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Why menopause increases risk of eating disorders (May 2024)

By Carrie Dennett, MPH, RDN

Ask several people what someone with an eating disorder looks like, and most of them would probably say something like, “thin, white, young, female.” But eating disorders know no demographic boundaries, and the truth is that eating disorders in midlife—and beyond—are all too common among women.

For example, a 2012 study estimated that 13 percent of American woman age 50 and older have eating disorder symptoms, higher than the rate of breast cancer. Data from STRIPED (Strategic Training Initiative for the Prevention of Eating Disorders), indicates that among females suffering from an eating disorder in 2018-2019, 34% were age 40 and above, and 20% were ages 40-59.

But pervasive myths about who gets eating disorders and who doesn’t means that these women are more likely to go undiagnosed, and untreated. A 2017 study found that about 3.5 percent of women over 40 have a diagnosable eating disorder, yet most are not receiving treatment.

 So, why are eating disorders happening during this phase of life? Research suggests the hormonal changes of perimenopause—the “transition” to menopause, which is marked by cessation of menstrual cycles for 12 months—may open a “window of vulnerability” to developing eating disorders. A small 2019 study of eight women in early perimenopause that found that increasing estrogen levels were associated with an increase in binge eating when progesterone was high, but not when progesterone was low. A 2021 study found that women reporting more severe menopausal symptoms were more likely to experience disordered eating and body dissatisfaction.

Puberty and menopause are both marked by fluctuating hormones that affect, thoughts, moods, and body shapes—all of which can feed into eating disorders—but there’s much less focus on how the changes around menopause increase eating disorder risk. The bodily changes that come with the absence of estrogen can feed body dissatisfaction, leading to unhealthy behaviors aimed at fending off aging, which then have the potential to trigger eating disorders.

A 2023 study found that body dissatisfaction—specifically, fear of gaining weight and fear of losing control of eating habits—is a core feature of eating disorder pathology during the menopause transition. But that’s not all that’s going on for women around menopause. They’re also experiencing changes in their social roles as they get older, and may fear becoming less important and less attractive.

These changes are happening at a time when women’s lives may already feel out of control due to major life transitions such as children leaving for college, aging parents’ health struggles, divorce, career changes. Add the impact of anti-aging messages, weight stigma and weight bias in healthcare, and it’s a perfect storm for the development of extreme body dissatisfaction and disordered eating.

Research suggests that most midlife or older women with eating disorders experienced at least some disordered eating—if not an actual eating disorder—earlier in life. They may have never fully recovered, or they may have recovered only to relapse around menopause. For many, they never received treatment because there were areas of life that became more of a priority, like finding a partner and starting a family. Because they never learned formal coping tools and strategies, when body dissatisfaction and disordered eating behaviors flare up later in life, they’re likely to spiral out of control—because when everything else in life feels out of control, it can be easy to look to food and body as two things you can control.

However, some women do develop an eating disorder for the first time later in life—a 2017 study found that 3.6% of midlife women had experienced an eating disorder in the previous 12 months—with 41.6% of those being brand new. Regardless of when an eating disorder started, it takes a toll on just about every body system—including bones, heart and digestive system—and aging bodies may be especially vulnerable to medical complications. And then there’s quality of life—even if an eating disorder doesn’t kill someone, it makes their life less than what it could have been.

Unfortunately, while eating disorders are generally underdiagnosed, they’re more likely to be missed in midlife. Women age 40 or older admitted for treatment at an eating disorder facility tend to have had their eating disorders longer than younger women who are admitted for treatment. Many midlife women are struggling with subclinical eating disorders, and because they don’t meet the full criteria for anorexia or bulimia, they don’t get identified—by themselves or by anybody else.

Stereotypes about eating disorders mean that doctor still have trouble seeing eating disorders in anyone other than young patients. Doctors may even encourage or praise weight loss in women who have eating disorders, because they never ask the right questions to uncover if women are struggling with their eating or their body image.

A woman’s own shame can also get in the way of seeking help. Shame that she’s ridiculous for having an eating disorder at her age. Shame that she can’t just “fix” things on her own. But all kinds of people struggle with body dissatisfaction and disordered eating behaviors, and not only is there no shame in seeking help, but seeking help could save your life.

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