Mental Health Concerns and Eating Disorders During Perimenopause

What is Perimenopause?

Perimenopause is the life stage when a woman’s body transitions toward menopause (the end of her reproductive years, when the body no longer produces eggs). Perimenopause typically begins sometime in a woman’s 40’s, but there can be significant variance with some women noting changes in their 30’s, and some not until their 50’s.

The perimenopause period usually lasts between 5-10 years, and in Australia the average age for reaching menopause is 51 years.

Menopause is most often a natural life event, but it can also be triggered by gynaecological surgeries or the use of certain medications (including some treatments for cancer). Perimenopause can be experienced by all people assigned female at birth (AFAB) who sill have their ovaries, including trans-men.

Why is it important that we know about Perimenopause?

Perimenopause can bring a variety of physical and emotional changes which significantly impact on wellbeing and quality of life. These changes vary in severity from person to person, and across the perimenopausal period. There’s a lot that can be done to support women during perimenopause, and it’s important that everyone is aware of the symptoms associated with this time, considering how they can support women during the transition. Some of the compounding factors which can exacerbate the experience of perimenopause are isolation, misinformation, judgement, and a lack of care or support.

There are numerous mental health concerns which women transitioning through menopause may experience, along with increasing risk of cardiovascular disease and reduced bone density. Women at midlife also have significantly increased risks of mental health concerns such as depression and anxiety, and an increased risk for the development or re-occurrence of an eating disorder.

Common symptoms of Perimenopause

According to a 2023 study conducted by the Jean Hailes Foundation for Women’s Health, approximately 20% of women experience no symptoms of perimenopause at all. For those who do experience symptoms, these can be triggered by fluctuating hormone levels, which often coincide with major life changes and stressors associated with midlife. The range of symptoms which may be attributed to perimenopause can include, but are not limited to, those below.

Some possible physical symptoms of perimenopause:

• Irregular or missed periods, or changes in menstrual flow

• Changes in ovulation patterns

• Hot flushes and night sweats

• Sleep disturbance

• Fatigue and headaches

• Muscle and joint aches

• Vaginal dryness and breast tenderness

• Bladder weakness and more frequent urge to urinate

• Skin dryness and sensitivity

• Loss of libido or reduced sexual pleasure

• Altered digestive patterns and tolerance of foods

• Changes in body shape, size and composition

Some possible mental and emotional symptoms of perimenopause:

• Feeling anxious or irritable

• Low mood or mood swings

• Forgetfulness or ‘brain fog’, difficulty concentrating

• Difficulty coping with life events

• Challenges adjusting to your changing body

Perimenopause and Mental Health

The emotional challenges of perimenopause should not be underestimated. Hormonal fluctuations associated with this life phase are linked to an increased risk of anxiety and depression, even for those without a prior history of mental health issues.

Research has found an increase in suicidal thoughts for women at midlife, and completed suicide rates for women in Australia are highest in the perimenopause period.

Physical symptoms like night sweats, brain fog and fatigue can exacerbate mood disturbances. Additionally, perimenopause often coincides with major life changes such as retirement, family and relationship changes, increased caregiving responsibilities, and personal loss, which can all contribute to increased stress.

The changing relationship with the body during menopause can also present a significant change for many women. There may also be a period of adjustment as women come to terms with no longer experiencing monthly reproductive cycles, which can impact on identity and the experience of femininity.

Body size and shape changes during Perimenopause

Perimenopause often brings significant changes in body weight, shape and composition. While hormonal changes contribute to these shifts, other factors such as lifestyle changes also have an impact. Women transitioning through menopause may also notice changes in their appetite and digestive patterns. The aging process, which naturally decreases lean muscle tissue, can make it more challenging to maintain muscle mass and manage weight. Additionally, weight cycling, or repeated dieting, can lead to further muscle loss and fat gain over time.

