DELICATELY sipping a glass of vegetable juice, Tina McGuff vowed nothing else would pass her lips that day, then she laced up her trainers before starting a vigorous online workout.
In the grips of perimenopause, suffering from insomnia, hot flushes, anxiety, bleeding and major mood swings, Tina had found herself slipping back into her historic eating disorder.
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Tina McGuff first developed anorexia aged 15Credit: Supplied
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Tina’s eating disorder resurfaced aged 49 when her perimenopause started, above aged 17Credit: Supplied
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Today she says: ‘I felt so ashamed that I had an eating disorder at my age’, Tina above aged 11Credit: Supplied
“I felt powerless in the face of the havoc my hormones were wreaking, but I knew my eating disorder – which I had believed was firmly in my past – would give me some feeling of control back,” says Tina, now 54, from Dundee.
She’d first developed anorexia aged 15, after overhearing someone comment that her bum was big while at the beach.
The size-10 dance and gymnastics enthusiast had never had any body hang-ups before, but later that year she was hospitalised after her weight plummeted.
She spent the next four years in a psychiatric unit receiving treatment.
“I was so consumed by it, I remember panicking over how many calories I’d ingested licking a stamp,” recalls Tina.
With treatment and support from her family, Tina recovered, going on to lead a “normal” life working in finance and later in student support services.
She married and had four children, now aged between 25 and 36, plus she wrote Seconds To Snap, a memoir of living with an eating disorder.
However, she realises now that her eating disorder was never fully gone. Rather, it lay dormant, waiting for a new trigger – which the menopause provided.
“I always had a regimented approach to food and exercise, even after I recovered from anorexia as a teen,” says Tina.
“For example, I didn’t allow junk food in the house. I never went back to the dark days, but over the years, I went up and down between a dress size 10 and 18.
A psychologist’s ultimate guide to eating disorders – how parents can spot the subtle signs & what they can do to help
“That was until the perimenopause started in 2019, when I was 49, and I had no idea what was happening to me.
“I suffered horrendous hot flushes at least once an hour, and insomnia had a profound effect on my ability to function, but I was worried about the risk of blood clots, so decided against HRT, even though my GP said the risk was very low.
‘Perfect storm’
“Meanwhile, my children were flying the nest, which broke my heart, and the doctor had recently told me I was overweight.
“It was a perfect storm for my eating disorder to resurface.”
Tina began to survive on glasses of juiced vegetables and one “healthy” meal a day, and she exercised daily.
“My weight plummeted and my menopause symptoms worsened, but I just couldn’t confide in my husband, Jock, 65, my children or friends,” she says.
“I felt so ashamed that I had an eating disorder at my age.
“But I knew that I wasn’t alone in not breezing through perimenopause, and I understood why some women could even be driven to take their own lives during midlife.
“In autumn 2023, I finally started HRT, when another GP questioned why I wouldn’t take something that would make me feel better.”
The HRT – patches and the Mirena coil – had what Tina calls a “transformative” effect very quickly.
Her flushes, bleeding and anxiety eased within weeks, enabling her to tackle her eating disorder as her mental wellbeing improved.
“The HRT kicked in very quickly and I started to feel better mentally as I was suddenly able to sleep, which made me feel almost normal again,” she says.
“My main concern was staying alive and not letting the desperate, suicidal thoughts take over.
I felt so ashamed that I had an eating disorder at my age
Tina
“As soon as I started to feel more like myself, I made a conscious effort to refer back to all the therapy I’d had in the past for my eating disorder, shifting my focus from negative eating and exercise behaviour patterns to eating three healthy meals a day and reducing the amount I exercised, and also being kinder to myself to ease my mind and body back into a better place.
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Experts warn many women in the grip of ‘meno-rexia’ are too afraid to seek helpCredit: Plainpicture/Aurelia Frey-the Rauschen Collection
“Now, I feel happy, healthy and back to my old self. My figure is stable at a size 12, I go to the gym three times a week, and I eat and sleep well. It’s been a huge turnaround.
“When I finally confided in my husband and children, they were incredibly supportive and were so glad to see I was well again.”
Sadly, Tina’s experience isn’t unique.
