The menopause is triggering eating disorders – we need to talk about it

It’s absolutely been retriggered and has manifested in slightly more sinister forms. I could feel certain attitudes, thoughts and shame creeping back in.” Kirstie, a 42-year-old commercial lawyer, is talking about her eating disorder. Anorexia first reared its head when she was 12 years old; 30 years later, she’s had to grapple with it again as a result of entering perimenopause.

After the birth of her daughter 11 years ago, her relationship with food had markedly improved – but this new life stage saw her relapse. Although Kirstie could spot the warning signs, the difficulty for her was physical: she felt nauseous much of the time and suffered from a reduced capacity to eat. Her stomach felt sore; she wanted food less and less. “That just made me think, ‘Well, I can’t eat.’ You know, that food isn’t good for me,” she says.

Kirstie compares the experience of perimenopause to that of puberty. “It’s still so poorly understood, but your digestive system and your body really are more unpredictable,” she tells me. “You feel you don’t actually know what you want, or how to nourish yourself, or what your body needs. And that’s missing from the menopause conversation – we understand that younger girls going through puberty don’t understand their hormones and might be struggling with body image because their body is changing. Well, that vocabulary also applies to someone who’s perimenopausal.”

She is one of an increasing number of women who are revealing that starting perimenopause has retriggered a previous eating disorder or sparked one for the first time in their lives. A 2024 academic review of studies looking at the link between disordered eating behaviours and the menopause transition found “strong positive associations with disordered eating”, including “potentially higher levels of binge eating during the perimenopausal stage” and “restrictive eating behaviours” post-menopause.

Meanwhile, a 2022 study of eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women concluded that these stages are associated with binge eating and orthorexia nervosa – the latter being an obsession with restrictive eating and consuming only “healthy” foods. “Those results may serve as a first step towards spreading awareness among women within this age group regarding eating attitudes,” read the conclusion. “Moreover, healthcare professionals should screen for the presence of disordered eating during those women’s routine visits to the clinics.”

Unfortunately, “awareness” is currently a big part of the problem. As is the case for so many issues pertaining to female health, there’s a frustrating lack of research in this area, leading to a vicious cycle in which it’s hard to make the case for resources and funding. “Further research is needed to verify these findings and better assist health professionals in supporting healthy eating behaviours in menopausal women during this complex transition,” according to the 2024 review.

Anecdotally, more women are presenting with symptoms, according to Amy Goldsmith, founder of Kindred Nutrition & Kinetics, a private practice that provides evidence-based medical nutrition therapy for eating disorders and disordered eating. “I think social media has played a role in this,” she tells me. “The average person can see more than 500 images a day and women are celebrated or viewed as powerful when they are thin, have great style, and look ageless.” Plenty of celebrity icons who’ve hit menopause – think Demi Moore, Nicole Kidman or Jennifer Anniston – undeniably embody these attributes.

The disorder Goldsmith has noticed grow the most among peri- and menopausal women is orthorexia, “due to the combination of social media and the fearmongering and misinformation about diet, food ingredients and exercise”. As a woman of a certain age, you need only to scroll on Instagram for a few minutes to see what she means; content plugging niche superfood supplements, anti-ageing products and whole-food recipes where every single item is whipped up from scratch by a Stepford Wife so perfect she looks more femmebot than woman lies in wait at every turn.

Add into this toxic mix the huge hormonal changes and physical symptoms induced by perimenopause, and it’s not difficult to understand why a latent eating disorder might be rekindled – or why someone who’d always enjoyed a healthy relationship with their body might suddenly find themselves struggling.

Physically, hormones can manipulate fat storage, cause insomnia, decrease lean muscle mass and exacerbate moods. Many women will notice that their body is changing, despite their eating and exercise habits remaining the same – leading to feelings of “frustration or hopelessness”, says Goldsmith. “This can cause body dysmorphia or create a desire for control that can be an unhealthy focus on food restriction, diets, and/or over-exercise.”

Tom Quinn, director of external affairs at eating disorders charity Beat, describes perimenopause as a time of intense “upheaval”. He cites symptoms such as heavy bleeding or hot flushes impacting confidence and increasing feelings of loneliness; feelings of perfectionism or low self-esteem; and external stressors that occur in mid-life such as children leaving home and older relatives needing care. “It can mean that women don’t feel like their usual self, or feel under pressure to lose weight,” he adds. “As a result, dangerous coping mechanisms such as disordered eating can develop in order to feel more ‘in control’ over the changes occurring, or to manage difficult emotions.”

Kirstie can particularly relate to this last issue. “You typically are dealing with ageing parents, a stressful job, the mental load of family life,” she agrees. “And then you layer into that an unpredictable physical self and an emotional self…”

Aside from your body looking and feeling different, the shift in hormones during perimenopause can have a huge impact on mental health. “Menopause” describes the point when a woman hasn’t had a period for over a year; “perimenopause” is the lead-up beforehand, which can last 10 years or more, during which oestrogen, progesterone and testosterone levels fluctuate significantly before declining.