All of these factors can add more stress for women in perimenopause, especially when faced with diet culture messaging about body ideals and fear of weight gain.

A balanced perspective on understanding and accepting the naturally occurring body changes, while also focusing on nutrition and activity levels for optimal wellbeing is important, particularly to avoid extreme or all-or-nothing responses to the changing body.

Eating Disorders and Perimenopause

Eating Disorders can be experienced by people of all ages and all genders. Traditionally thought of as conditions impacting young women, we now know that the rates of eating disorders being experienced by older women are increasing, and are a significant concern at midlife. These mid life eating disorders can be triggered by the changes of perimenopause, and may be either a first presentation at midlife, or a re-occurrence of a condition which had been experienced earlier in life.

According to the Butterfly Foundations ‘Paying the Price’ report (2024), almost one in four people experiencing an eating disorder in Australia each year are aged between 40-59. When sub-threshold eating concerns are included, 15% of perimenopausal women report at least some elements of disordered eating.

Major hormonal shifts experienced by women during perimenopause, like those experienced during puberty, pregnancy and postpartum periods, combine with pressures on women to meet cultural ideals of thinness and ‘anti-ageing’ to create a high risk period for the development of an eating disorder. Significant life events and stressors such as increased caregiving responsibilities or significant lifestyle changes can also trigger challenging eating behaviours and body image dissatisfaction in midlife.

Eating disorders during perimenopause are often overlooked by health professionals, who may not be aware of the prevalence of these conditions for women at midlife.

This is particularly notable when the full range of eating disorder presentations is considered, including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Other Specified Feeding and Eating Disorders. Midlife eating disorders can have complex and serious health consequences, as the body is more vulnerable to complications such as digestive issues, osteoporosis, and dental problems, and fluctuating eating patterns can also exacerbate many of the symptoms of perimenopause.

“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’.”

(From The Butterfly Foundation: ‘Eating Disorders and Body Dissatisfaction During Menopause’.)

Seeking help during Perimenopause

The hormonal and life changes associated with perimenopause can be challenging, with the difficulties exacerbated for people who feel isolated and unsupported during this time. If you or someone you know is struggling with the symptoms of perimenopause, or may be experiencing body dissatisfaction or eating disorder symptoms during midlife, the team at Mind Body Well can offer support and guidance to help navigate this phase. We also recommend the links below for further information.

• Australasian Menopause Society

• Jean Hailes Foundation for Women’s Health

• Perimenopause Symptom Checker

• Eating Disorders Victoria free online course - Menopause and Eating Disorders

• Butterfly Foundation - ‘Paying the Price for Eating Disorders’

Our Director Janet Lowndes reflections after attending the Asia Pacific Conference on Women’s Mental Health in October, 2024. (General information only, please consult your health professionals for individualised medical or psychological advice).

Navigating Social Media to Promote Positive Body Image

In our digitally driven world, social media has become an integral part of our daily lives. From connecting with friends to staying updated on the latest news, it's a tool which has immense influence on our lives. Alongside the convenience and benefits, social media also presents a number of challenges, particularly in relation to body image.

The prevalence of unrealistic beauty standards portrayed on social media can have a big impact on how we perceive ourselves. Repeated exposure to these perfected images can cause us to feel inadequate, and may contribute to body dissatisfaction.

Social media can also be a great tool to assist in promoting positive body image, fostering self-acceptance and encouraging inclusivity. The key factor is how we choose to engage with social media. Here are some tips on how to use social media in a way which promotes positive body image and can protects us from dissatisfaction or potentially disordered eating behaviours.

1. Check in with Your Feelings

Notice how you feel during and after being on social media. If certain pages, accounts or images leave you feeling negative about yourself or trigger comparison, consider whether following them is beneficial to your well-being. Your mental health should always be the priority.

2. Curate Your Feed

Follow accounts and people who promote body diversity and inclusivity, and unfollow those which perpetuate harmful beauty standards. Exposure to a broad variety of body types, shapes, ages, genders, and ethnicities can reshape your perception and foster inclusivity.

