Perimenopause and Disordered Eating: Why Midlife Can Disrupt your Relationship with Food
- Irina Pollastri
- Jan 23
- 4 min read
Photo by Anastasiia Nelen on Unsplash
Not Just Hot Flushes: Perimenopause and the Return of Disordered Eating Patterns
Perimenopause is often discussed in terms of hot flushes, erratic cycles and decisions around HRT. For many women, however, one of the most unsettling changes is a sudden shift in their relationship with food and body image. Old restrictive rules may quietly return, binge–restrict cycles can reappear after years of relative calm, or exercise may become increasingly rigid and guilt-laden.
For women who have worked hard on recovery, this can feel confusing and deeply discouraging, often accompanied by self-blame for “slipping” at a time when life is supposed to feel more settled. Rather than reflecting a lack of willpower or discipline, growing evidence suggests that midlife eating-disorder symptoms often arise from a complex interaction between hormones, brain chemistry, gut health and cumulative life stress. [1]
A genuine risk window
Research now shows that midlife is not a quiet zone for eating disorders. Perimenopause and the menopausal transition appear to be distinct high-risk windows for both new and recurrent eating disorders in women. Hormonal shifts collide with powerful social messages about youth, thinness and productivity, creating a perfect storm for women who are already under pressure at work, at home and within their own bodies.
Naming this as a genuine risk window is not about creating fear, but about validation and opening the door to more targeted support. Studies following women across the lifespan suggest that symptoms such as restrictive eating, bingeing and compensatory behaviours are more common during this stage than previously assumed. Research in midlife women also highlights fear of weight gain, dissatisfaction with body shape and a sense of loss of control over eating as central themes. [2]
Why midlife and “why now”?
One key piece of the puzzle is hormonal turbulence. During perimenopause, oestradiol and progesterone can fluctuate dramatically from month to month, and even day to day. These hormones interact closely with neurotransmitters such as serotonin and GABA, which play an important role in mood regulation, sleep, impulse control and appetite. [1]
As hormone levels rise and fall, women may experience increased anxiety, irritability, low mood or emotional reactivity, alongside changes in hunger and fullness cues. For someone with a history of disordered eating, the brain may naturally reach for familiar coping strategies that once provided a sense of control or relief.
Sleep disruption often adds another layer of strain. Night sweats, insomnia and early-morning waking are common during this transition and can be profoundly exhausting. Poor sleep is strongly linked with increased appetite, stronger cravings for high-energy foods and reduced emotional regulation. A run of disrupted nights can quickly contribute to emotional eating, late-night grazing or a feeling of being “out of control” around food.
Body changes, life load and why this is not “just vanity”
Alongside this, the body itself is changing. Many women notice weight gain, particularly around the middle, along with shifts in muscle mass, skin, hair and breast tissue. These visible changes can feel confronting and are often interpreted as personal failure, reigniting body dissatisfaction and weight-control behaviours. For women with a history of disordered eating, the sense that the body is becoming unpredictable can be deeply triggering.
At the same time, life load often peaks. Perimenopause frequently coincides with caring for ageing parents, supporting older children, managing demanding careers and navigating relationship or financial stress. In this context, eating-disorder behaviours may resurface as a way to cope, numb difficult emotions or create a sense of predictability. These patterns are rarely about vanity; they are often sophisticated survival strategies shaped by years of adaptation.
A functional, root‑cause approach
From a root‑cause, functional‑medicine perspective, support for perimenopause and disordered eating focus on stabilising the body while protecting psychological safety and flexibility. Practical steps might include:
Supporting blood sugar and appetite regulation with regular, balanced meals that emphasise adequate protein, fibre and healthy fats instead of fasting or aggressive calorie cuts.
Assessing and optimising key nutrients (such as iron, B12, folate, vitamin D, magnesium and omega-3s) that influence mood, energy, cravings on hormones.
Supporting digestive function to ensure optimal breakdown and absorption of nutrients, recognising that even a well-balanced diet may not fully meet needs if digestion is compromised.
Gently improving gut health by adding diverse plant foods and, where tolerated, small amounts of fermented foods, rather than broad, long-term elimination diets, recognising the close, two-way relationship between the gut microbiome and hormone metabolism.
Building nervous‑system resilience through realistic stress‑regulation strategies, including sleep support, movement, rest and connection.
If this resonates with you and you can feel old patterns around food, movement or your body creeping back in as you move through perimenopause, you do not have to navigate it alone.
As you move through perimenopause, you deserve support that honours both your lived experience and the very real changes happening in your body and brain. If you recognise yourself in this, lets chat about how I can help.
You can book a free 30‑minute discovery call with me here so we can talk through what you are struggling with, explore whether this approach feels safe for you, and gently map out your next steps together. Simply click the button below to find out more.
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