GP and medical specialist Dr Louise Newson, founder of menopause and wellbeing clinic Newson Health and menopause support app Balance, emphasises the need to think holistically when tackling the issues and symptoms that intersect between perimenopause and eating disorders. “The problem is, for decades, people have thought menopause is just about flushes and sweats and maybe some vaginal dryness and reduced libido, but they haven’t thought about the mental health aspect,” she says. “We know already that women are inappropriately medicalised for their hormonal changes, because people think, ‘Oh, they’re just depressed or they’re anxious’ – a lot of people who have eating disorders will not be thinking about their hormones at all.”

And hormones, as it turns out, can be the key to unlocking why perimenopausal and menopausal women might be susceptible to eating disorders. “Awareness is really important – knowing that hormonal imbalance can have an effect on our brains, on our behaviours, on the way we process, on our relationship with food, alcohol and other things as well,” says Newson. Hormones like oestrogen, progesterone and testosterone can affect other neurotransmitters, such as feel-good dopamine and “reward” hormones. “People get less pleasure in things when they don’t have those hormones,” says Newson.

open image in gallery

A lot of behaviours from adolescence can return in perimenopause too; those who struggled with addictions or negative behaviours in puberty might find these bubbling back up to the surface due to hormonal imbalances they last experienced as a teenager. This in itself can make it difficult for women to admit they’re struggling. “I felt a lot of shame and stigma,” Kirstie says of her eating disorder flaring up again. “It took probably a good few years before I could actually say the words out loud, and even then only with a couple of friends who I really trusted and felt wouldn’t judge.”

An added complication for those who’ve previously struggled with an eating disorder is that their periods may stop earlier, essentially putting them into early menopause, because women’s ovaries “switch off” to prevent pregnancy when body mass index drops below a certain weight ratio. This creates a vicious, chicken-and-egg cycle, explains Newson: “People are just focusing on the periods. They’re forgetting the role of the hormones in the brain, and that often without those hormones their mental health worsens – and therefore their eating disorder worsens. And it creates this downward spiral that continues.”

Many doctors aren’t clued up on the intricacies of either menopause or eating disorders, and therefore leap straight to treating the symptom, rather than the cause. Newson says that psychiatrists she’s met will simply prescribe the contraceptive pill – packed with synthetic hormones – to restart a woman’s periods if they’ve stopped due to anorexia. “They’re not addressing the problem,” she argues. “And a lot of synthetic hormones will lead to weight gain, which is the last thing people want when they’ve had an eating disorder.”

So what are the warning signs that could indicate you may be developing an unhealthy relationship with food or disordered eating? Goldsmith lists the following: a change in mood; isolation; fear of meeting friends or going to restaurants due to food preferences; fatigue; and compulsive thoughts about food, recipes, shopping, or eating a certain way. If you notice these symptoms creeping in, “Reach out to meet with a provider who specialises in eating disorders to help you process how you are feeling and ensure you are getting the nutrition you need,” she recommends.

Although Newson stresses that the causes behind eating disorders are complex and there is no miracle cure, she believes rebalancing women’s natural hormones via hormone replacement therapy (HRT) can have a huge impact – both in terms of physical and mental health. “If there are symptoms related to a patient’s hormonal changes, the best thing is to put the hormones back,” she advises. “You see with a lot of patients that when they have their hormones balanced, their mental health improves, their metabolism improves, their ability to function improves, and then their eating disorder can often improve as well, because they’re thinking in a very different way. It’s a real shame that, for many women, hormones simply aren’t thought about.”

HRT can also help with osteoporosis, a condition that weakens the bones, making them fragile and more likely to break. Women who’ve had anorexia in adolescence may be faced with a double whammy – they’re more susceptible to it due to lower oestrogen and higher cortisol levels, combined with periods of malnutrition during development, and the perimenopausal hormone decline exacerbates it further.

Kirstie cites HRT as being instrumental to her recovery, helping “tangibly” and “practically” within two weeks. “It’s not to say it completely takes all the symptoms away, but it certainly makes them more manageable and helped me feel more in control of my body,” she says. Speaking to a healthcare professional who knew the ins and outs of perimenopausal symptoms and how to treat them was also a game-changer; part of Kirstie had been in denial because of the common misconception that menopause doesn’t affect women until they’re in their fifties.

“I certainly didn’t feel empowered to get a test,” she admits. “I just thought I’d made my life too stressful with my job, too busy, being a single parent and trying to keep a relationship going – I thought it was my fault for taking too much on.”

Her advice for other women is simple: don’t suffer in silence. “Mealtimes and shared experience are pretty fundamental to life. Try and find support, whether that’s professional or otherwise, and keep an open mind – potentially go and speak to somebody about hormonal balance to see whether there’s something that can be done there.

“Seeking support and not feeling ashamed is key.”

For anyone struggling with the issues raised in this article, eating disorder charity Beat’s helpline is available 365 days a year on 0808 801 0677. NCFED offers information, resources and counselling for those suffering from eating disorders, as well as their support networks. Visit eating-disorders.org.uk or call 0845 838 2040