‘Shrouded in secrecy’
While the menopause has recently become a prominent topic of discussion, thanks to celebrities including Davina McCall and Lisa Snowdon and campaigns such as Fabulous’ Menopause Matters, the prevalence of eating disorders in midlife remains shrouded in secrecy.
Teens and young adults are at highest risk, but experts believe menopause brings a window of vulnerability for women, during which major hormonal fluctuations, body changes and conflicting thoughts about womanhood increase the likelihood of developing a disorder.
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Adding to this pressure are the external stresses in a woman’s life at this time, with many juggling children in school with work and caring for elderly parents, or possibly mourning an emptying nest.
While eating disorder charity Beat confirms that research into the link between menopause and eating disorders is limited, one study of more than 5,000 women in their 40s and 50s found that 3.6% had experienced an eating disorder in the previous months, and less than 30% had sought help or received treatment.**
But experts warn that the actual figure is likely much higher, as many women in the grip of “meno-rexia” are too afraid to seek help.
Between April 2022 and March 2023, more than 16% of Beat’s support sessions were provided to people aged 41-65 years old.
“We are seeing more women with eating disorders during perimenopause and menopause.” says Dr Louise Newson, one of the UK’s top menopause specialists.
“Often, women experience a worsening or resurfacing of historic eating disorder behaviours, but there are also some who develop an eating disorder for the first time.
“Women are increasingly educating themselves about the important roles of hormones in their bodies via apps like Balance and my podcast and website.
“Oestrogen decreases during perimenopause, and this can alter your hunger, appetite, how your body metabolises food and the distribution of fat in the body.
“This imbalance means that many women find that the lifestyle that’s enabled them to maintain a healthy weight up until then, no longer works.”
Exact figures vary, but experts estimate that, on average, women may gain about half a kilogram per year during perimenopause.
Dr Newson adds: “If you have a background of worrying about your weight, perimenopause and menopause may exacerbate that, and can be made worse by other common symptoms such as reduced stamina, extreme tiredness, muscle and joint pain, which make it more challenging to exercise and eat the right things.
We are seeing more women with eating disorders during perimenopause and menopause
Dr Louise Newson
“This may make women susceptible to the development of eating disorders through desperate efforts to lose weight or regain their pre-menopausal shape.”
This is a sentiment that part-time solicitor Catherine* can attest to.
Until perimenopause brought on migraines, mood swings, tearfulness and exhaustion two years ago, the 48 year old had been perfectly happy with her size-10 body, having embraced a lifelong healthy attitude to food and daily exercise. But now, she’s in the grip of an eating disorder.
“Having always had a flat tummy, including within a few months of having each of my two children, I got to 46 and suddenly developed a chubby little pouch, as well as cellulite on my upper arms and thighs.
“My stomach seemed constantly rounded, which made me incredibly self-conscious,” says Catherine.
“In a total panic and convinced I was going to balloon as perimenopause progressed, I began restricting food, while also doing up to three hours of exercise each day.
“I lurch from barely eating at all to bingeing and purging, because I’m terrified of gaining weight.
“I’m ashamed to say that the first time I secretly made myself sick was in the toilets of a country pub after a meal with my husband and children.
“I’d wanted them to see me eating normally, but couldn’t bear the idea of my body absorbing all those calories.”
Catherine says that while her husband knows she’s been struggling with the menopause and general feelings of self-loathing about her body, he would never suspect an eating disorder.
“It’s become my guilty secret at a time when I feel like nothing else is within my control,” she says.
“Having never had an eating disorder before, I feel utterly blindsided, more so because I have a 12-year-old daughter, and the last thing I ever want is for any of this to put her at greater risk of developing one herself.
“I’ve always been so in control of everything in my life, particularly my career as a solicitor.
“I suppose I’ve worn my slim figure like a badge of honour for decades, but now I don’t recognise myself in the mirror – physically or metaphorically.
“I would never want my colleagues to know, for fear of people thinking I’m a failure in some way or that I’ve lost control.
“My doctor has recommended HRT, but I’m reluctant in case I end up with bleeding and other symptoms. Mostly, though, I’m terrified about gaining weight on HRT, as some close friends have done.”
Chair of the British Psychological Society’s faculty for eating disorders, Dr Amy Wicksteed, agrees that there’s a range of factors that may make this life transition a vulnerable period.
