Weight gain is a really distressing symptom that many women experience as they enter the menopause transition. This can be a triggering conversation for some. The excess weight women experience can feel like they are losing their identity. Wherever you are in your journey, know that there are practitioners here to support you and you can find a way to navigate this transition.
Given that cardiovascular disease is the leading cause of death in postmenopausal women, the importance of weight management in midlife cannot be overemphasized. In this blog post, we will review what causes this weight gain and answer commonly asked questions about menopause and weight gain that I receive in practice.
What Is Menopause?
The average age of menopause is 50-52 years of age. The menopause transition (perimenopause) is defined as the period of timing leading up to the final menstrual cycle that’s characterized by hormonal fluctuations which result in irregular periods and symptoms such as hot flashes and night sweats.
Symptoms
In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:
- Hot flashes (also known as hot flushes)
- Night sweats
- Dizziness
- Heart racing/skipping beats
- Tremors
- Feeling restless or tired
- Difficulty concentrating
- Forgetfulness
- Mood swings
- Vaginal dryness
- Breast tenderness
- Migraines
- Waking at night
It is not entirely clear what is responsible for weight gain during menopause. It is important to note that menopause symptoms themselves can affect weight indirectly, such as having disturbing sleep secondary to night sweats. Mood swings can also interfere with healthy lifestyle behaviours.
What Causes Weight Gain During Perimenopause and Menopause?
It is unlikely that the use of hormone therapy itself is responsible for this weight gain. Contrary to the belief that hormone therapy leads to weight gain, it can actually help with weight management. Since hormone therapy can improve symptoms of hot flashes, night sweats, insomnia, and mood, it can lead to better quality sleep and increased energy and daily movement.
Factors Related to Age, Lifestyle, & Genetics
Inadequate or fragmented sleep can lead to weight gain. Women who sleep 5 or fewer hours a night have been shown to gain on average 2.5 lbs more than those sleeping 7 hours. Therefore, addressing lifestyle factors is a very important part of weight management.
What we do know is that body composition and fat distribution change significantly during menopause. There are two types of body fat – visceral and subcutaneous fat. Subcutaneous fat is the fat just beneath the skin and it makes up about 90-95% of body fat. Visceral fat is inside the abdomen, found around the abdominal organs like the liver and stomach, and it is the fat that is most concerning health-wise. Visceral fat is associated with cardiovascular disease, elevated cholesterol, type 2 diabetes, a fatty liver, and other health conditions.
During menopause, women are more likely to experience increased abdominal and visceral fat, and decreased lean body mass, during the menopause transition.
Perimenopause and menopause are associated with a more rapid increase in fat mass and redistribution of fat to the abdomen (referred to as belly fat.) Studies have shown that postmenopausal women have greater amounts of intra-abdominal fat compared to premenopausal women.
Impact of Lowering Estrogen Levels
Estrogen is primarily responsible for telling fat where to go (fat distribution.) It is responsible for the accumulation of fat in the subcutaneous tissue, particularly in the gluteal and femoral regions (hips and thighs.) This is nothing to be concerned about. Women with gluteofemoral obesity often remain metabolically healthy. Gluteofemoral fat is more insulin sensitive and is able to more effectively clear triglycerides after meals. Other sex hormones, androgens, promote the accumulation of abdominal fat.
During perimenopause and menopause, there is a decrease in estrogen relative to androgens, which is one of the reasons why fat redistributes from the hips and thighs to the abdominal location. Studies have confirmed that the weight gain we see during this time is not due to the hormonal changes at menopause, but rather due to aging.
During the menopausal transition, as weight increases so do menopausal symptoms. Therefore, obesity is an independent risk factor for more severe menopausal symptoms.
What is the Best Diet for Menopause Weight Gain?
No single diet has been consistently shown to be better than any other for weight loss. Women start to lose 3–6% of muscle mass every decade after the age of 30, therefore protein optimization becomes really important.
Adequate protein intake improves metabolism, leads to better blood sugar balance, increases energy and productivity, and reduces hunger cues. I always tell my patients that the diet that they can keep is the diet that works for them. It does not need to be labelled a certain name, such as paleo or keto. It is a diet that helps support your ideal weight, in conjunction with balancing blood sugar and sustaining muscle mass.
Does Hormone Replacement Therapy Affect Weight and Body Composition?
Most randomized controlled trials that we have on hormone replacement therapy show a reduction in central adiposity, and a few that are neutral (no increase). Overall, the effects of estrogen therapy appear to be favourable in terms of body composition, and hormone therapy is not associated with increased weight or increased visceral adiposity.
