Disordered eating and body dissatisfaction in women with non-natural menopause

Archives of Gynecology and Obstetrics https://doi.org/10.1007/s00404-025-08022-6 RESEARCH Disordered eating and body dissatisfaction in women with non‑natural menopause Barbara Mangweth‑Matzek1 · Timo Schurr2 · Sophia Vedova1 · Vanessa Dunst3 · Claudia Ines Rupp2 · Katharina Feil4 Received: 20 December 2024 / Accepted: 25 March 2025 © The Author(s) 2025 Abstract Objective Research on menopause and eating behavior has mostly focused on women with premenopausal, perimenopausal, and natural postmenopausal stages. The aim of this study was to investigate eating behavior and body image in women with non-natural menopause. Methods The sample included 330 postmenopausal women, classified as non-natural menopause (NNMP) (N = 103) due to gynecological surgery (oophorectomy/hysterectomy) and natural menopause (NMP) (N = 227) who completed an anonymous questionnaire on current health, weight history, eating behavior including eating disorder symptoms (EDS) and body image. We compared women with NNMP and NMP and in a subanalysis, women with oophorectomy and hysterectomy using various logistic regression models. Results NNMP women were similar in most demographic characteristics to NMP women except younger age, higher maximum BMI, more mental illnesses, restrictive dieting, and EDS. The group difference in EDS disappeared after adjustment for confounders. Our subanalysis of oophorectomized women showed a significantly higher prevalence of EDS (29%) compared to hysterectomized women (11%) (p = 0.017), even after adjustment for confounders, and a significantly more pronounced body weight dependence of their self-esteem. Body satisfaction was below 50% in all groups. Conclusion Women who have undergone oophorectomy appear to be highly susceptible for EDS compared to those with natural menopause, unlike hysterectomized women, whose menopausal transition is less abrupt. While body image was generally moderate to negative across all groups, oophorectomized women showed a stronger focus on weight-related selfesteem. Incorporating eating behavior into clinical care is crucial, especially for women post-oophorectomy. Keywords Eating behavior · Eating disorders · Non-natural menopause · Oophorectomy · Hysterectomy What does this study adds to the clinical work * Barbara Mangweth‑Matzek 1 Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria 2 Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria 3 Present Address: Private Practice, Singergasse 14, 6820 Frastranz, Austria 4 University Hospital of Gynecological Endocrinology and Reproductive Medicine, Medical University Innsbruck, Innsbruck, Austria Women who have undergone oophorectomy appear to be highly susceptible for eating disorder symtoms compared to those with natural menopause. Incorporating eating behavior into clinical care is crucial, especially for women post-oophorectomy. Introduction Clinical eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder are mental disorders defined by abnormal eating behavior (binge eating = eating too much, restrictive eating = eating too little, purging behavior, self-induced vomiting, use of laxatives or diuretics to control weight) with high risk of chronicity and adverse Vol.:(0123456789) Archives of Gynecology and Obstetrics effects on physical and psychological health [1]. There is clear evidence that clinical eating disorders and body image distortions do occur in women in midlife and beyond, despite being more common in young women aged 18–25 years [1, 2]. For a long time, menopause was a taboo subject and the majority of women with menopausal symptoms suffered silently. However, the younger generations of women no longer tolerate hormonal symptoms and their impact on normal life including work [3, 4]. Thus, menopause has become a new important topic both focusing on menopause care management and empowerment, including physical, social and psychological aspects [3–7]. Menopause is defined as the cessation of menstruation. The classification includes natural menopause, premature menopause and induced menopause [8, 9]. Induced menopause, due to the surgical removal of both ovaries or treatment like chemotherapy or radiation results in an abrupt and complete loss of ovarian function and leads to more severe symptoms and increased mortality compared to the natural menopause [8, 9]. The consequences described are an increase in overall mortality rate and an increase of somatic diseases and psychiatric disorders including cognitive impairment [9]. Simple hysterectomy (without oophorectomy), one of the most common surgeries performed on women worldwide [10] leads to the cessation of menstrual bleeding, but it does not result in the immediate loss of ovarian function. However, research shows that hysterectomy is associated with non-natural menopause through premature ovarian failure, earlier onset of menopause [10, 11] and increased and more severe menopausal symptoms compared to women without such interventions [12–15]. For example, Farquhar et al. [10] showed that 21% of women with hysterectomy reached menopause during the 5-year follow-up period compared with only 7% of women without hysterectomy. Both oophorectomized and hysterectomized women share the non-natural process and earlier menopause onset when surgery is performed pre-menopausal. [15] There is a small but growing literature on menopause and eating behavior [16–24]. Data showed significantly higher rates of eating disorders (DSM-IV) in peri-menopausal women compared to pre- and postmenopausal women [18]. Although this finding was confirmed by several subsequent studies [16, 17, 21], it was not a consistent finding. Following studies found no differences in disordered eating (e.g., bulimic behavior, restrictive eating) in premenopausal, perimenopausal, and postmenopausal women [19–21]. Further, regardless of the menopausal stage, eating disorder symptoms (EDS) were not associated with specific menopausal stages, but with menopausal symptomatology (Menopausal Rating Scale, MRS) [25]. The more menopausal symptoms were reported, the more EDS occurred [19, 20]. Existing data from various studies on eating behavior and menopause provide clear evidence that the menopausal transition (premenopause, perimenopause, and postmenopause) is associated with an increased prevalence of disordered eating and associated pathologies [16–24]. Menopause might resemble puberty, as both periods show major hormonal [23, 24] and psychological changes that may represent complementary windows of vulnerability for the development of eating disorders. Most of the limited research on eating behavior and menopausal transition has focused on women in the natural menopausal stages [16, 17, 21, 2 (...truncated)