Menopause & Weight
Weight Changes in Menopause
Written by: Dr. Madeleine Clar, nd mscp
You hit your mid-40s and suddenly you start experiencing changes to your body that weren’t there before.
One of these changes may be that you are gaining weight - despite nothing changing in your exercise or diet routine. And even more frustratingly, this weight might be centred around your abdomen - a new location for you.
If this sounds familiar, you are not alone. This is a common concern of perimenopausal/menopausal women who land in my office.
Typically this change in weight can be a pound a year, which can sneak up on patients. In 20% of patients, this may end up looking like 10 pounds or more, which can have a significant impact on their health.
So let’s understand two things; why is this happening, and what can we do about it?
Why does weight gain occur at midlife?
Hormonal changes
The perimenopause/menopause transition is marked by a decline in estrogen, and often a flurry of symptoms that accompany it. These hormonal changes also impact how our body metabolism works in a few different ways.
How estrogen loss contributes
Body composition & fat storage
In the four years surrounding the final menstrual period, we see the most significant change in body composition - specifically changes in where we store our fat. Typically in the presence of estrogen we store fat and weight more in our hips, thighs and bum area. When estrogen levels declines, this fat distribution shifts, and we begin to store fat more in the abdominal area. This abdominal fat distribution is associated with higher cardiometabolic risk. Putting us at increased risk for type II diabetes, elevated blood pressure, increased liver fat, and increases our risk of cardiovascular events (heart attack and stroke).
Patients might note this change alongside the weight gain, as they begin to notice they have more of a “belly” then they did in the past with weight changes.
Hunger cues
Low estrogen influences hunger signals, increases our insulin sensitivity and increases our glucose uptake. Typically estrogen inhibits these signals, and as estrogen levels fluctuate during perimenopause, the body's ability to modulate hunger hormones and use the food we do eat is reduced - leading to increased in caloric intake.
Symptoms that make us feel bad
Finally, low estrogen leads to symptoms like sleep disturbances, fatigue, vasomotor symptoms, and mood changes which can contribute to increased caloric intake and decreased physical activity, further promoting weight gain. I often tell patients, it is really hard to do all lifestyle factors that keep us healthy (eat well consistently, move our bodies) when we don’t feel great, so sometimes this is the first step we need to address so the other parts get easier.
Fighting the age clock
While hormones play a role at this time, we are also fighting chronological age. Everyone of any gender experiences a decline in lean muscle mass that starts after the age of 30. Muscle is a very metabolically active tissue, meaning that it contributes to how many calories our body burns at rest. The more muscle mass we have, the more metabolically active our bodies are (even at rest).
It also becomes harder for us to build muscle during this time - our body’s are not as sensitive to the cues we normally give them (through diet and exercise) so we have to work a bit more intentionally on this.
Maintaining muscle mass is also important at this time of life, as muscle contributes to bone health. The prevention of bone loss to osteoporosis which can accelerate at this time due to the decrease in estrogen. Beyond preventing osteoporosis, we also want to maintain muscle mass to prevent falls, keep our balance, ensure our cardiometabolic health is good. Muscle mass at 70th and 80th decade can be one of the biggest predictors of our ability to live independently.
How does exercise contribute?
Many patients will be frustrated with the weight gain they experience because it will feel as if they haven’t changed their exercise routine. However research shows us that our exercise may actually slow down a bit during this time without us realizing it.
Research has shown those with suppressed estrogen have lower moderate to vigorous activity and lower spontaneous exercise compared to individuals with higher estrogen. This decrease in energy expenditure can be as high as 40% when compared to earlier in a patient’s life - meaning that we are actually moving almost half as often as we were before. Like many things, this may have been a gradual decline, and when combined with our body not being as efficient as it used to be, contributes slightly to our current situation.
Often this is a time in life that can be very busy for patients - they may be at the height of their careers, caretaking for parents and children, and they may struggle to find a time in their routine for exercise, especially exercise of higher intensity.
Finally, patients may have stopped moving a bit more because of other symptoms or health concerns and getting in the way - they may have started sleeping poorly or are experiencing pains. Often we need to address these concerns first to remove this barrier to why people are having a harder time getting moving regularly.
Whatever the cause, it just means we need an intentional plan to ensure we are moving to take care of our current and support ourselves long term.
How does diet contribute?
Similar to exercise, we may feel as if nothing has changed in our diet during this time to contribute to weight gain, but research tells us the reality is subtle shifts may be happening that influence how we are eating.
As discussed earlier, the shift in estrogen can change how we metabolize our food, our hunger cues and the breakdown of our muscle mass, which all may be gradual.
During menopause, we experience an increased breakdown of our body’s protein (and muscle mass) which triggers our appetite for protein. When we don’t eat enough protein through the diet, we may end up overconsuming calories to satiate our appetites. This leads to weight gain. We call this appetite for protein in the context of muscle breakdown the “protein leverage effect”.
What can we do?