3. Remember: It's Not Reality

Keep in mind that what you see on social media is often a curated portrayal of someone's life… the highlights reel. Remember also that images may be edited, filtered or enhanced, so what you’re seeing may be not be real. Remind yourself of this when comparing your life to others. Share authentic moments from your own life to contribute to a more genuine online community.

4. Combat Comparison

As the saying goes, ‘Comparison is the thief of joy’, and this is especially so on social media. Remember that you’re comparing yourself to the best possible version of another persons life, and if you begin to slip into critical self-talk, it’s probably time to move away from social media for a while to do something which focuses on your own life, your own opportunities and achievements.

5. Prioritise Health and Well-being

Move your focus away from appearance, to instead pay attention to your overall health and well-being (which is much broader than just the things we’re able to photograph and share on the socials). Embrace discussions about what makes you feel good physically, mentally, and emotionally.

Social media can either perpetuate harmful beauty standards or serve as a platform for promoting positive body image and inclusivity. By curating our feeds, being aware of our emotional responses, and fostering empowering content, we can contribute to a healthier and more accepting online community.

Wishing you a Non-Diet New Year

As the year draws to a close we’re encouraged to reflect on the past, and to contemplate changes we'd like to make for the year ahead. This time of year is ‘peak-season’ for the diet industry, and we’re exposed to a plethora of messages telling us that the problems in our lives can be solved through weight loss – which is of course a very long way from the truth.

This year we encourage you to break free from diet culture, and to focus on positive and sustainable goals which can contribute to positive well-being. Here are some strategies to consider:

1. Unplug from Negative Influences

Social media has become an integral part of our lives, but its impact on mental well-being is often underestimated. Take a close look at your social media accounts and unfollow any content which triggers negative thoughts or feelings about your body or lifestyle. Instead, curate your feed with accounts that inspire and uplift you, fostering a positive online environment. More puppies and kittens, less wellness influencers!

2. Break Free from Food Rules

‘Food rules’ are beliefs or vales which can dictate when, how, and what we eat. Challenge these rules to embrace a more intuitive approach to eating, paying attention to what you really want to eat (as opposed to what you think you ‘should’ have). Remember that food is not inherently good or bad; it's a source of nourishment and enjoyment. Shift your mindset by using neutral and non-judgemental terms to describe the food you consume.

3. Cultivate Self-Compassion

While we may be adept at showing kindness to others, extending the same compassion to ourselves can be challenging. Building self-compassion is an important step toward fostering resilience and self-care. Even if your thoughts are not yet self-compassionate, take actionable steps to be kind to yourself. Schedule self-care and self-nurturing activities in the day, week and year ahead.

4. Prioritise Quality Sleep

Our sleep patterns impact so many aspects of our lives and have a powerful influence on our physical and mental health and wellbeing. Establishing a good night-time routine can significantly assist your sleep patterns. Create a conducive sleep environment by limiting screen time before bed, maintaining consistent sleep and wake times, eating nourishing foods across the day, and engaging in relaxation or meditation strategies.

5. Engage in Joyful Movement

If incorporating more movement into your routine is a goal, focus on activities you genuinely enjoy. Instead of seeing exercise as a chore or punishment, see it as a celebration of what your body can do. Think about physical activities you’ve enjoyed at different times in your life, and explore all kinds of different forms of movement. Pay attention to how each activity makes your body feel, and let joy be your guide.

Happy New Year, from the team at Mind Body Well

Challenging Stereotypes: Masculinity and Eating Disorders

For far too long, eating disorders have been stereotypically associated with women, most commonly young women. However, the truth is that eating disorders do not discriminate based on gender, size, sexual orientation, cultural background, age, or ability. Men, too, grapple with these complex mental health conditions, and it's time to break the stigma surrounding men and eating disorders. In this article, we shed light on the prevalence of eating disorders among men, the unique challenges they face, and how we can challenge societal norms to support those in need.

