Menopause and Eating Disorders: What You Need to Know
Eating disorders are complex mental health conditions with many co-occurring physical health symptoms. They’re a difficult condition to treat at any age, but can be even tougher to navigate in the transition through the hormonal rollercoaster of menopause.
Eating disorders stem from many factors, including genetics, core feelings, high rates of body dissatisfaction, and looking outward to a culture obsessed with looks and thinness.
It’s no wonder that more people are having a tough time with their body image and mental health when they’re riding the tumultuous waves of perimenopause and menopause. Hang in there, friend, I’m here with a life raft and a path forward that is kind, gentle, and nourishing.
If we haven’t met yet, I’m Melinda Staehling, an Oregon-based Certified Nutrition Specialist and Menopause Society Certified Practitioner. I specialize in the important work of supporting midlife people with eating disorders, and have special skills with ARFID, anorexia and atypical anorexia, and binge eating in the menopause transition.
In this post, we’ll look at what eating disorders are (and what they’re not).
Then, we’ll take a look at how the hormonal changes of menopause, combined with the pressures of midlife, might lead to an increase in eating disorders in midlife.
And most importantly, we’ll chat about how to navigate this chapter of your life, cultivating true health and a better body image.
Let’s dive in.
I. Beyond the Stereotypes: Eating Disorders and Midlife
Before we talk about eating disorders and menopause, I think it’s important to dispel some long-standing myths about eating disorders in general. There are so many.
When we think of the common stereotypes of eating disorders, most often we come up with the image of a thin, young, white woman. While this image persists in media and culture, this couldn’t be further from the truth.
Eating disorders affect people of all ages, genders, races, neurotypes, and socioeconomic statuses. People with higher weight are just as, if not more, susceptible to eating disorders.
Prevalence in Midlife:
Between 2.1%-7.7% of middle-aged people have a diagnosable eating disorder [1]. The most commonly diagnosed eating disorders for this age group were OSFED and Binge Eating Disorder (BED). We’ll take a closer look at those categories in a moment.
Why They're Missed:
Eating disorders are often underdiagnosed in midlife due to persistent stereotypes, shame, stigma, and a lack of awareness among healthcare providers. Many medical professionals still mistakenly believe eating disorders only occur in young people - not true!
Common Eating Disorders in Menopause
Here’s a brief overview of the most common eating disorders.
For the individual, there may be more crossover in characteristics from one eating disorder to another, or, at the midlife stage, a diagnosis may shift from one presentation to another.
Anorexia nervosa: Partaking in energy restriction with the intention of weight loss. This could mean eating far less food than is needed and/or over-exercising. Intense fear of gaining weight or ongoing behaviors that interfere with weight gain.
Avoidant Restrictive Food Intake Disorder (ARFID): ARFID is characterized by a lack of interest in eating, sensory sensitivity, and/or a fear of negative consequences with eating, like choking and vomiting. It is a lot more complex than simply “picky eating”.
READ: More about ARFID and creating ARFID-safe food lists, here.
Binge Eating Disorder (BED): Eating large amounts of food in a short time and often feeling guilty or out of control afterward. Binge Eating Disorder is also associated with eating after feeling full, eating even when not hungry, and eating alone. While not discussed in the DSM, there is usually a restrictive side to binge eating.
Bulimia nervosa: eating a lot of food at once (bingeing) and then trying to get rid of the food or weight gain by throwing up, fasting, taking laxatives, or exercising too much.
Other Specified Feeding and Eating Disorder (OSFED): A diagnosis for people whose symptoms don’t fully meet the requirements of another diagnosis, but still experience a serious eating disorder.
Quick Note: I’ll point out that atypical anorexia currently falls under the umbrella of OSFED. While atypical anorexia can be just as severe as anorexia nervosa, atypical anorexia is a restrictive eating disorder for people of higher body weight. I’m not a fan of the labeling of this diagnosis, because it’s stigmatizing.
Atypical anorexia occurs at a greater prevalence than does anorexia nervosa (people with low body weight), and can have many of the same mental and physical health challenges.
II. The Menopause Transition and Eating Disorders
The menopause transition (perimenopause through postmenopause) is a critical period of hormonal shifts and life. These changes can increase the risk of developing or relapsing into an eating disorder.
Menopause occurs on average at age 52, but the transition itself can vary in length and symptom intensity for up to a decade for some.
I like to remind people that everyone’s menopause is unique. Some people find themselves moving through the transition without too many symptoms, and for others, it’s a challenging, unpredictable menu of hot flashes, increased menopausal anxiety, and depression.
Personally, perimenopause launched me into a mental health spiral that I wasn’t prepared for and didn’t understand, and also became the missing link to my AuDHD (autism + ADHD) diagnosis.
READ: For more on the stages of menopause and associated symptoms, check out this post.
When we’re thinking about the menopausal timeline and eating disorders, we can be talking about a few different possibilities:
New onset - An eating disorder emerges for the first time.
Relapse - In recovery, the eating disorder reappeared with the hormonal fluctuations and social pressures of midlife.
Persistent - The eating disorder was and is continuous throughout life.
III. Understanding Menopause and the Window of Vulnerability
The menopause transition can be a time of intense hormonal shifts, particularly in estrogen and progesterone. During perimenopause, shifting hormones can be associated with changes in eating disorder symptoms and an increase in mood disorders.
Similar to puberty, perimenopause is a period of intense hormonal fluctuation that can last for many years.
We might take a “biopsychosocial” lens. Eating disorders during the menopause transition are a time when biology, mental health, and our greater culture come together in what can feel like a perfect storm for the launch of an eating disorder.
