Eating disorders and body dissatisfaction during menopause

Butterfly’s Submission to the Senate Standing Committees on Community Affairs Inquiry into Issues related to menopause and perimenopause was published this month. Our Head of Knowledge Research and Policy, Sarah Squire, summarises key parts of the Submission in this blog.

While eating disorders are more prevalent among adolescents and young women, eating disorders affect people of all genders and ages, including those in experiencing perimenopause and menopause in midlife. According to Butterfly’s Paying the Price (2024) report, almost one in four (24 per cent) of people experiencing an eating disorder in Australia each year are aged between 40-59.

Studies such as Khalil et al. (2022) show that menopausal stages are associated with disordered eating behaviours among women. Another study has found that, similar to young adult samples, dissatisfaction with body image is a core feature of eating disorder pathology across the life course. When subthreshold eating disorders are included, 15 per cent of perimenopausal women report at least some elements of disordered eating, a markedly higher prevalence compared to premenopausal women in this study. Finch et al. (2023) find that symptoms of eating disorders at midlife can have prevalences as high as 29.3 per cent.

Older women who have spent their lives dieting and over-valuing their size, weight and shape may be more vulnerable to developing body dissatisfaction, disorders eating and eating disorders. One study of women in their 50s found that that they had higher levels of body dissatisfaction compared to their younger years – including in their 40s – with 50 per cent of women considered to be of ‘normal’ size (a BMI of <25) reporting an increase in body dissatisfaction.

Some people may experience an eating disorder for the first time during menopause, while others may experience a relapse, or worsening of pre-existing eating disorder symptoms (Gagne et al., 2012). Weight and hormonal changes, increased anxiety, low mood, and feelings of loss of control are not only symptoms of menopause, but also risk factors for eating disorders.

Contributing physical, psychological and social factors

Drawing on a summary of evidence by Samuels, Maine & Tantillo (2019), factors which contribute to body dissatisfaction and eating disorder prevalence in midlife include:

• Stress and anxiety in relation to the physiological changes of ageing, which can contribute to feelings of loss of control in the context of a culture that valorises youthfulness
• The impact of weight suppression and disordered eating over many decades of life
• The lack of older women role models amidst ageist social norms which frame ageing as something to defy and combat with diet, exercise and medication regimes
• The ongoing impact of diet culture, where disordered eating is framed as normal behaviour from a young age
• High levels of body dissatisfaction among women aged 50 and over
• Experiences of shame, stigma and isolation, given that eating disorders are stereotyped as illnesses affecting young people, and health professionals may perceive older people as ‘too old to have an eating disorder’.

Merima, a woman with lived experience of an eating disorder who has shared her story with Butterfly, describes the pressures of midlife and the menopausal transition in this way:

“Ageing is confronting in a world where beauty is valued and financially rewarded . . . Mid-life has unique pressures; ageing parents, raising teens, marital discord, divorce, return to the workplace because of financial pressure and of course menopause . . .

The hot flushes and sleep deprivation are enough to tip the mental balance. When combined with the end of one’s reproductive capacity, it shakes one’s esteem. More confronting than any of these factors is weight gain. Our bodies change as fat deposits are laid down to augment our flagging oestrogen supplies.”

Eating disorders may arise to cope with these challenges, in addition to a range of contributing clinical factors.

Butterfly’s recommendations

Knowledge of eating disorder risk for women in middle age and later in life is critical for health care providers, who need to be adequately trained in how to screen, assess and refer or treat people with these conditions across the life course.

As with other age cohorts affected by eating disorders, a public health approach is required with a commitment to mental health promotion and prevention, including an avoidance of harmful anti-obesity messages. Butterfly recommends investment in mental health promotion to improve eating disorder literacy, reduce stigma and support early help-seeking during menopause and perimenopause.

Health promotion activities should be inclusive of non-binary, gender diverse and trans men to ensure equity of access to appropriate information, care and support. Community education should include awareness and stigma reduction campaigns with supporting resources to help those affected and their loved ones to identify early warning signs and take action.

Better data on prevalence, types of eating disorders and disordered eating, and the development of tailored treatment options for people transitioning to menopause and post-menopause are also required.

Butterfly hopes that the Senate Inquiry – which is due to report in September 2024 – will recommend changes to health promotion, professional training and community education in relation to eating disorders and body dissatisfaction to ensure that people achieve their best possible physical and mental health during the menopausal transition.

Learn more

• Read Butterfly’s full Submission to the Senate Standing Committees on Community Affairs Inquiry into Issues related to menopause and perimenopause.