Eating Disorders in Men: The Numbers Speak

Recent statistics from Australia's Butterfly Foundation revealed a significant presence of eating disorders among men. It is estimated that over one-third of eating disorder presentations are seen among men, with 360,131 Australian men living with an eating disorder (Butterfly, 2019).

According to the National Eating Disorders Collaboration, it is estimated that men account for:

• 20% of people in Australia who experience Anorexia Nervosa

• 30% of people in Australia who experience Bulimia Nervosa

• 43% of people in Australia who experience Binge Eating Disorder

• 55-77% of people in Australia who experience Other Specified Feeding or Eating Disorder (OSFED)

• 67% of people in Australia who experience Avoidant Restrictive Food Intake Disorder (ARFID)

Heightened Risk Among Certain Groups

Certain groups of men face a higher risk of developing eating disorders. This includes queer men, transmen, gender diverse groups, and men involved in fields that promote specific body ideals or physiques, such as athletes, bodybuilders, and actors.

Unique Presentations in Men

Eating disorder presentations among men may differ from those commonly associated with women, or they may also be very similar. Men may focus on low body fat and high muscularity as well as weight. They might also be more concerned with high protein foods and counting macros, as well as engaging in excessive or compulsive exercise with an emphasis on muscle appearance. Concepts like ‘bulking’ and ‘shredding’ and the use of supplements and performance-enhancing drugs can also be prevalent.

The Impact of Stigma

Unfortunately, eating disorders among men are often underreported due to the stigma surrounding these conditions. The stigma can lead to a lack of awareness of symptoms, misdiagnosis, delayed diagnosis, difficulty accessing appropriate treatments, and a feeling of exclusion from available treatments.

Cultural Expectations and Norms

Cultural expectations and ideals surrounding body size and appearance can play a significant role in the development of eating disorders among all genders, including men. Society's narrow definition of masculinity, characterised by being muscular, strong, stoic, and independent, contributes to the pressure men face to conform to unrealistic body ideals. ‘Diet culture’ preys on this by promoting fasting, high protein products, and ‘biohacking’ – all of which contribute to the normalisation of disordered eating behaviours and a focus on gaining muscle.

Challenging Stereotypes: Redefining Masculinity

To address the stigma and promote a healthier understanding of masculinity, it’s important that we challenge existing stereotypes and societal norms. Here are some prompts to think differently:

1. Question the origins of the narrow definition of masculinity, and how this impacts the lives of men and masc folk

2. Develop media literacy skills to recognise how masculinity is portrayed

3. Notice how diet culture products are marketed toward men and women

4. Learn about the gendered and socialised nature of emotions

5. Explore and redefine masculinities, encouraging a broader and more inclusive sense of identity

Seeking Help: An Act of Courage

Remember that all people are worthy of support, and seeking treatment is a brave and essential step for anyone struggling with an eating disorder, regardless of gender. At Mind Body Well, our team of Psychologists and Dietitians is here to support you on your journey to a healthier relationship with food, exercise, your body, and identity. We welcome people of all genders, ages, sexual orientations, and cultural backgrounds.

Self-Care in the Festive Season

The festive season can be a particularly challenging time for people with food and body image concerns. Factors like warmer weather, summer activities, social eating, weight loss marketing and diet talk can all mean that these anxieties are at the forefront of our minds. Here are some of our tips for supporting yourself during this time.

Be a critical consumer - You’ve probably noticed that diet ads are everywhere right now - even more than usual! Remember no matter how ‘new and improved’ these diets claim to be, diets don’t work, and in fact they can cause significant harm to our physical and mental health. Remember these weight loss diet companies are part of a multi-billion dollar industry which profits from making us feel dissatisfied with our bodies. It’s a powerfully radical act to say no to diets and yes to self-care.