Exercise
For weight management during this time, it is recommended to engage in both aerobic and resistance exercises. The general guideline is to aim for at least 150 minutes per week of moderate to vigorous exercise. This can include activities like brisk walking, jogging, cycling, or swimming for aerobic exercise, combined with strength training exercises for resistance.
Increasing exercise duration and intensity has been associated with decreased body fat percentage in peri- and postmenopausal women.
Studies have shown that 3 to 4 hours of moderate to vigorous exercise per week can be beneficial for weight management and overall health during this period. It's important to note that both aerobic and resistance exercises are beneficial for weight loss during menopause. Resistance exercise is particularly crucial for preserving muscle and bone mass, which tend to decline during this life stage.
For people who are just getting started or back into it, it's ideal to start slowly and gradually increase activity levels. Even small changes, such as increasing daily steps by 500, can lead to improvements in health risks. Additionally, avoiding or breaking up prolonged periods of sitting is recommended as a first step towards a more active lifestyle.
For most patients I like to build on what they are already doing - can we extend your walk, add one extra work out class a week consistently. If resistance exercise is totally new to you - starting with a personal trainer or group programming is the easiest way to learn!
Nutrition
Increasing Protein
Through diet we want to increase protein intake in an intentional way. For menopausal women, the recommended dietary protein intake is higher than for younger adults. The general recommendation is between 1.2 to 1.5 grams of protein per kilogram of body weight per day. For a 150 lbs person this would be 80-100g per day, which may look like 20-25 g per meal.
Some research suggests that protein intake should increase from a minimum of 16% of total calories (around 1.0 g/kg) at age 40 to 18-20% (around 1.2 g/kg) at age 50. Other studies indicate that a higher intake of 1.5-1.7 g/kg/day may be needed to prevent age-related muscle loss in menopausal women. The exact amount may vary based on individual factors such as activity level, overall health, and weight management goals. It is important to chat with your healthcare provider about what makes sense for you.
Mediterranean diet
The Mediterranean diet has been shown to be effective for weight loss and weight management. This eating pattern is based on traditional foods consumed in countries bordering the Mediterranean Sea, emphasizing plant-based foods, fish, seafood, and olive oil as the primary fat source.
The Mediterranean diet's weight management benefits likely stem from its focus on nutrient-dense, wholesome foods. It includes plenty of fruits, vegetables, whole grains, legumes, nuts, and seeds, which are high in fiber and nutrients but relatively low in calories. This can help promote satiety and reduce overall calorie intake.
Additionally, the diet's emphasis on fish and lean proteins, along with healthy fats from sources like olive oil, can contribute to feeling full and satisfied, potentially aiding in weight control.
The mediterranean diet helps even without weight changes
Research has shown that adopting healthier eating patterns, including the Mediterranean diet, can improve metabolic health regardless of body mass index (BMI). This suggests that the quality of food consumed in the Mediterranean diet may be as important as, or even more important than, the quantity of food for managing weight and overall health. The diet's potential to improve metabolic status could contribute to its effectiveness in weight management and overall health promotion.
There is even research that eating in a mediterranean style of diet can improve depression, and prevent cognitive decline in menopause.
How does hormone replacement therapy help?
Hormone replacement therapy does not totally prevent hormonally associated weight gain, but it may have beneficial effects on weight management and body composition during menopause.
Estrogen therapy has been shown to improve the accumulation of abdominal fat that often occurs during menopause, even in lean women. It can lead to a reduction in overall fat mass and improved insulin sensitivity.
Studies have demonstrated that women on HRT experienced improvements in waist circumference and a lower rate of developing type 2 diabetes. Some research has shown a reduction in fat mass and an improvement in fat-free mass (lean tissue) with estrogen replacement therapy.
However, it's important to note that while HRT may help with body composition, it does not necessarily prevent weight gain entirely.
The primary approach to weight management during menopause should still be maintaining a healthy diet and engaging in regular physical activity. HRT is not recommended specifically for the purpose of preventing weight gain or reducing cardiometabolic risk.
Instead, it should be considered as an additional treatment that may help alleviate other menopausal symptoms (like hot flashes, sleep issues, depression), which often make it harder for women to implement lifestyle changes necessary for weight management.
How can working with me (Dr. Madeleine Clark, ND MSCP) help?
Working with a Naturopathic Doctor focused with additional training in menopause can help support you in a few different ways.
Comprehensive assessment
I will work with you to complete a comprehensive assessment of your health concerns, not just addressing one or two symptoms. My plans will provide education, helping you understand the changes that are taking place in your body, and what is to come. Since my approach is holistic, she takes a broad look at how your hormonal health influences your quality of life and your life to come as you age, ensuring we are supporting your long term health goals.
Due to my additional training in menopause (with my certification through The Menopause Society) and my additional prescribing rights, I can provide prescriptions for hormone replacement therapy, and you can feel confident in her expertise in this area of health.
My support is always tailored to your individual needs, and encompasses nutrition, lifestyle recommendations, supplements and medications that make sense for you. Appointments with me can get you on the right track in your health, and keep you accountable to your goals.
Want to learn more? Book a complimentary meet and greet appointment today to learn how we can get started!