Eating disorders and menopause

Zoe Hodson, GP and menopause specialist

Although eating disorders have been traditionally viewed as an issue for younger women, we know that many women will experience a resurgence of symptoms and behaviours during the menopause or even develop an eating disorder for the first time.

Anorexia, bulimia, binge eating disorder and other eating disorders are often exacerbated by feelings of loss of control, anxiety, low mood, loss of motivation, of being overwhelmed and these are all common symptoms of the menopause.

The psychological impact of the menopause is vastly under recognized and these symptoms can present many years before the more commonly known vasomotor symptoms such as hot flushes and night sweats.

We know that protecting future health and in particular bone and cardiovascular health is crucial during the menopause. Behaviours such as food restriction, vomiting, laxative use and over eating can put women more at risk of conditions such as obesity, type 2 diabetes, heart disease and osteoporosis.

Metabolic changes also happen due to fluctuating female hormones and these can cause cravings for eg. sugary foods. Weight gain can be triggered by low ovarian oestrogen and loss of testosterone. Disrupted sleep also has an effect on hunger hormones as well as mood and energy and low estrogen can have a huge impact on the quality of sleep.

Many women worry that Hormone Replacement Therapy (HRT) will cause weight gain and exacerbate their symptoms further. Replacing female hormone deficiencies with body identical Hormone Replacement Therapy will more commonly help women to bring their weight back into a healthy range. Body identical oestrogen can reduce cravings, improve sleep and mood and also regulate hunger hormones. It has a protective effect on bones and the heart as well as reducing insulin resistance.

Body identical progesterone can also help with sleep quality which in turn helps to regulate hunger hormones as well as improve energy.

If women have a co-existing testosterone deficiency then replacement can help with energy, strength and wellbeing.

We know that many women with eating disorders will also use alcohol in an unhealthy way in order to cope with symptoms such as anxiety. Treating the underlying cause of the anxiety with HRT often makes it easier to reduce or stop alcohol which in turn can help with weight stabilisation. This will also help to reduce the risk of osteoporosis and heart disease as well as many other health conditions.

Menopause can come at a particularly busy time of life and many women are juggling work, childcare, caring roles etc. It can all feel very overwhelming and we also know that unresolved past traumas can often resurface at this time. Many women find that psychological support can really help to identify the underlying ‘drivers’ behind the disordered eating patterns and this can work really well alongside HRT treatment.

If you are struggling with an eating disorder or know someone who is, please reach out for help. Your GP will know the local services for your area and the website www.beateatingdisorders.org.uk has a helpline as well as online resources. Menopause is a time to stop, reflect and prioritise your future health and wellbeing so please don’t hide away with this if it is impacting on your life.