The Transition to Menopause: Time of Increased Risk for Eating Disorders

Eating disorders are not limited to the realms of youth or young adulthood. In what is believed to be the first study examining menopausal status, eating disorders, and body image in women, Dr. Barbara Mangweth of Innsbruck Medical University, Innsbruck, Austria, and colleagues found that the transition to menopause is associated with increased risk of eating disorders and negative body image (Int J Eat Disord 2013; 2013; 46: 609). (See also “Late Life Eating Disorders,” elsewhere in this issue.)

Dr. Mangweth’s group administered an anonymous questionnaire to a randomly selected nonclinical sample of women 40 to 60 years of age in Innsbruck, Austria. The authors first assessed five demographic variables (age, marital status, number of children, country of origin, and level of education). The women were subsequently divided into groups of premenopausal women, perimenopausal women, and postmenopausal women.

The authors then assessed current eating disorders with questions adapted from the German version of the Structured Clinical Interview for DSM-IV (SCID). Among women who did not meet full DSM-IV criteria for an eating disorder diagnosis, but who had some eating disorder symptoms, the researchers searched for recurrent eating binges associated with loss of control over eating or for purging behaviors and use of laxatives, diuretics, appetite suppressants, and/or vomiting while overweight. Women reporting neither an eating disorder nor a subthreshold eating disorder were classified as “normal eaters.” The researchers also administered 3 subscales of the Eating Disorder Inventory (EDI): Drive for Thinness, Bulimia, and Body Dissatisfaction. To assess preoccupation with body shape, they administered the Body Shape Questionnaire. They also administered the Center for Epidemiology Studies Depression Scale (CES-D).

Assessing Menopausal Symptoms

The authors used a simplified version of the Menopausal Rating Scale to measure menopausal symptoms. This scale covers 11 items in 3 main domains: psychological symptoms, somato-vegetative symptoms (sweating, flushing, cardiac complaints, sleeping disorders,) and urogenital symptoms (vaginal dryness, sexual difficulties).

The authors found no significant differences in measures of current or past body weight or on dieting behavior after adjustment for age. However, the women differed markedly in the prevalence of eating disorders: 9% of perimenopausal women, compared to 2% of premenopausal women, reported having a DSM-IV eating disorder. A small group of women with surgically induced menopause showed no significant differences from the other three groups on any demographic variables, except that only 4 had children. These women showed a high prevalence of eating disorders.

Dr. Mangweth’s group also found feelings of fatness and body image concerns were elevated in perimenopausal women compared to the premenopausal women, even after the authors adjusted for age and body mass index (BMI).They did not, however, find significant differences among the groups in self-ratings of depressive symptoms.

The major clinical implication is that perimenopausal women have a heightened risk of developing eating disorders. Just as in puberty, the transition to menopause may make some women more vulnerable to eating disorders due to changes in hormonal function, body composition, and social pressures. Since these women seldom spontaneously disclose their concerns or symptoms to clinicians, the authors advise keeping alert to this “window of vulnerability” to eating disorders.