Be mindful of diet talk - You might notice those around you talking about dieting and weight loss more at this time of year. There are many ways you could choose to approach this, depending on your relationship with the person and your energy at the time. You might let people know you’d prefer not to discuss food and body size, and share your knowledge about the harms of weight-loss dieting. Or you could decide to use the helpful strategy of distraction to divert the conversation to another topic. At other times you might subtly (or overtly) excuse yourself and take some time away from the conversation, it might be the perfect opportunity for a bathroom break.

Take care of yourself when social eating - Try to avoid the urge to restrict food in anticipation of, or after eating a meal which might be larger or more challenging than foods you usually eat. Maintaining regular eating can help to regulate appetite and not set yourself up with all or nothing thoughts and eating behaviours. During social meals try to focus on conversation and connection with others to distract you from distressing food thoughts. If there are particular foods you’re expecting to be challenged by, your therapy team can help you practice exposure to these foods ahead of time in a safe environment.

Engage your support system - Let your support people know this could be a more challenging time, and explore how they can help. This could be creating supportive meal environments, encouraging you to eat regularly, or being available to talk through your challenges. Making regular appointments with your therapy team can also help to hold you steady. You could also explore and engage with non-diet, recovery focused content, see the ideas on our Inspiring Links page

Be kind to yourself - It’s understandable that this can be a difficult time, with many potential challenges and triggers. Do your best to practice self-compassion, and remember that this period will pass. Also remember to look for and really pay attention to the joyful moments - even if they’re brief, don’t let them pass by without your full attention.

(Here’s our Director Janet’s dogs sharing a joyful moment last Christmas!).

Getting Away for the Holidays?

Many people have mixed feelings about the holiday season - while it can be a time of joy there can also be significant challenges for people with eating disorders or body image concerns.

These challenges can be even more intense when you’re planning to go away for holidays, or to visit family. Time away from home can bring changes to routine and daily activities; spending time with different or more people than usual; different food availability or access; increased social eating; and reduced access to usual coping strategies or activities. We’ve put together some suggestions to help prepare for the holiday season.

Food and eating suggestions

• Discuss your holiday with your treatment team, and problem solve to make a plan together

• Where possible, plan at least some of your meals, and think about when you might eat out or do your food shopping

• Have some easy options available while travelling, pack snacks or foods you’re more comfortable and familiar with and use these as a back-up when needed

• Work with your Dietitian to consider what a balance of safe and challenging foods might be like for you during the trip

• Pack clothing you feel most comfortable in

Support suggestions

• Have a trusted person you can debrief with - a friend or family member. It’s ok if the person isn’t with you on the trip, plan some phone check-ins with them if needed

• If you know you need plenty of alone or quiet time, let the people around you know and plan it in advance

• Think about different types of supports outside your immediate network, e.g. helpful social media accounts, helplines or online chats (see below)

• When you’re in social eating situations, trying to focus your attention on being present with the people around you and use this as a distraction to help you avoid over-thinking about food

Coping suggestions

• Think about distractions or activities you find helpful at home which you could take with you, e.g. journalling, knitting, reading, puzzles

• Write yourself a list of helpful coping strategies which you can use as a reminder when things get difficult, e.g. distraction, urge surfing, challenging thoughts, mindfulness or self-compassion practices

• Prepare some resources to keep you motivated while you’re away, e.g. podcasts, books, social media accounts. Check out our inspiring links

• Where possible, try to pay attention to things you enjoy or feel grateful for while you’re away, e.g. being able to travel, basking in the sunshine, spending time with people you care about

• Remember this is a temporary situation and you will soon be back in your familiar comfort zone

Useful Services

• Eating Disorders Victoria Hub

• Butterfly Foundation Helpline

'Wellness' Program or Diet in Disguise?

