Is it perimenopause?

My theme for research this week is eating disorders in midlife and older women.

In the last few years, conversations about perimenopause have finally become louder. Women are sharing experiences that were once whispered about or dismissed. Hormones, sleep changes, brain fog, joint aches, mood shifts, heavy periods, and exhaustion are now being talked about openly. That shift matters. For many people, it has been validating to realise they are not alone.

But there is another side to the growing narrative online. When one explanation becomes very visible, it can begin to feel like the answer to everything.

Sometimes, symptoms that are attributed to perimenopause may actually have other causes. And sometimes those causes deserve careful attention.

I know this personally.😖😩😳

A few years ago, I experienced severe back pain. At the same time, I was seeing a lot of discussion online about joint pain being linked to perimenopause. That idea felt plausible. I assumed that was what was happening and even asked my GP about hormone replacement therapy. What I didn’t fully explain was how severe my back pain actually was.

It turned out I had a herniated disc that progressed to cauda equina syndrome, a serious neurological condition that could have left me paralysed. Looking back, it is clear how easy it is to interpret symptoms through the lens of whatever health narrative is most visible at the time.

This experience reminded me of something important: even people with scientific training can misinterpret symptoms when information is simplified online. None of us are immune to this.

And this is where another conversation is worth having.

Recent research highlights how complex the menopausal transition can be to interpret. In one study of women aged 40–58, many participants who believed they were in a particular stage of menopause were actually classified differently when researchers reviewed their menstrual history and medical information in more detail. In fact, a large proportion of women who thought they were pre-menopausal or peri-menopausal were found to be in a different stage entirely. This doesn’t mean women are “wrong” about their experiences. Rather, it reflects how complicated midlife physiology can be and how easily symptoms can be interpreted through the lens of the narratives we hear most often.

Not every symptom in midlife is hormonal. Sometimes nutrition plays a role too.

Many women in their 40s and 50s are juggling enormous demands. Careers, caring for children, supporting aging parents, managing households, navigating relationship changes, and trying to look after their own health in the middle of it all. Food can easily become something squeezed into the margins of the day.

Some women are unintentionally under-fuelling. Others may have long-standing patterns of restrictive eating or dieting that have gone unnoticed for years. For some, eating disorders or disordered eating behaviours that began earlier in life quietly continue into midlife.

Research suggests eating disorders do not disappear with age. They can persist for decades or emerge later in life during periods of stress, transition, or hormonal change.

Unfortunately, they are often missed because clinicians tend to associate eating disorders with teenagers or young adults. When an older woman experiences weight loss, fatigue, or appetite changes, these symptoms may be attributed to aging, stress, or depression instead.

Malnutrition can affect many of the same systems that people often associate with perimenopause.

Low energy availability can influence mood, concentration, sleep, and energy levels. Nutrient deficiencies can also contribute to symptoms that feel psychological but have physiological roots.

Iron deficiency is one example. Many women experience heavier periods in the years leading up to menopause. Repeated heavy bleeding can gradually reduce iron stores. Low iron can contribute to fatigue, brain fog, irritability, and low mood. Zinc, another nutrient that can become depleted in restrictive diets, also plays a role in immune function and mental health.

These are not dramatic or unusual deficiencies. They are common, and they are treatable.

If you are noticing changes in your health, it can be helpful to approach your GP with curiosity rather than assumptions. Some people find it useful to ask about basic investigations that help build a clearer picture of what is happening in the body.

Examples may include tests that look at:

• Iron levels and ferritin

• Zinc status

• Vitamin B12 and folate

• Thyroid function

• Full blood count

These tests are not about “proving” anything is wrong. They are simply tools that can help rule things in or out.

For people who suspect they may be struggling with disordered eating or an eating disorder, bringing this up with a doctor can feel vulnerable. Many adults worry they will not be taken seriously because they are “too old” or because their symptoms do not match stereotypes.

But eating disorders can affect people at any stage of life. Seeking support is a reasonable and courageous step.

Advocating for yourself in a medical appointment can sometimes mean saying something simple and direct, such as:

“I’ve noticed changes in my eating patterns and energy levels, and I’m wondering whether my nutrition might be affecting my health.”

or

“I’m concerned that I may not be eating enough to support my body properly. Could we look into this together?”

These conversations do not need to be dramatic. They simply open the door to exploration.

Midlife is often portrayed as a time when women should quietly endure symptoms, push through exhaustion, and keep everything running for everyone else. But bodies deserve attention and care at every stage of life.

Perimenopause is real. Hormonal changes are real. But nutrition, mental health, stress, and physical conditions also shape how we feel.

Sometimes the most powerful thing we can do is slow down and ask a broader question:

What does my body actually need right now?

For many people, the answer begins with listening closely and seeking the support they deserve.

Some facts worth knowing

• Around 1 in 10 women may experience an eating disorder at some point in their lifetime, and many cases persist into midlife or later but go unrecognised.

• Studies suggest that up to 9% of adults over 50 show clinically significant eating disorder symptoms, challenging the idea that these conditions only affect teenagers.

• Iron deficiency is the most common nutrient deficiency in women worldwide, and heavy menstrual bleeding in the years before menopause is a major contributor. Low iron levels are strongly linked with fatigue, cognitive difficulties, and low mood.

• Research shows that binge eating symptoms can increase during the menopausal transition, likely influenced by hormonal fluctuations and life stressors during midlife.

• Yet studies interviewing general practitioners show that eating disorders in older adults are frequently overlooked, because clinicians often assume symptoms are due to aging, depression, or physical illness.

A hopeful and proactive perspective

Midlife is often framed as a time when women should simply endure symptoms quietly. Push through the exhaustion. Accept the brain fog. Carry on caring for everyone else.

But the truth is that women’s bodies are extraordinarily resilient and deserving of attention, nourishment, and care.

A feminist approach to health is about expanding the conversation so that women are given the information, support, and medical attention they deserve.

That means:

• recognising that nutrition matters for brain health and mental wellbeing

• understanding that eating disorders can affect women at any stage of life

• encouraging women to advocate for themselves in medical settings

• ensuring that symptoms are investigated thoughtfully rather than dismissed

Women are not “too old” to deserve good care, and they are certainly not too old to ask questions about their health.

Sometimes change begins with a simple shift in perspective.

Instead of asking “What is wrong with me?”

We might begin asking, “What does my body need?”

And when women are supported in asking that question, with curiosity, compassion, and appropriate medical care, better outcomes become possible.