Body Changes & Body Dissatisfaction
The ever-changing decline and ultimately, lack of estrogen can lead to a shift in body fat redistribution and other body changes. Combined with a society focused on youth and maintaining the same body throughout life, this can feel really upsetting and contribute to increased body dissatisfaction.
Social & Psychological Factors
Midlife often brings the stress of significant life transitions (e.g., children leaving home, aging parents, career changes, divorce, or all of the above). A society full of anti-aging messages, weight stigma, and weight bias in healthcare can create a "perfect storm" for extreme body dissatisfaction and fear of eating.
Periods of depression and anxiety are also more common in perimenopause.
The Neurodivergent Connection
Rates of eating disorders and disordered eating are significantly higher in the neurodivergent community (e.g., ADHD, autism, giftedness). This intersection with menopause is an under-researched but crucial area to consider, as neurodivergent individuals may experience higher rates of eating differences and distress around eating, like with ARFID (avoidant restrictive food intake disorder).
IV. Barriers to Recovery in Menopausal Eating Disorders
Midlife eating disorders bring about a set of unique challenges. People have full and busy lives, which leaves little time for treatment, stress reduction, and self-care.
Physical health risks are different at this stage. Eating disorders take a toll on nearly every body system (digestive, skeletal, cardiovascular, immune).
There can be a lot of crossover between menopause symptoms, usual body aging around the time of menopause, and eating disorder symptoms.
Midlife bodies can be especially vulnerable to the medical complications of eating disorders, making recovery more challenging. We can have a lot going on already, including:
Anemia, autoimmunity, digestive issues (IBS/GERD, IBD).
Osteopenia and osteoporosis (lack of bone-building nutrients like calcium and vitamin D).
High cholesterol, increased risk for Type 2 Diabetes, and insulin resistance.
Digestive issues, electrolyte imbalances, and kidney/liver problems from eating disorders can lead to a more difficult recovery because the body is less resilient than in youth.
Mental Health Co-occurrence: Eating disorders often co-occur with depression and anxiety, and the menopause transition is also a time when mental health challenges of all kinds can increase.
Disordered eating behaviors tend to rise during perimenopause and postmenopause, and these are significantly associated with higher levels of depression, anxiety, sleep disturbance, pain, and cognitive complaints like brain fog [2].
Body dissatisfaction is a central feature that links menopause and midlife-related physical changes to disordered eating risk; in turn, high body dissatisfaction also correlates with worse mental health outcomes in midlife women [3].
What can we do? Psychological resilience (for example, intuitive eating, a more positive perception of aging, and social support) may cushion against eating disorder risk. More intense menopause symptoms (hot flashes, sleep problems), greater body dissatisfaction, loneliness, and social pressure tend to increase risk [4].
V. Resources
Have I piqued your interest? If you’d like to keep learning, here are a few more vetted resources to learn about the intersection of eating disorders and menopause:
Project Heal: An eating disorder nonprofit with valuable resources. Check out this post about eating disorders over 40.
The Emily Program Peace Meal Podcast Episode 83: Eating Disorders and Menopause with Val Schonberg
VI. Taking the Next Steps in Menopausal Eating Disorders
It is important to use the right tools and to reduce the risk of harm for folks navigating menopause and an eating disorder. But, with the right training, healthcare professionals such as myself can provide a compassionate path forward. With eating disorder education, treatment, and a comprehensive care team, we can reduce eating disorder risk in midlife. These are the four steps that I recommend:
Step 1: Embrace a Weight-Inclusive Approach: This means focusing on health-promoting behaviors rather than weight loss. Avoid recommendations that exclude specific foods or food groups or dictate eating times and windows, as these can contribute to more rigid thinking about food.
Step 2: Recognize Shame and Stigma: Many people feel deep shame about their bodies and their eating disorder behaviors, which can prevent them from seeking help. Knowing this, dietitians can create a safe, non-judgmental space for discussion.
Step 3: Consider Menopausal Hormone Therapy Support: Consult with a Menopause Society Certified Practitioner for a comprehensive look at how menopausal hormone therapy (MHT) might help relieve both the physical and mental health symptoms.
Step 4: Build a Care Team of Eating Disorder-Informed Providers: Seek out eating disorder-informed dietitian-nutritionists, therapists, and medical professionals who specialize in eating disorders and understand the nuances of midlife./
VII. That’s a wrap.
Let’s take a look at what we’ve learned.
Eating disorders don’t have an age limit. They affect people in all body sizes and life stages—yet in midlife, they’re often missed due to outdated stereotypes and stigma.
Menopause is a high-risk window. Hormonal changes, weight shifts, stress, and cultural pressure around aging can create a “perfect storm” for new or recurring eating disorders.
Body image struggles run deep. Menopausal anxiety, depression, and brain fog can also show up alongside eating disorders.
Health risks hit harder in midlife. Eating disorders can be associated with other health conditions at this stage, raising risks for bone loss, heart problems, high cholesterol, and Type 2 diabetes.
Healing takes a personalized approach. The most effective path forward blends compassionate, weight-inclusive care, stigma reduction, supportive therapy, and, in some cases, hormone treatment.
You don’t have to navigate menopause and eating struggles alone.
As a Certified Nutrition Specialist with extensive training in managing eating disorders and menopause, I’m uniquely qualified to partner with you in finding balance with food, easing body changes, and supporting your well-being during this often messy middle season of life.
You deserve to feel better in your body - I’m here to help.
Reach out for an Introductory Call to take the first step toward compassionate, personalized care.
I’m in network with many commercial insurance plans - check out this page for more info.