Eating disorders and menopause

Information and advice on the perimenopause and menopause if you have a history of eating disorders

An estimated 1.25 million people in the UK have an eating disorder [1].

But eating disorders do not only affect people in earlier decades of life.

A 2017 study of 5,000 mid-life women found 3% had an eating disorder in the previous 12 months, and more than one in seven (15.3%) reported having had an eating disorder at some point in their life [2].

Here, we look at how menopause may impact you if you have a history of eating disorders.

What are eating disorders?

Eating disorders are a group of mental illnesses that cause unhealthy eating patterns and often include worrying about body weight or shape and a fear of gaining weight.

They can affect people of any age, gender and ethnicity.

The most common eating disorders are:

• anorexia nervosa: trying to control your weight by not eating enough food, exercising too much, or both
• bulimia: losing control over how much you eat and then taking drastic action to not put on weight
• binge eating disorder: eating large amounts of food until you feel uncomfortably full [3].

There is often a lot of overlap between them and it’s possible to move between these diagnoses if their symptoms change.

Physical and psychological impact of eating disorders

If you have an eating disorder, you may use disordered eating behaviours to help you cope with difficult situations or feelings.

This might include limiting the amount of food you eat, eating large amounts of food at once (binging), purging food through unhealthy means (making yourself sick and/or misusing laxatives), exercising excessively or a combination of these.

Aside from altered eating patterns and worrying about their weight, people with eating disorders can often feel anxious or depressed.

Other symptoms might include feeling cold, tired or dizzy, problems with digestion and menstrual periods stopping, or not starting at all in adolescence.

There are some conditions that you may be at greater risk of developing if you have an eating disorder. Behaviours such as food restriction, vomiting, laxative use and over-eating can put you more at risk of conditions such as obesity, type 2 diabetes, heart disease and osteoporosis.

An eating disorder is never your fault, and it’s important to get specialist help and support.

The perimenopause and menopause explained

The menopause is when the ovaries stop producing eggs and levels of the hormones estrogen, progesterone and testosterone fall.

The definition of menopause is when a woman hasn’t had a period for 12 months. The perimenopause is the time leading up to this and varies from months to years, when you still have periods, but the fluctuating and low hormone levels – especially estrogen – can herald a range of symptoms.

You have estrogen receptors on cells throughout your body so the impact of low hormones can trigger symptoms including:

• brain fog
• low mood
• anxiety and depression
• hot flushes and night sweats
• fatigue and sleep issues
• joint aches and pains
• vaginal dryness.

You can read more about the full range of perimenopause and menopause symptoms in the balance menopause library or by downloading the balance menopause support app.

The average age of the menopause in the UK is 51. However, it’s really important to state that it doesn’t just happen in mid-life: menopause before 45 is known as an early menopause, while menopause before the age of 40 is known as premature ovarian insufficiency (POI).

How can the menopause impact me if I have an eating disorder?

Some women experience a worsening or resurfacing of eating disorder symptoms and behaviours during the menopause, and some may develop an eating disorder for the first time.

Eating disorders can be triggered or worsened by feelings of loss of control, anxiety, low mood and a loss of motivation; these are all common symptoms of the menopause.

Metabolic changes due to fluctuating hormones can cause cravings for foods (often those with high sugar content). Weight gain can be triggered by low estrogen and loss of testosterone. Low estrogen can have a real impact on the quality of your sleep and this in turn affects your hunger hormones. These changes can be very challenging and triggering for someone with an eating disorder.

Treatment for perimenopause and menopause

The most effective treatment for symptoms of the menopause is to replace the hormones your body no longer produces. Hormone replacement therapy (HRT) contains estrogen, a progestogen (or progesterone) if you still have your womb, and in some cases, testosterone.

HRT also protects your future health. HRT has been shown to be protective against osteoporosis, heart disease, type 2 diabetes, bowel cancer and dementia. For most individuals, the benefits of taking HRT outweigh any risks.

Many women with eating disorders worry that HRT will lead to weight gain, but there is no evidence to support this claim.

Estrogen can reduce cravings, improve sleep and mood and also regulate hunger hormones. Body-identical progesterone can also help with sleep quality which in turn helps to regulate hunger hormones as well as improve energy.

Lifestyle changes

Other ways to minimise the negative impact of the menopause on your health and wellbeing are to make some healthy changes to your lifestyle by cutting out smoking and reducing alcohol, taking regular exercise that keeps your heart healthy and your bones strong, and eating a well-balanced diet that promotes gut health.

Finding time to do things that help you relax and having strong social and emotional connections with others can also help your menopause journey.

Menopause tends to come at a busy time in life, when women are juggling pressures at work with childcare, or children getting older and moving away, other caring roles etc. It can feel overwhelming, and many women with an eating disorder find that psychological support can really help to identify any underlying triggers behind their disordered eating, and this can work really well alongside HRT.

Where can I get help with my eating disorder or more information?

If you are struggling with an eating disorder or know someone who is, please reach out for help.

Your GP can refer you to local services for your area. In addition, the charity BEAT has a helpline and many online resources, while the National Centre for Eating Disorders is another good source of information.

References

1. Beat, ‘How many people have an eating disorder in the UK?’

2. Micali, N., Martini, M.G., Thomas, J.J. et al. (2017), ‘Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors’, BMC Med, 15(12). doi.org/10.1186/s12916-016-0766-4

3. NHS.uk (2021) ‘Eating disorders – an overview’