Eating disorders of the perimenopause

Abstract

Except for psychosis, women’s mental health problems across the reproductive lifespan are common. There are periods in a woman’s life, associated with significant sex hormone fluctuations, that render her particularly susceptible to mood disturbance and mental health illnesses, including eating disorders. Whilst eating disorders are usually conceptualized as diseases afflicting adolescence and young adults, there is increasing evidence to suggest the landscape for eating disorders has considerably changed and includes a peak in midlife, correlating with the perimenopause. Inpatient admissions and outpatient clinic attendances have increased amongst older women. It is likely this increasing trend is the result of numerous biopsychosocial factors. A diagnosis of an eating disorder in midlife may be more common in those women simultaneously navigating the perimenopause than in midlife women who remain pre-menopausal owing to the significant ovarian hormonal fluctuations encountered in the perimenopause. Eating disorders are serious illnesses associated with significant morbidity and mortality, which are exacerbated when present at older ages. Research is beginning to recognize the importance of including this typically under-represented cohort of middle-aged women in empirical studies, which is critical to a complete etiological understanding. Recognizing and treating these varied presentations and establishing effective treatments for chronic, recurrent and new-onset eating disorders in midlife women is crucial.