One of the most common concerns of women in perimenopause/menopause is weight gain and the inability to lose weight. It is estimated that, between the ages of 45 and 55, women will gain on average around half a kilo per year.
Both men and women are likely to gain weight as they age due to lifestyle and ageing, but for women, weight gain is often associated with the hormonal and metabolic changes that take place during midlife hormone transition.
In this blog post I will explore the hormonal and metabolic changes that occur during this transition, to explain why it is harder to lose weight in menopause.
As women enter menopause, their bodies undergo hormonal changes that can lead to an increase in body fat, a decrease in muscle mass, and a slower metabolism.
Oestrogen plays a key role in regulating body weight. It influences the production of leptin, a hormone that signals the brain to stop eating when the body has had enough food. When oestrogen levels decline during menopause, leptin levels also decrease, leading to an increase in appetite and food intake.
Lower oestrogen levels also affects the distribution of fat in the body. Before menopause, oestrogen helps to distribute body fat in more of a "pear-shaped" pattern, where fat is stored in the hips and thighs. However, during menopause there is a shift towards an "apple-shaped" pattern, where more fat is stored in the abdominal area. This type of fat distribution is known as android fat distribution and is thought to be due to changes in the balance between estrogen and androgens (male hormones such as testosterone).
Oestrogen also improves insulin sensitivity, the ability of cells to respond to insulin and uptake glucose from the blood. As oestrogen levels decline, the balance shifts towards androgens, which are associated with decreased insulin sensitivity and increased abdominal fat deposition which leads to a higher risk of metabolic disorders, such as insulin resistance, type 2 diabetes, and cardiovascular disease.
Progesterone helps to increase insulin sensitivity, improving the ability of cells to respond to insulin. The decline of progesterone levels in menopause contributes to reduced insulin sensitivity and further increases the risk of insulin resistance.
Progesterone also has an anabolic effect on muscle tissue, meaning it helps to build and maintain lean muscle mass. Increased muscle can help to boost metabolism and burn more calories at rest, helping to prevent weight gain. However, as progesterone levels decline during menopause, muscle mass can decrease, leading to a slower metabolism and an increased risk of weight gain.
As discussed earlier, testosterone is an androgenic hormone that is present in females in smaller amounts and declines during midlife hormone transition.
Like progesterone, testosterone is an anabolic hormone that helps to build and maintain muscle mass, so a decrease in testosterone levels can lead to a reduction in muscle mass and a slower metabolism. This means that women may burn fewer calories at rest than they did when they were younger, making it harder to lose weight.
Metabolic changes contribute to the difficulty of losing weight in menopause.
1. Redistribution of fat: During menopause, many women experience a shift in fat distribution, with an increased tendency to store fat around the abdomen rather than the hips and thighs. This visceral fat accumulates around the internal organs, such as the liver, pancreas, and intestines. Visceral fat produces hormones and chemicals known as adipokines which promote further fat storage by influencing appetite regulation, insulin sensitivity, and lipid metabolism.
2. Lower BMR: As women age, their basal metabolic rate (BMR) decreases, which means that they burn fewer calories at rest . This decline in BMR results from a decrease in lean muscle mass and an increase in body fat. So, even if women are eating the same amount of food and exercising the same amount, they may still gain weight due to a slower metabolism.
3. Muscle loss: During menopause, hormonal changes can lead to a decrease in muscle mass. As muscle burns more calories than fat, women with reduced muscle mass may experience a decrease in their basal metabolic rate, making weight management more challenging.
4. Increased insulin resistance: Some women may develop increased insulin resistance during menopause. Insulin resistance occurs when cells in the body become less responsive to the hormone insulin, which is responsible for regulating blood sugar levels. When cells are less responsive to insulin, the body produces more insulin to compensate. High levels of insulin in the blood can cause the body to store fat and make it harder to lose weight.
5. Changes in appetite and cravings: Hormonal fluctuations during menopause can influence appetite and food cravings. Some women may experience increased hunger or cravings for high-calorie foods.
What can you do?
Balanced diet: Focus on whole foods, adequate quality proteins, fruits, vegetables, whole grains and healthy fats. Avoid processed and sugary foods.
Regular exercise: Incorporate regular aerobic exercise, flexibility and strength training into your routine.
Manage stress: Practice stress-reducing techniques such as meditation, yoga, mindfulness or deep breathing.
Get enough sleep: Aim for 7-8 hours of quality sleep each night.
Stay hydrated: Drink plenty of water to support metabolism and reduce cravings.
Limit alcohol and caffeine: These can disrupt sleep & metabolism and intensify perimenopause symptoms such as anxiety and hot flushes.
Monitor portion sizes: Be mindful of portion control to avoid overeating or undereating.
Stay consistent: Maintain a consistent routine of healthy diet, regular meals, exercise and sleep.
Menopause is a natural transition phase that can cause a wide range of physical and emotional symptoms. It's important to note that every woman's experience and journey through menopause is as individual as she is. In my clinical practice I spend time with my clients, listening to your health concerns and priorities and then present the many options available for managing your symptoms. Together we will tailor a Treatment Plan that addresses nutrition, diet and lifestyle factors to support you through the changes.