Midlife women with perimenopause suffer from a 'lack of awareness' when it comes to disordered eating

Australia Broadcast Center

02-06-2025

Warning: This article mentions eating disorders, disordered eating and restrictive eating practices.
Sue Cody's decades-long battle with an eating disorder began when she was 22 years old and in love.
That was when she suddenly became self-conscious about her figure.
"I thought if I lost a bit of weight, he might like me more. But then it spiralled out of control," she says.
Sue experienced bulimia, which lasted until she was 30.
Now aged 57, she can see how the eating disorder has often reappeared during stressful times in her life, particularly once she reached midlife.
"I was able to manage it while my daughter was growing up. Then when she left school and went to uni … I was going through what I'd never heard of before — perimenopause," Sue says.
"My body was changing and … I kind of lost my purpose in life. [My eating disorder] spiralled out of control for about four years."
Pre-existing disorders triggered by the hormonal and emotional changes of perimenopause are common among the patients that psychologist Janet Lowndes sees.
"I also see a lot of people who tell me about what was happening to them as a late adolescent or early adult, and it's pretty clear they were experiencing an eating disorder back then, but it wasn't identified," she says.
"Thirty years ago, that was at a time when eating disorders were far less recognised and less likely to be identified."
The lead-up to menopause — known as perimenopause — often features a raft of debilitating symptoms that can last as long as 10 years.
According to new research from the Butterfly Foundation, a national charity for Australians impacted by eating disorders, more than half of all women experience some level of body dissatisfaction during this time.
Around 3.5 per cent of people in menopause experience an eating disorder.
Sarah Cox is a clinical psychologist and the Butterfly Foundation's national helpline manager.
She says the physical process of aging, hormonal changes and potential health issues can make people more vulnerable to the development of an eating disorder.
"This stage of life can also bring a host of social pressures and change, from children moving away, divorce, loss of loved ones, the natural aging process, moving away from society's harmful 'young, thin' ideal and increased body dissatisfaction," she says.
"Disordered eating behaviours may arise to cope with these changes."
Ms Lowndes believes the diet culture message given to women in midlife is also to blame.
"The whole multi-billion-dollar anti-aging industry tells women that their bodies aren't supposed to change," she says.
"So, we see a lot of people who are really struggling with their body being larger than they want it to be and then getting into a diet mindset and dietary thinking that isn't helping their health and wellbeing.
"I've been to women's health conferences where there is so much conversation around menopause and it's a very fear-based message: 'Be careful of weight gain around menopause'."
She says the problem is that "some sections of the health industry" can then perpetuate this message of weight gain during menopause as "being the most terrible thing that could happen".
It's a commonly held belief that eating disorders only affect young girls, a myth that specialists in the field are working hard to dispel.
Around one in four people experiencing an eating disorder in Australia each year are aged between 40 and 59.
Eating disorders can occur in diverse populations, including the LGBTQIA+ community and people from different cultural backgrounds, says Ms Lowndes.
"The stereotype of who experiences a eating disorder, being the young, thin white woman — we now know that that is absolutely not the only person who experiences an eating disorder," she says.
Ms Cox says there is also a "lack of awareness around eating disorders and body image concerns in mid-life and beyond".
That prompted Gemma Sharp, the director of Consortium for Research in Eating Disorders, to develop an online resource for health professionals and those impacted by a midlife eating disorder.
"Often the stories we've heard are people reaching out for support for eating issues in midlife and being met with, 'You should have grown out of this by now. You should know better by now.' And that is a completely inappropriate, unhelpful response," she says.
It's something Sue has experienced at medical appointments.
"When they ask if there is any medical history, I mention anorexia and they go, 'Oh, you don't look like the typical anorexic person', because I'm older," she says.
She says when you get opinions like that, "it just makes you feel so much worse".
"I had to fight tooth and nail for an inpatient programme and then once I was in there, I felt like I didn't belong because, once again, I was older and I was treated like I should have known better," she says.
"I was only there for four weeks, but the whole time I was thinking 'I've made a mistake, I shouldn't be here'."
While women and girls are disproportionately impacted by eating disorders and body dissatisfaction, it can happen to anybody, at any age.
There's another complication: the similarity between perimenopause symptoms and those associated with an eating disorder.
"Hot flushes, night sweats, insomnia, bone density issues, body composition changes — these are all issues that can happen both in eating disorders and the menopause transition," Professor Sharp explains.
"Not to mention mood disturbances. Some people have cognitive or concentration concerns, and often in eating disorders, the menstrual cycle is irregular or completely absent.
"It can mean that women who are experiencing an eating disorder really don't understand that they're going through the menopause transition because their periods aren't regular enough to be able to tell.
"So yes, that was something that came up very strongly in our research. Just complete and utter confusion as to what's going on in one's body."
Sue is now in recovery but concedes it's a struggle. Experiencing an eating disorder has taken a profound toll on both her physical and mental health.
A year ago, she fell and broke her ribs and she's developed an ulcer from the bulimia, which has meant having to take medication every day to help with indigestion.
Recently Sue was also diagnosed with breast cancer.
"I hate looking at myself in the mirror. I just want to smash the mirror every time I see myself because I just cannot stand the sight of myself," she says.
"But when I think about recovery, I think about making memories with hopefully grandchildren and the rest of my family rather than lying on my death bed, full of regret for not having any happy memories at all."
For support with eating disorders and body dissatisfaction call the Butterfly National Helpline on 1800 ED HOPE (1800 33 4673) or visit www.butterfly.org.au.