Perimenopause and Disordered Eating: How Hormones, Culture, and Compassion Intersect

Perimenopause is a season of profound transition — hormonally, physically, and emotionally. For many women, it’s a time of growth, reflection, and redefinition. But for others, it can reawaken struggles with body image, food, and control that may have felt long resolved.

Emerging research shows that perimenopause is a vulnerable period for both the development and recurrence of disordered eating. This is not about vanity or a lack of willpower — it’s about complex biological, psychological, and cultural forces intersecting at a sensitive life stage.

Women in perimenopause are at risk for disordered eating based on multiple factors. Therapy effectively treats the mental health elements of this transition.

🌿 The Estrogen Hypothesis: Why Hormones Matter

One of the most compelling biological frameworks linking perimenopause and disordered eating is the estrogen hypothesis.

Research over the past two decades has highlighted that fluctuations in estrogen levels — not simply low or high levels — influence vulnerability to eating disorders. During puberty, surging estrogen is thought to interact with genetic and neurobiological factors, triggering the onset of disordered eating behaviors in susceptible individuals (Klump et al., 2012).

Fast-forward a few decades, and we encounter another time of major hormonal fluctuation: perimenopause.

Just as estrogen rises and falls unpredictably in adolescence, it fluctuates dramatically again during the perimenopausal transition. These shifts affect serotonin, dopamine, and appetite regulation, influencing mood, reward processing, and body perception — the very systems implicated in disordered eating.

It stands to reason, then, that perimenopause can mirror puberty as a “second window of vulnerability” — this time shaped by both biological changes and the psychological weight of midlife.

💫 Why Perimenopause Can Reignite Body Image and Eating Concerns/Eating Disorders

1. Hormonal Fluctuations and Emotional Sensitivity

Estrogen has a powerful impact on mood, anxiety regulation, and cognitive flexibility. As levels rise and fall unpredictably, many women experience emotional lability, increased anxiety, and shifts in appetite. These mood changes can amplify body dissatisfaction or urges to restrict, binge, or “control” through food. (Baker, 2016; Klump et al., 2012; Khalil et al., 2022)

2. Body Changes and Dissatisfaction

Weight redistribution to the abdomen, decreased muscle mass, and changes in skin elasticity can leave women feeling unfamiliar and dissatisfied in their own bodies during peri.  I can feel like our bodies are changing quickly and out of control!

A 2025 Butterfly Foundation study found that over 55% of women report body image dissatisfaction during perimenopause and menopause.This dissatisfaction — strongly linked to disordered eating across the lifespan — underscores that midlife body-image concerns are both common and clinically relevant.

3. Cultural Pressures and Midlife Transitions

In a culture that glorifies youth and thinness, women in midlife face double pressure: to appear ageless and to “manage” their bodies as they change. Combine that with life transitions — caregiving, empty nest, aging parents, shifting partnerships, or career reinvention — and it’s easy to understand why control over food or exercise can feel temporarily stabilizing.

But what begins as a coping strategy can quietly evolve into a pattern of restriction, bingeing, or obsession.

💭 How Disordered Eating Can Look Different in Midlife

Disordered eating in perimenopause often looks more subtle — and therefore goes unnoticed.

Common patterns include:

• Increased binge eating or emotional eating tied to stress or rapid hormonal changes

• Rigid “clean eating” or orthorexia, which unfortunately often gets justified as “healthy living”

• Overexercise to counteract negative body image and weight changes

• Body checking, comparison, or avoidance of social or intimate situations

Even if symptoms don’t meet full diagnostic criteria, they can cause real distress — and they deserve compassionate attention and treatment.  There are therapists out there who get it. 

📚 Key Takeaways

• Fluctuating estrogen may heighten risk for disordered eating during perimenopause, echoing mechanisms seen at puberty (Klump et al., 2012).

• Over 55% of women report body image dissatisfaction during perimenopause/menopause (Butterfly Foundation, 2025).

• Perimenopausal women show higher rates of binge eating and body dissatisfaction than premenopausal women (Anaya et al., 2022; Vincent et al., 2023).

• Clinicians note that perimenopause is a key period for both new-onset and relapse of eating disorders (Baker, 2016).

• Qualitative studies emphasize that midlife women with eating disorders often feel unseen or misunderstood in healthcare settings (Sharp et al., 2024).

Together, these findings make a clear case: hormonal changes and cultural pressures intersect in ways that can destabilize even long-held recovery.

🌸 Pathways to Healing in Midlife

The good news? Healing is possible — and sometimes, midlife provides the wisdom and readiness to do this work in a deeper, more integrated way.

1. Compassionate, Evidence-Based Therapy

Therapies such as ACT, DBT, and body-image–focused interventions are compassionate and effective. Addressing both physical symptoms (e.g., hot flashes, fatigue, sleep disruption) and emotional distress of perimenopause leads to more durable recovery.

2. Mind-Body Integration

Incorporating awareness practices, such as HRV biofeedback, gentle movement, and interoceptive skill building, can help women reconnect with their bodies from the inside out — a key step when the body feels like it’s betraying them.

3. Body Respect and Cultural Deconditioning

Therapy that helps unlearn ageist and weight-stigmatizing messages allows for greater freedom. The goal isn’t to “love your body every day,” but to respect it, nourish it, and live fully within it.  Body neutrality and even acceptance is possible and can free us up to live a full life.

💬 You’re Not Alone

“Perimenopause doesn’t have to mean losing trust in your body.It can be the time you finally make peace with it.” — Dr. Tera Lensegrav-Benson

If you’re noticing renewed preoccupation with food, exercise, or your body — or worry an old eating disorder may be resurfacing — you’re not alone.

I’m Dr. Tera Lensegrav-Benson, a psychologist with 20 years of experience treating women’s health issues, body image dissatisfaction, disordered eating, and eating disorders. I specialize in helping women navigate midlife transitions like perimenopause with warmth, research-based care, and deep understanding of the mind-body connection. I am also a perimenopausal woman walking this path, so when I say I get it-it’s more true than you know.

Together, we can help you find calm within the change — and begin to trust your body again.

🌿 Telehealth available across 43 US PSYPACT states💻 Learn more or schedule a session at www.mindfulpathpsy.org or email  Tera Lensegrav-Benson

🩶 References

• Anaya, C. et al. (2022). Binge eating risk during midlife and the menopausal transition.

• Baker, J. H. (2016). Eating disorders in midlife women: A perimenopausal perspective.

• Butterfly Foundation. (2025). Periods, pregnancy, and hormones: New research reveals the major life moments that contribute to women’s body dissatisfaction.

• Khalil, J. et al. (2022). Eating disorders and their relationship with menopausal stages. BMC Women’s Health.

• Klump, K. L. et al. (2012). Estrogen and the genetic risk for eating disorders: Evidence for the estrogen hypothesis.Psychological Medicine.

• Sharp, G. et al. (2024). Developing an educational resource for people experiencing eating disorders during the menopause transition. Journal of Eating Disorders.

• Vincent, C. et al. (2023). Associations between menopause and body image: A systematic review.