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.
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).
