Binge Eating in Perimenopause - What's Going On?
Over the past decade, more women in midlife have been presenting for eating disorder treatment with both inpatient admissions and outpatient attendances rising among older women. Interestingly, binge eating is the pattern most often involved.
Whilst eating difficulties have long been framed as something that belongs to adolescence and early adulthood, that framing is inaccurate. Eating disorders affect people of all ages and, in fact, midlife is now recognised as a period of raised vulnerability.
In this blog, I explore the themes and life experiences that increase the risk of developing eating disorder in older women, or exacerbate eating disorder symptoms.
A SECOND window of vulnerability
A population-based study found that around 3.6% of women in their forties and fifties met the criteria for a diagnosable eating disorder. But when researchers have looked at disordered eating behaviours, rather than formal diagnoses, the figures rise sharply. A 2024 systematic review of the menopausal transition found rates of between 10.8% and 15.7%, and studies looking at individual symptoms have reported prevalence as high as 29%.
In other words, for every woman who would meet a clinical threshold, there are many more struggling in ways that never get named.
Within the midlife picture, binge-eating-type patterns are more common than restrictive ones. It seems perimenopause specifically may be associated with an increase in binge eating, while food restriction tends to become more prominent later, after menopause.
The framing that some researchers have arrived at is that perimenopause functions as a kind of second puberty - a second window of vulnerability.
Adolescence is obviously the first period of significant hormonal change and it is also the classic period of onset for eating difficulties. This isn't simply about adolescent social pressures, research has established puberty as a critical risk period in its own right with the hormonal changes themselves implicated in the raised risk.
Perimenopause involves hormonal change of a comparable scale but this time in the other direction as oestrogen levels begin to fluctuate unpredictably before declining. Whilst more studies are needed, if shifting oestrogen contributes to vulnerability at one end of reproductive life, it is reasonable to expect something similar at the other.
However, from what we see in the research so far, it's not simply the case that menopause per se is a predictor of disordered eating - it's more specifically about the severity of menopausal symptoms. It is what falling oestrogen during menopause does to an individual's sleep, mood, cognitive flexibility, energy and sense of being at home in their body.
And it makes a lot of sense that women experiencing more disrupted sleep, more mood disturbance, more hot flushes and more distressing physical change report more difficulty with eating and greater dissatisfaction with their bodies. The risk of a depressive episode roughly doubles during perimenopause, which is also relevant because low mood and binge eating are closely linked.
Broken sleep raises stress hormones and lowers the threshold at which food becomes hard to resist, and a run of poor nights is one of the most common precursors to a difficult evening with food.
Unfortunately all of this lands during a decade that is frequently amongst the most demanding of a woman's life when they may be dealing with ageing parents, teenagers, career pressure and often have very little time that isn't spoken for.
So if eating has ever been a way of soothing difficult feelings for a women, then a period of stress combined with hormonal changes affecting mood, anxiety or irritability, is very likely to make emotional urges to eat feel even more complicated to navigate.
HOW diet culture AMPLIFIES DISORDERED EATING
One study of over a thousand women aged 50 to 69 found that more than 90% wished to lose weight and more than 70% were dieting. Whether it’s a menopause diet, fasting protocol, cutting carbs or sugar, tracking protein, earning your food through exercise or messages about being more disciplined and taking charge, midlife women are an easy target for diet and wellness culture. And the underlying message is consistent: your changing body is a problem, and the solution is more control.
However, for anyone with a tendency towards binge eating, this is close to the worst possible advice.
Restriction - whether it takes the form of a formal diet, skipping meals or simply eating less than you need across a demanding day - is one of the most well-established drivers of binge eating there is. The body responds to under-fuelling by intensifying the drive to eat - and it responds particularly forcefully when it is already depleted, under-slept and under strain.
So the pattern that so often emerges in perimenopause is this: The body naturally changes and so might appetite. Culture says get this under control now. The control creates deprivation. The deprivation drives eating to feel even more out of control. Shame and a renewed resolve to be stricter tomorrow follow.
TACKLING BINGE EATING IN MIDLIFE
The good news is that binge eating responds well to the right kind of support.
I've written elsewhere on my blog about the layers this work usually involves - including support for the physiological, psychological and emotional aspects of eating. In Nutritional Counselling, nourishing the body is typically an early priority for support. This is because eating regularly and enough directly reduces the physiological drive to binge.
An appropriately qualified practitioner such as myself can also help you think about the kinds of foods that support your hormones, bone health, appetite and energy through this transition - without that tipping into another set of rules to follow.
During perimenopause, supporting sleep and finding ways to manage overall stress load are typically other key interventions as part of a holistic approach to help directly support both physiology and eating behaviours. It is also worth knowing that the stress-binge relationship runs both ways. Binge eating places significant stress on the body which can in turn affect hormonal balance - so easing the eating pattern often supports the wider picture too.
And where it is wanted, direct medical support for menopausal symptoms is of course available and can be a source of real relief for many.
My conclusions
Research tells us that perimenopause is a real window of vulnerability for disordered eating, with binge eating being the most commonly associated pattern. So if you are in your forties or fifties and struggling with new eating difficulties, or old ones have resurfaced, you are definitely not alone.
Hormonal changes can impact sleep, mood, energy and metabolism - all of which are likely contributing factors for binge eating during perimenopause. However, the cultural instruction to respond to this with more ‘control’ is precisely the wrong direction, especially for those with any history of disordered eating.
Know that change really is possible. Even if your body feels at its least trustworthy right now, please know that you can move beyond this and support is available.
You may also find this blog helpful - it explores the opportunity to rethink how you relate to your changing body during this transitionary time.
Take a nourishing step forward today
If this resonated with you, you don't have to navigate this alone. I offer nutritional therapy and behaviour change support for binge eating disorder, emotional eating, disordered eating and yo-yo dieting patterns, and I'd love to help you find your way back to more ease and trust with food.
Explore my support options or book a confidential, no-obligation enquiry call to see if working together feels right.
Reference sources:
Micali, N. et al. (2017). Lifetime and 12-month prevalence of eating disorders amongst women in mid-life. BMC Medicine, 15(12).
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0766-4
Vincent, C. et al. (2024). Disordered eating behaviours during the menopausal transition: a systematic review. Applied Physiology, Nutrition, and Metabolism, 49(10), 1286-1308.
https://doi.org/10.1139/apnm-2023-0623
Finch, J.E. et al. (2023). Network analysis of eating disorder symptoms in women in perimenopause and early postmenopause. Menopause, 30(3), 275-282.
https://doi.org/10.1097/GME.0000000000002141
Baker, J.H. & Runfola, C.D. (2016). Eating disorders in midlife women: A perimenopausal eating disorder? Maturitas, 85, 112-116.
https://doi.org/10.1016/j.maturitas.2015.12.017
Hawrylyshen, N. & Lengyel, C. (2022). Body satisfaction and associated predictors among baby boomer women in rural and urban Manitoba. Canadian Journal of Dietetic Practice and Research, 83(4), 160-167.
https://doi.org/10.3148/cjdpr-2022-013
