Eating disorders don’t just affect teen girls. The risk may go up around pregnancy and menopause too.

The 3 ‘P’s: Puberty, Pregnancy, and Perimenopause – A Recipe for Eating Disorders and Body Image Concerns

Eating disorders impact more than 1.1 million people in Australia, representing 4.5% of the population. These disorders include binge eating disorder, bulimia nervosa, and anorexia nervosa. Meanwhile, more than 4.1 million people are affected by body dissatisfaction, a major risk factor for some types of eating disorders.

But what comes to mind when you think of someone with an eating disorder or body image concerns? Is it a teenage girl? If so, you’re not alone. This is often the image we see in popular media.

Eating disorders and body image concerns are most common in teenage girls, but their prevalence in adults, particularly in women, aged in their 30s, 40s, and 50s, is actually close behind.

So, what might be going on with girls and women in these particular age groups to create this heightened risk?

The 3 ‘P’s

We can consider women’s risk periods for body image issues and eating disorders as the three “P”s: puberty, pregnancy, and perimenopause.

A recent report from The Butterfly Foundation showed the three highest prevalence groups for body image concerns are teenage girls aged 15–17 (39.9%), women aged 55–64 (35.7%), and women aged 35–44 (32.6%).

We acknowledge there’s a wide age range for when girls and women will go through these phases of life. For example, a small proportion of women will experience premature menopause before 40, and not all women will become pregnant.

Variations in the way eating disorder symptoms are measured across different studies can make it difficult to draw direct comparisons, but here’s a snapshot of what the evidence tells us.

Puberty

In a review of studies looking at children aged six to adolescents aged 18, 30% of girls in this age group reported disordered eating, compared to 17% of boys. Rates of disordered eating were higher as children got older.

Pregnancy

During pregnancy, eating disorder prevalence is estimated at 7.5%. Almost 70% of women are dissatisfied with their body weight and figure in the post-partum period.

Perimenopause

It’s estimated more than 73% of midlife women aged 42–52 are unsatisfied with their body weight. However, only a portion of these women would have been going through the menopause transition at the time of this study.

The prevalence of eating disorders is around 3.5% in women over 40 and 1–2% in men at the same stage.

So, what’s going on?

Although we’re not sure of the exact mechanisms underlying eating disorder and body dissatisfaction risk during the three “P”s, it’s likely a combination of factors are at play.

These life stages involve significant reproductive hormonal changes (for example, fluctuations in oestrogen and progesterone) which can lead to increases in appetite or binge eating and changes in body composition. These changes can result in concerns about body weight and shape.

These stages can also represent a major change in identity and self-perception. A girl going through puberty may be concerned about turning into an “adult woman” and changes in attitudes of those around her, such as unwanted sexual attention. Pregnancy, as we’ve seen, can represent a major change in identity and self-perception.

Perimenopause, on the other hand, can be a complex and often challenging time, as women navigate the physical, emotional, and psychological changes associated with this stage of life.

Research has shown interpersonal problems and stressors can increase the risk of eating disorders.