Intuitive eating and non-diet approaches to weight and nutrition have been gaining popularity as many people elect to step off the dieting treadmill and change their relationship with their body, and their eating attitudes and behaviours. As these approaches have gained momentum however, many diet programs, companies and influencers have begun to co-opt the language of ‘non-dieting’ to mislead people back into the diet cycle. A number of established weight loss companies have re-branded, and new ‘wellness’ programs have emerged, with strong marketing messages about supporting people to make ‘sustainable lifestyle changes’ rather than focusing on weight loss.

However, when you really look at many of these programs it’s clear that they have not really changed their focus, but have instead become traditional diets in disguise – the new breed of diet industry companies. These so called ‘wellness’ programs continue to promote restrictive eating behaviours, encourage people to monitor their weight, and hold at their core the false idea that thinness equates to health - only now with an added side-serve of ‘wellbeing’.

So how can you tell the difference between an actual non-diet approach and a wolf in sheep’s clothing? One of the main differences between dieting and intuitive eating is the focus on weight loss and changes to body shape which are integral to dieting programs. Intuitive eating however is weight neutral, and focused on healing your relationship with food and your body. Intuitive eating is not about weight loss, it won’t ask you to eliminate any foods from your diet, or to label foods as ‘good’ or ‘bad’. Intuitive eating is a not a hunger-and-fullness diet but rather is about unconditional permission to eat all foods, building body trust and eating foods which feel satisfying and enjoyable. Another main difference between intuitive eating and dieting is that intuitive eating has a strong evidence base supporting its effectiveness, compared to traditional diets which are shown to be ineffective for 95% of people (especially in the medium to long term).

This re-branding of weight loss dieting to ‘wellness’ is dangerous and confusing for so many people. This new generation of diets aims to differentiate themselves from traditional diets by claiming that they are not ‘fad diets,’ that they value ‘wellness over weight loss,’ and some even use the language of eating disorder recovery as part of their marketing campaigns. Yet most of these programs continue to focus on food restriction, monitoring or logging what you eat, and weight monitoring. These programs now commonly offer self-care activities ‘on the side’, and may market themselves with health buzzwords or topics such as gut heath or inflammation. They offer a simplistic view of health and wellness, and a narrow assumption that weight loss equals health.

Studies show that weight loss dieting is one of the biggest risk factors for the development of eating disorders and disordered eating. Yo-yo dieting which is characterised by the cyclic nature of losing and re-gaining weight has been shown to have negative effects on physical health and how you feel about your body. Dieting also promotes the development of maladaptive eating behaviours. When our food intake is restricted, food often becomes our focus, which can cause obsessive thinking about food, and can result in either further food restriction, or episodes of reactive binge eating – where the body tries to gain back some of the energy which has become depleted from restrictive eating.

So how can you tell the difference – how can you differentiate a diet in disguise from an approach which is truly focused on enhancing health and wellbeing?

An approach may be a ‘diet in disguise’ if it:

• Encourages you to disconnect from your body by ignoring body signals (including hunger and fullness)

• Is focused on changing your body - weight loss or body shape/size

• Asks you to count points, macros, or uses approaches like a traffic light system

• Uses negative language around ‘good’ and ‘bad’ foods, classifying certain foods as inflammatory, detoxifying, guilt-free, or clean

• Recommends that you restrict or eliminate certain foods or food groups

• Acknowledges that diets don’t work followed by a BUT… (insert dieting behaviour here)

• Causes you to feel preoccupied with food and weight loss

• Recommends you buy expensive supplements or unusual foods

As an alternative to diet industry programs we recommend an individualised and therapeutic approach to understanding your nutritional needs, and changing your relationship with your body. If you’re ready to make this change, the team of Psychologists and Dietitians at Mind Body Well can assist.

Other relevant Blog posts:

• What is Intuitive Eating?

• Let’s set some perspective on ‘Food Addiction’

• What does it mean to be a Non-Diet Dietitian?

• Breaking up with weight loss