telling you not to age.As Dr. Marshall puts it, “The reality is, our bodies change throughout our lives.” Yet women, especially, are bombarded with messages telling them physical change is not okay. There’s “inordinate pressure,” Dr. Marshall says, for women to remain frozen as their 20- or 30-something selves. There can be a real fear, the experts say, of becoming “invisible” or even replaced—whether at work or by a partner—and that can add fuel to the eating disorder fire.

Some research suggests that social media can be a danger zone for people who are prone to judging themselves against others. In one study of women age 40 to 63, those who tended to compare and despair while scrolling were more likely to report disordered eating symptoms.

Take steps to buffer yourself—and get help when you need it.Eating disorders are tricky things, with multiple contributing factors. So while there’s not necessarily one thing you can do to avoid developing one entirely, there are some things you can try to stay positive about your changing body and mitigate the mental and emotional toll of this difficult transition.

Talk about perimenopause. Dr. Bulik says that part of the problem is we’re not talking about perimenopause enough, including the normal body changes that can happen. Talk to your mom, your friends, anyone you’re comfortable with about their experience. Bring your concerns to your primary care doc or ob-gyn. Dr. Rosser agrees that forewarned is forearmed, and she tries to give her patients “anticipatory guidance” on what’s typical as you move through this transition.Think “health,” not weight loss. Perimenopause is a great time to take stock and optimize your lifestyle habits, Dr. Rosser says. She’s a fan of the American Heart Association’s (AHA) Life’s Essential 8, which focus on supporting heart and brain health for the long haul. Set your mind on adding healthy years to your life, Dr. Rosser says, rather than fitting a rigid body mold.Eat to nourish your body. Fad diets are everywhere, but Dr. Rosser says she’s dumped the word “diet” from her vocabulary—and rejects the idea that women should just “eat less” to manage perimenopause weight or body-shape changes. As Dr. Marshall notes: Restrictive eating plans are often an invitation to “obsess.” Instead, medical experts like the AHA encourage some limits (on added sugar and alcohol, for example), but emphasize that you should actually enjoy eating and get plenty of the good stuff—protein, calcium and vitamin D (critical for bone health), nutrient-packed vegetables and fruit, fiber-rich whole grains, and unsaturated fats.Exercise to build yourself up. Aerobic exercise to boost your cardiovascular fitness is important, Dr. Rosser says, but so is strength training to maintain (or increase) muscle and bone mass after age 40. Exercise also has amazing benefits for your mental health, including reducing the risk of anxiety and depression and improving sleep.Spend your social media time wisely. Like the research suggests, the way we use social media matters. Follow people who uplift and inspire you. Ditch the content that leaves you feeling down.Set up a good sleep routine. It’s hard to overstate how important sleep is for your physical and mental well-being, the experts say. If night sweats are keeping you up, try some stay-cool hacks, like a bedroom fan or even pillows and mattress covers outfitted with cooling gels.If those night sweats, or any perimenopause symptoms, are beyond DIY tricks, talk to your doctor. There are ways to manage symptoms, Dr. Rosser says, including hormonal and nonhormonal therapies.

Finally, if you think you may, in fact, be struggling with an eating disorder, help is available. One option, Dr. Marshall says, is to use the free screening tool on NEDA’s website. It will give you a better sense of where you stand, plus a starting point for a conversation with your doctor. “Print it out and hand it to your doctor and say, ‘This is what’s happening for me,’” Dr. Marshall suggests.

Alternatively, Dr. Bulik says, you might go straight to a psychologist who focuses on this area (often, a referral isn’t needed, she notes). NEDA has resources for finding eating disorder specialists in your area or online. And if the first provider you try isn’t a good fit, don’t give up.

“Keep knocking on the door until you find someone who’s going to be able to accompany you through this transition,” Dr. Bulik says. “We all deserve that.”

If you or someone you know is struggling with an eating disorder, help is available. You can contact the Alliance for Eating Disorders’ fully-staffed helpline at 1-866-662-1235 or visit their website for additional support.

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