By Dr. John Thomas
Far too many female patients throughout their menopausal transition are being sent home from a doctor’s visit feeling as if they’ve gone crazy. Or worse, they feel too embarrassed, ashamed, or frustrated to return, and menopausal signs and weight gain end up being accepted as their new normal.
Given this all-too-common reality amongst women in their thirties, forties, and fifties, it becomes clear that first and foremost, practitioners must educate themselves on the specificities –general and individualized factors –that contribute to menopausal weight gain. Next, healthcare providers need to go the extra mile in educating their patients about what their body is going through, and what they can do to feel better.
What is Menopause?
The textbook definition of menopause is the absence of a woman’s menstrual cycle for twelve months unless someone has undergone a surgical menopause procedure where the uterus and ovaries have been removed. In this case, the process happens abruptly and typically with more menopausal signs.
While the average age of functional menopause is forty-eight, we see that chemical markers for menopause commonly show up as much as fifteen years earlier. Indicators of chemical changes preceding the cessation of menstruation can include increased irritability, mood swings, decreased libido, low energy, hair loss, trouble sleeping, food cravings, weight gain, or weight loss resistance.
5 Factors Contributing to Menopausal Weight Gain
Many women find that weight loss became increasingly difficult after later pregnancies, and this can be due to hormonal and chemical changes preceding menopause that begin in their mid-thirties. Weight gain or an inability to lose weight is one of the most common complaints of women during their menopausal transition.
Here are five common factors contributing to menopausal weight gain:
1. Hormonal Imbalances
The first hormone affected by menopause is testosterone, which is a fat-soluble hormone that is made by cholesterol and is a fuel for both men and women. Because it lives in fat, the body will hold onto fat stores in an effort to preserve this key hormone when testosterone levels are low.
Weight gain during perimenopause can also be due to high estrogen levels in relation to progesterone and has been linked with low estrogen causing excess visceral fat.12. Inactivity
With the reduction of testosterone along with potential imbalances of estrogen, progesterone, and thyroid hormones, women can experience a decreased sex drive, low energy, and less motivation to stay active. Signs of imbalances in all of these hormonal key players often mimic each other during the menopausal transition, so it’s important to learn each body’s “normal” since ranges can significantly differ from woman to woman.
Regardless of the numbers, if a woman has low energy and a lack of motivation to exercise and stay active, this can contribute to menopausal weight gain.3. Increased Food Cravings
For many women, hormonal changes of menopause increase food cravings and appetite. One study published in the European Journal of Clinical Nutrition found that a desire to eat, hunger, and decreased fasting fullness were all higher during the menopausal transition.2 Another study found ghrelin levels to be significantly higher in premenopausal women, while another looked at weight gain in menopausal women being influenced by impaired function of neuropeptide Y and leptin, hormones that control appetite and satiety.3'4
When women don’t feel good about their bodies and have chronically low energy, the temptation eat foods that release dopamine in the brain—particularly sugar—can also be a major factor contributing to menopausal weight gain.4. Poor Sleep
Research has shown the connection between inadequate sleep and poor metabolic health.5 Other various factors during the menopausal transition make sleep even more challenging. Hot flashes, stress, low testosterone, and other hormonal changes are all factors that can contribute to sleeplessness and weight gain.
5. Inadequate Medical Care
A dire lack of understanding, compassion, and appropriate treatment from some medical providers might be the leading cause of weight gain during the menopausal transition.
Women are prescribed medications far more frequently than men.6 For example, if a woman in her menopausal transition visits her doctor for support with mood swings or other signs of menopause and is immediately treated for the signs rather than the underlying hormonal imbalances, she may experience weight gain, decreased libido, and further lack of energy.. Essentially, it creates a vicious cycle that can be difficult to break out of.
Three-Step Action Plan
3. Understand Menopausal Signs
Most importantly, women need to be educated and guided through their menopausal transition. This starts with a basic conversation about what menopause is and when it starts. Many women don’t seek help until they are in the final stages of menopause and are very symptomatic. They have accepted that these health challenges are a normal part of aging when, in reality, many measures could have been taken to mitigate weight gain and lessen the impact of other menopausal markers.
For example, hot flashes are one of the main reasons women will end up seeking medical help, and this is usually one of the final stages of menopause. Whether they are experiencing an estrogen-depleted or testosterone deficient hot flash (both of which have their own distinct signs and manifestations), proper understanding and support beginning in the initial stages of perimenopause could have prevented or at least lessened this common sign.2. Hormone Testing
The key to hormonal testing (which can be done via saliva, blood, or urine) is not only having the technology available to measure testosterone and other hormones but also understanding that each woman is unique.
In other words, each woman’s level of cholesterol, testosterone, estrogen, progesterone, cortisol, thyroid, and other hormones during the menopausal transition might be different. These differences need to be taken into consideration to best support her.
3. Adopt a Metabolism-Boosting Diet and Lifestyle Changes
The impact of diet and lifestyle on hormone balance is powerful, meaning that specific foods rich in key micronutrients for hormone synthesis, detoxification, and metabolism can all help to restore hormonal balance and prevent menopausal weight gain. The same can be said for food rich with macronutrient ratios and fiber to support healthy gut flora. On the other hand, harmful foods high in anti-nutrients can have the opposite effect, such as refined sugar and grains and foods high in xenobiotics, antibiotics, and exogenous hormones.
Finally, learning tools for better sleep, limiting or avoiding alcohol, increasing physical activity, and stress management are all foundational strategies to break the cycle of menopausal signs causing weight gain. Strength training is especially vital for improved body composition, bone strength, and metabolic health.
Sadly, many providers have dropped the baton when it comes to guiding their female patients through menopause. Women are left believing that what they are experiencing is “all in their head” and end up dealing with discomfort that could have been prevented. Instead, women need to feel heard and confident to talk about these concerns with their health care provider, so that the root causes can be addressed as soon as possible.
1 Mauvais-Jarvis F, Clegg DJ, Hevener AL. “The role of estrogens in control of energy balance and glucose homeostasis.” June 2013. https://www.ncbi.nlm.nih.gov/pubmed/23460719 Accessed 26 June, 2019.
2 Duval Karine, Prud’homme Denis, Rabasa-Lhoret Remi, Strychar Irene, Brochu Martin, Lavoie Jean-Marc, Doucet Eric. “Effects of the Menopausal Transition on Dietary Intake and Appetite, a MONET Group Study.” 25 September, 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954773/. Accessed 26 June, 2019.
3 Sowers MR, Wildman RP, Mancuso P, Eyazzadeh AD, Karvonen-Gutierrez CA, Rillamas-Sun E, Jannausch ML. “Change in adipocytokines and ghrelin with menopause.” 20 February, 2008. https://www.ncbi.nlm.nih.gov/pubmed/18280066. Accessed 26 June, 2019.
4 Fernando Lizcano, Guillermo Guzman. “Estrogen deficiency and the origin of obesity during Menopause.” 6 March, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964739/. Accessed 26 June, 2019
5 Nedeltcheva AV, Scheer FA. “Metabolic effects of sleep disruption, links to obesity and diabetes.” 21 August, 2014. https://www.ncbi.nlm.nih.gov/pubmed/24937041. Accessed 25 June, 2019.
6 "Women prescribed more drugs than men but don't always take them ...." 20 Mar. 2012, https://www.washingtonpost.com/blogs/the-checkup/post/women-prescribed-more-drugs-than-men-but-dont-always-take-them-research-shows/2010/12/20/gIQAJm5hNS_blog.html. Accessed 8 Jul. 2019.