Identification and Treatment of Anorexia Nervosa in Women With Perimenopause

Disordered eating is a common problem that midwives will encounter as frontline primary care providers. Anorexia nervosa (AN) is a form of disordered eating that results in chronic starvation state, creating significant risk of morbidity and mortality to the patient. AN is traditionally considered a disorder of adolescence and young adulthood; however, recurrence and new-onset eating disorders (EDs) also occur during midlife, particularly during the menopausal transition. Hormonal changes, psychosocial stressors, and body image concerns may contribute to symptom emergence or relapse, yet EDs in this population frequently remain underrecognized. This case highlights the importance of considering EDs in the differential diagnosis of amenorrhea, weight loss, and menopausal symptoms in midlife adults. Certified nurse-midwives and certified midwives are uniquely positioned to identify EDs through longitudinal, relationship-based care and routine preventive visits. Early recognition, appropriate screening, comprehensive health evaluation, and timely multidisciplinary referral are essential in reducing morbidity and improving long-term outcomes for patients experiencing recurrent EDs across the life span.