Weight Gain in Menopause - WTF?
According to Menopause.org, “...there is no scientific evidence that menopause or hormone therapy is responsible for midlife weight gain….Age and lifestyle are the main culprits.” WTF? If you ask any woman in America aged 48-52 - they might just disagree. The majority of my patients are experiencing an unexplainable 10–25 pound weight gain around the age of perimenopause (40-51 on average) and menopause (52+ on average) - often despite an increasingly strict focus on diet and exercise. This quote from Menopause.org seems reductive, and for many women, is likely contrary to their reality. Scientific literature demonstrates that there are profound changes in hormone production and subsequent metabolic responses that undeniably impact a propensity toward weight gain in women over the age of 40. For example, the following illustration will give you an idea of the fluctuations that occur with estrogen production as women age.
Additionally, many reputable scientific studies are in direct opposition to this statement. According to the Journal of Clinical Investigation, “At the start of the menopause transition, the rate of fat gain doubled, and lean mass declined; gains and losses continued until 2 years after the final menstrual period. After that, the trajectories of fat and lean mass decelerated to zero slope.” This study goes on to discuss why it’s so difficult to pin weight gain exclusively on menopause. It’s challenging to segregate chronological aging from hormonal aging because these are happening concurrently. The reason I believe this study is so illuminating is because it considers the entire “menopause transition” (i.e. the time between perimenopause and two years following your final period). The study concludes that “Accelerated gains in fat mass and losses of lean mass are Menopause Transition-related phenomena.”
THE REASONS FOR PERIMENOPAUSAL AND MENOPAUSAL WEIGHT GAIN
The reasons for perimenopausal and menopausal weight gain are multifactorial. We know that estrogen and testosterone impact metabolism, muscle mass, the types of fat we gain where we gain it, and even our relationship with insulin. Additionally, aging in general changes our mitochondrial health and our energy expenditure - meaning our basal metabolic rate (i.e. the number of calories we burn in a day) can decline due to all these factors.
This means that even if you eat the same healthy diet you’ve been eating since your 30s, you’re increasingly likely to gain weight. And, it’s much more difficult to shed pounds you might have put on.
THE HORMONE EFFECT
Below are several key hormones that contribute to women’s metabolic rate and their propensity to gain weight - and should be monitored during women’s late forties as they transition into perimenopause.
Estrogen (Estradiol) - According to Ben Bikman, PhD, hormones play a significant role in a woman’s metabolic health. More specifically, Estradiol, a woman’s primary estrogen, acts as a metabolic boost and has an anorectic effect that helps you feel less hungry. Estradiol also activates brown fat - the type of fat we have more as babies and children that is more metabolically active - making the body warmer and increasing one’s ability to burn fat. Estrogen impacts the type of fat we store and where we store it, and incorporates with our DNA that influences our metabolism. Dr. Sara Gottfried states, “As estrogen levels decline, the rate of fat gain doubles, and lean body mass declines — these gains and losses continue until two years after the final menstrual period. Body fat, waist circumference, and the waist-to-hip ratio increase during the menopausal transition except in women who take hormone therapy.”
Testosterone helps build muscle and burn fat. In women, it also contributes to a strong metabolism and healthy libido. It also has been shown to reduce insulin resistance. Testosterone declines as we age - dropping more drastically in perimenopause and menopause. You can learn more about testosterone in women in our blog Testosterone & Women’s Sexual Health.
Progesterone levels also decrease during menopause which does not directly lead to weight gain but does have some downstream effects - like water retention. More importantly, loss of progesterone often causes women to struggle with deep, restorative sleep impacting other hormones like cortisol and blood sugar, which can lead to weight gain. Progesterone does increase hunger - so too much is not necessarily a good thing. This explains why women may have increased cravings around their period.
Thyroid disorders often mimic those of menopause: weight gain, poor sleep, irritability, fatigue, depression, hair loss, and hot flashes. A comprehensive thyroid panel can determine if the thyroid is playing a role in your weight gain.
Insulin is the fat-storage hormone. Too much insulin too often will lead to insulin resistance, weight gain, and metabolic dysfunction. Things that cause insulin resistance include a diet high in carbohydrates or sugar, stress, inadequate exercise, and a lack of quality sleep. Unfortunately, the loss of hormones around menopause has also been associated with insulin resistance. Insulin resistance is particularly dangerous because it leads to fat gain around the abdomen and organs (visceral fat) - and of course, is a precursor to diabetes.
Growth Hormone stimulates growth and cell regeneration and plays a key role in building muscle and burning fat. Growth hormone declines as you age - and more rapidly if you have high levels of stress, a diet higher in carbohydrates, and are sedentary and inactive.
Leptin is the hormone that tells you to stop eating, which sounds like a great thing. However, too much leptin leads to leptin resistance, which means we stop responding to this important signal to stop eating. Insulin resistance, which is so common around perimenopause and menopause, contributes to leptin resistance, leading to erratic cravings. Loss of hormones can also impact leptin - sometimes causing too little or too much.
It’s important to remember that perimenopause can start in your mid-40s - and this loss of hormones can lead to unexpected weight gain. The good news is, there are several things you can do to help combat it - which we detail in part two of this series.
You can also read about our Medical Weight Loss program here as well as learn more about how we work with various weight loss medications, including semaglutide, here.
PLEASE GIVE THE OFFICE A CALL AT 425-230-6893 IF YOU WANT TO DISCUSS YOUR OWN PERIMENOPAUSAL OR MENOPAUSAL WEIGHT GAIN CHALLENGES.
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