Eating disorders (ED) are becoming more common among women over forty, yet this issue remains largely unspoken. Doctors and specialists have reported a noticeable rise in women aged forty to seventy seeking help for eating disorders. These women often face incorrect diagnoses or delayed care because they do not fit the typical image of someone with an ED. "Nothing is more disabling than your doctor telling you that you are too old to have ED," says Cynthia Bulik, director and founder of the Eating Disorder Center at the University of North Carolina. "And yet, this is the experience of countless women in perimenopause." Some studies estimate that between 2 and 7% of women over forty meet the formal diagnostic criteria for an eating disorder. Other research suggests that 13% of women over fifty struggle with certain forms of eating-related disorders. Elizabeth Wassenaar, a certified eating disorder specialist and regional medical director of the Eating Disorder Treatment Center of Colorado, notes that "nearly 30% of middle-aged women may present symptoms of ED," and "we have definitely observed an increase." Uncontrolled hyperphagia, characterized by excessive eating, is one of the most common disorders among women aged forty to sixty, followed by bulimia nervosa, which involves binge eating followed by purging behaviors. Jason Nagata, a specialist in ED at the Benioff Children's Hospital at the University of California, San Francisco, notes that "we are also observing an increasing number of less discussed 'purging' behaviors, such as misuse of laxatives in this age group." Women in their forties may also suffer from anorexia nervosa, although this is much rarer, as well as orthorexia, a less known condition involving obsessive behavior around physical exercise and eating "healthy" foods. Elizabeth Wassenaar explains that orthorexia is sometimes specifically associated with perimenopause and can "in fact lead to malnutrition." The symptoms of perimenopause and menopause are often at the heart of midlife ED diagnoses because both bring complex physiological and psychological changes. Menopause can lead to ED in the same way that puberty affects adolescents. "Puberty and menopause are, respectively, the beginning and the end of the metabolic book of life," explains Cynthia Bulik. During both periods, women experience fluctuations in estrogen levels, a hormone that plays a crucial role in serotonin production, which affects mood. These changes can influence happiness and self-esteem and directly affect body composition. During perimenopause and menopause, women often notice an increase in body fat, especially around the abdomen, explains Jason Nagata. "This is largely due to the base levels of estrogen, which affect body fat storage and regulate appetite and mood." The decrease in estrogen levels is also linked to a decrease in basal metabolism, meaning the body burns fewer calories per day. These hormonal changes can also lead to sarcopenia, a condition that leads to muscle loss and increased fat storage, which can lower energy levels and activity levels, further affecting body image. Beyond hormonal fluctuations, menopause often occurs during significant life disruptions: children leaving home, relationship problems or divorce, career changes, or caring for aging parents. These disruptions can profoundly influence dietary choices. Robyn Kievit, a nurse practitioner and certified ED specialist in Massachusetts, notes that "women in midlife bear the heaviest family burdens," and these pressures can lead to the development of ED as a way to "regain control that has been lost." Elizabeth Wassenaar adds that this desire to regain a form of power and predictability "is a known psychological driver of ED in all age groups but particularly observed in midlife." As one patient said in a 2009 study: "Controlling what I ate was a way to control at least part of my life. I felt that if I could control what went in and out, the exercise I did, then I could control other aspects of my life." Such factors coincide with cultural pressures to remain thin and young in a body that naturally moves away from the idealized proportions promoted by the media. Research shows that 73% of middle-aged women report not being satisfied with their weight, highlighting that these disorders are not just personal but systemic. This dynamic has intensified with the emergence of weight-loss medications like Ozempic and harmful diets promoted by social media trends, such as #SkinnyTok. Robyn Kievit states that "asking a woman aged forty-five to fifty-five to wear the same clothing size as she did at fifteen, twenty, or even thirty years old is an aberration." Cynthia Bulik adds that women in perimenopause or menopause will experience "changes in shape, weight distribution, hair texture, bone density and more," which can push them "to feel increasingly disconnected from the body they were used to knowing; and this only intensifies ED as a defense mechanism."