The pervasive myth that eating disorders only affect young people (especially girls) eclipses a common reality for many women: eating disorders often actually surface during menopause. Since the International Journal of Eating Disorders published a groundbreaking study that found about 13% of women over 50 exhibit eating disorder symptoms, many more research studies have indicated a significant link between disordered eating and menopause (the time frame 12 months after a woman's last period) and perimenopause (the years leading up to that point).

The prevalence of eating disorder symptoms during midlife can be as high as 29%. “While we don’t yet have a reliable data set, it’s thought that about one-third of middle-aged women have a chronic condition, one-third relapse, and one-third have a new onset eating disorder.” says Equip Senior Research Manager, Jessica Baker.

Physiological and lifestyle changes related to menopause may explain why many women experience an eating disorder at this time of life. Here’s what you need to know about why and how menopause can trigger an eating disorder.

What does menopause have to do with eating disorders?

There’s a higher prevalence in eating disorder symptoms among midlife women navigating menopause than those who are pre-menopause, “likely due to a 'perfect storm' of hormone changes coupled with physical and psychological changes that often occur during this time of life,” Baker says. “Further, cultural pressures for midlife women to remain thin and young-looking has steadily increased over the past decade.”

Potential weight gain

Most of us are well aware of the unrealistic beauty standards and “anti-aging” pressures that impact older women, but menopause-specific physical and psychological shifts are also important to consider. Along with common symptoms like hot flashes and vaginal dryness, weight gain may also occur during menopause, which could be triggering for those prone to disordered eating.

Hormonal changes

During menopause, women also experience significant hormone changes, namely a reduction of estrogen and progesterone. There’s some research to suggest that a sudden change to estrogen levels can lead to abnormal food intake, increasing the risk of an eating disorder. This may also contribute to why many young women develop eating disorders during puberty. Hormonal changes can also have significant mental health affects, such as anxiety, depression, and loss of control. These symptoms can often exacerbate an eating disorder.

Midlife challenges

Additionally, many women going through perimenopause and menopause are often concurrently experiencing challenges, ranging from role transitions (like "empty nest syndrome," retirement, and divorce) to increased body dissatisfaction, grief, and loss. These stressors can all play a role in the development or relapse of an eating disorder.

It wasn’t until Equip Family Mentor Inga Yanoski helped her own child recover from anorexia that she realized she’d developed her own share of food and body issues in adulthood. “While I was never officially diagnosed with an eating disorder, I believe I could have absolutely had orthorexia in my 20s,” she says. “Even though I have worked hard on healing my relationship with food and body, there is no shortage of diet culture messages around how to navigate perimenopause and menopause that can find their way into my psyche and sometimes make me doubt my choices.”

Diet culture pressures

Yanoski adds, “In diet culture, there’s an intense pressure to not let our bodies age, change, or grow” she says. “It’s this dangerous space where women could easily start with ‘lifestyle changes’ such as cutting out sugar and carbs, or experimenting with intermittent fasting, and eventually trigger a relapse or an onset of an eating disorder.” Yanoski also points to the hormonal shifts and mid-life stressors that are at play, like putting kids through college, career shifts, relationship changes, and caring for aging parents. “These factors all impact our moods, sleep cycles, and in turn, our appetite.”

The warning signs to be aware of

While eating disorders can and do manifest in a variety of ways, Baker says many of the hallmark signs and symptoms are consistent in all populations. “The early warning signs of an eating disorder are generally going to look similar across age groups.” These include:

• Dieting
• Food restriction
• Weight loss
• Frequent weighing behaviors
• Negative self talk about weight or body
• Excessive exercising
• Misuse of diet pills/laxatives

“While the warning signs may be similar across age groups,. what is different is that the medical and physical consequences of an eating disorder are exacerbated at older ages due to the body's lessened ability to bounce back from insult and injury, so it is even more important to get help early,” Baker says.

Treatment for eating disorders during menopause

Despite the increased research exploring the link between eating disorders and menopause, there’s still work to be done to ensure patients receive the most appropriate, targeted care. “Unfortunately, few studies have looked at treatment specifically for patients at older ages,” Baker says. “However, similar to younger age groups, cognitive behavioral therapy (CBT) has shown success in decreasing symptoms for this age group.”

Individualized treatment means emphasizing issues that are relevant and significant to the patient. In the case of menopause, that might mean centering CBT and other therapeutic approaches around age-related concerns, life transitions and stressors, and the experience of menopause. “I have seen patients experiencing the stereotypical 'midlife crisis' which can raise questions about the purpose and meaning of life. For this I have seen the benefit of helping the patient identify their values and living life according to those values,” says Baker

What everyone should know about eating disorders before, during, and after menopause

Eating disorders certainly aren’t an inevitable consequence of menopause, but aging is also not the protective factor against eating disorders that many may believe it to be. “First and foremost, it’s important to understand that eating disorders can occur at any age across the lifespan and that those at older ages aren't 'immune,'” Baker says. “This is especially important if the individual has a history of an eating disorder. This time of transition may be a good time to revisit previous tools and strategies that were helpful in recovery and to reconnect with treatment providers.”

Baker is also clear that the medical community must make a concerted effort to better comprehend eating disorders in menopausal women. While self-advocacy is important, patients should be able to depend on their clinicians to offer empathetic, evidence-based diagnosis and care. “Too often, women at older ages have the experience of being brushed off or told they are too old for an eating disorder. This is extremely concerning given that we know the physical and medical consequences of an eating disorder are worse for this group of women.”

While there is still a long way to go in better caring for perimenopausal and menopausal women with eating disorders, continuing to have frank, honest conversations and dispelling myths will help people of all ages and backgrounds get the help they need. “We need to continue to spread awareness about eating disorders in midlife,” Yanoski says. “We must stop normalizing or even praising disordered eating. We must continue to address anti-fat bias and stop praising the pursuit of thinness.”

Equip is proud to treat patients of all ages with tailored care. Because treatment is virtual, it meets middle-aged patients wherever they are as they navigate the particular responsibilities and challenges of that life stage. If you’re concerned you may have an eating disorder or a relapse, schedule a free consultation with our team.