“It’s a time in life when women potentially face changes in valued life roles alongside changes within their bodies, so working on self-acceptance is especially important,” she explains.
“Assumptions that the menopause is always associated with weight gain could lead to women being unnecessarily concerned and pre-emptively restricting their diet.
“Yes, our bodies might change. But the idea of being on the cusp of losing control of our weight or body shape during menopause is an unhelpful narrative that could breed fear into women, particularly those who’ve always been conscious of their weight or who have suffered with disordered eating or over-exercising.
“Our focus should be on supporting women ahead of perimenopause to value themselves in a range of ways and take steps towards looking after their body.”
I couldn’t bear the idea of my body absorbing all those calories
Catherine*
According to Dr Newson, greater research and education around the links between menopause and eating disorders is what’s required.
“Research is not just for healthcare professionals, but also for women approaching or going through menopause. This would allow them to be alert to the general and personal risks,” she says.
‘Seek help’
“Those around them also need educating around spotting symptoms, including increased anxiety, reduced self-esteem, low mood, rumination and undue concerns about body shape, so they can encourage them to seek help without fear or shame.
“Symptoms often really improve with the right dose and type of HRT, and often with testosterone, too.’
Tina is now what she describes as a healthy weight for her, and says the combination of HRT and revisiting the principles of the therapy she had when anorexia first took hold continue to help.
“When perimenopause hit, my inner voice said: ‘It’s OK, I’ll starve, and then I’ll be in control of my body again,’” recalls Tina, who devotes her time to advising schools and organisations across the globe on mental health and eating disorders.
“Now that I feel healthy again, I can reflect on the immense pressure put on women to celebrate menopause as the next chapter, when actually that’s really difficult for millions of women – and why so many are quietly seeking solace in disordered eating.
“I’m proof that it is possible to recover from an eating disorder again in midlife.
“I hope that other women reading this will take it to heart that they can too, and that it’s OK to speak out and seek help when they need it.”
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Dr Louise Newson says: ‘We are seeing more women with eating disorders during perimenopause and menopause’Credit: Supplied
The six main eating disorders
Dr Silver shares some of the main eating disorders and their common symptoms.
Anorexia nervosa
Typically, anorexia nervosa involves restrictive eating which is due to an irrational fear of gaining weight.
An anorexia sufferer may also have a distorted body image, exercise to excess and go through cycles of bingeing and purging.
Purging can involve vomiting, laxative overuse, excessive exercise or fasting.
Signs of anorexia include calorie counting, anxiety around food, food ‘rituals’ such as cutting food into small pieces, eating slowly or eating foods in a set order.
They may also suffer from insomnia and low self-esteem.
Bulimia nervosa
Someone who is bulimic tends to eat extremely large amounts of food in a process called bingeing, before purging it from their system.
This can be in the form of self-induced vomiting, laxatives, excessive exercise or going for long periods without food.
Often, bulimics are a normal weight. They may eat secretly or alone, they may have OCD or other mental health issues such as depression and they may have low self-esteem.
Binge eating disorder
Bingeing is similar to bulimia in the sense that it involves bingeing on large amounts of food, often in a hurry and in secret. But it isn’t followed by purging.
A binge often involves feeling out of control.
ARFID
Avoidant restrictive food intake disorders involves restrictions around certain types or amounts of food, often due to a dislike of a specific taste or smell or even appearance.
The difference with AFRID is that it doesn’t typically involve insecurities around body image.
AFRID may be triggered because someone had a particularly bad experience – such as choking – while eating.
Orthorexia
Obsessive behaviour towards food in the pursuit of a ‘healthy’ diet is known as orthorexia.
This can often cause someone to only eat ‘clean’ foods, and they may often label foods as ‘good’ or ‘bad’, restricting certain foods from the diet.
Obvious signs can include an excessive amount of time planning meals, guilt after eating particular foods, an obsession with food social media profiles as well as the food choices of others and even missing social events if healthy food options are lacking.
OSFED
The highest percentage of eating disorders are OSFED – other specified feeding/eating disorder.
A person may be diagnosed with OSFED when they don’t fit into any of the disorders described above, based on the expected behavioural, psychological and physical symptoms.
However, they have disordered eating which needs treatment.
Examples include someone who has symptoms of an eating disorder, such as anorexia, but their weight is considered normal.