Hormone therapy can indirectly benefit weight as it helps many women manage a lot of bothersome symptoms like hot flashes and night sweats. When you feel better and have more energy, you will be more inclined to be physically active, meal prep, and incorporate positive lifestyle behaviours into your everyday life. Preventing weight gain is currently not an indication to prescribe menopausal hormone therapy.
Natural Treatments & Remedies for Menopause Weight Gain
Exercise Regularly
Women who have a strategic plan in place to manage weight excess do better and are able to maintain weight loss. Having a regular exercise routine is important to prevent weight gain, achieve weight loss, prevent loss of muscle mass with increasing age and protect against bone loss.
Talking to your practitioner about what physical activity is right for you and your individual goals is an important first step. Weight training exercises are especially encouraged during this phase of life in order to maintain bone and muscle mass.
Practice Yoga
Yoga has been shown to improve serum lipid levels (cholesterol), and metabolic syndrome risk factors in obese postmenopausal women. Regular yoga practice may be effective in preventing cardiovascular disease caused by obesity.
Overall, regular exercise has benefits in menopausal women. Benefits include the management of menopausal symptoms, psychological distress, weight issues, immobility, and injuries.
Follow a Nutrition Plan
A review with your practitioner about your daily intake of calories and protein is important. No single diet has been consistently shown to be better than any other for weight loss. The nutrition plan that you are able to stick to in the long term is the plan that works for you.
Run Your Blood Work With a Practitioner
It is also important that you run some blood work with your practitioner. It can really help to rule out any thyroid conditions or insulin resistance that could be contributing to your inability to lose weight. A thorough blood assessment can be really helpful to guide your treatment plan.
Opt for Acupuncture
Acupuncture has also been shown to aid in weight loss. It is believed to help induce weight loss via its regulatory effects on the nervous system.
While these strategies may not contribute to fast weight loss, our goal is to make sure weight loss is healthy, and sustainable and supports your overall longevity. We know that women who get a coach on their team have more successful outcomes than women who try to go at it alone.
Impact of Weight Loss on Menopausal Symptoms
Reductions in weight, BMI and abdominal circumference not only improve psychological well-being but have also been associated with a reduction in vasomotor symptoms (hot flashes and night sweats) in overweight and obese women. Weight loss and exercise also exert a positive effect on insulin resistance in postmenopausal women, which together with a decrease in menopausal symptoms,e may potentially decrease cardiovascular risk.
Questions About Weight Gain During Menopause
What is the Average Weight Gain During Menopause?
The average weight gain during menopause is approximately 0.5 kg/year. Research has shown that this steady weight gain is due to age rather than menopause itself. Weight gain is complex. It is not just about calories and burning fat. Other factors can contribute to weight gains, such as poor sleep, stress, medical conditions, medications, and other social determinants of health.
Does Menopause Weight Gain Go Away?
Weight gained during menopause will not disappear post-menopause without intervention. It’s important to start tracking your activity levels. Research suggests that women walk up to 3000 steps less per day after menopause. This is likely due to fatigue, disruptions to sleep, and mood changes.
A loss of activity will lead to changes in body weight. Poor sleep will contribute to over nourishing and lower movement throughout the day. If your sleep is affected by night sweats, it is important to address that with your healthcare provider and develop a plan that will improve your quantity and quality of sleep.
What is the Fastest Way to Lose Weight During Menopause?
We always work with patients to make sure that weight loss is sustainable. The goal is not to lose weight quickly, but rather to maintain the weight loss. We do not recommend fad diets. We work with you to optimize your nutrition and lifestyle in a way that aligns with your current routine and schedule so that you can see long-term benefits and changes. If you feel like your nutrition plan is a chore and you don’t look forward to it, then it’s only a matter of time before that plan stops working for you.
What Does Hormonal Weight Gain Look Like?
Perimenopause and menopause are associated with a more rapid increase in fat mass and redistribution of fat to the abdomen, resulting in a transition from a gynoid to an android pattern of fat distribution and an increase in total body fat. By about 2 years after the final menstrual period, weight changes plateau.
Summary Points
- Weight gain does not appear to be affected by the hormonal changes of menopause.
- The fall in estrogen at menopause favours central abdominal fat accumulation.
- Other factors that may contribute to obesity in women include a low level of activity, sleep deprivation, family history of obesity, use of psychotropic drugs, a North American diet, and more.
- Obesity is an independent risk factor for more severe menopausal symptoms.
- Estrogen-only or estrogen-progesterone therapy does not adversely affect body weight and may ameliorate the accumulation of abdominal fat.
- Successful maintenance of weight loss involves a lifestyle change.
Source: Annex
