Menopause: Is weight gain inevitable?

Many women I work with have struggled with their weight and relationship with food for many years.  When we reach our time for the menopause these struggles can be amplified and it can be really disheartening to feel your body changing, and not necessarily in the way you’d like.  Often, my clients say that although they haven’t changed what they’re eating, the weight has still crept on.  Why is this?  

What is the perimenopause and menopause?

Firstly, we need to understand what these terms mean.  Menopause is defined as 12 months after having your last period.  It occurs when the ovaries have stopped producing eggs, which results in the levels of hormones, oestrogen and progesterone, to fall.  

The perimenopause is the period of time prior to the menopause, where we start experiencing symptoms due to changing hormone levels.  Symptoms may include mood changes, changes to your body shape, energy levels, hot flushes, brain fog, insomnia and gut changes [3].  This stage can typically last for many months or even years and during this time you may experience noticeable changes to your monthly cycle [2].  

Generally speaking, most women will go through menopause between the ages of 45-55 [1].  But as we’re all so different, this will vary from person to person, as will the symptoms we experience. 

Why have I gained weight?

It’s very easy to blame ourselves for unwanted weight gain, but there is a lot more going on in our body than we might realise.

During perimenopause, our bodies are experiencing a decrease in oestrogen levels, so it tries to make up this loss in other ways [4].  It does this by using fat, which produces a type of oestrogen called oestrone.  This is weaker and less effective than oestrogen, but the body still produces fat cells, especially around our middle, to try and create a reserve. 

As well as the changing levels of hormones, muscle mass is also reducing, which means that your body is less efficient at burning energy at rest.  Therefore, we may no longer need the same amount of energy from food, as we did in our younger years.  This subtle change in metabolism can also contribute to weight gain, despite no changes to our diet [5].  

Oestrogen plays a role in our sympathetic nervous system, which is involved in breathing, heart rate, blood pressure and controlling our digestive juices.  Therefore, low levels of oestrogen will trigger the ‘fight or flight’ response in our body which is its reaction to a perceived threat.  This releases adrenaline and cortisol, our stress hormones.  Adrenaline can be responsible for the anxiety symptoms some women experience.  The cortisol causes the body to release its glucose (sugar) stores for a ‘burst of energy’ to help us run from our ‘perceived threat’.  However, as the ‘burst of energy’ doesn’t come, insulin is triggered (a storage hormone), which packages the sugar away as fat.

Don’t forget how these fluctuating hormone levels make us feel too.  Mood swings, poor sleep, joint and muscle pains and hot flushes can all mean we don’t feel like exercising.  Poor sleep can also disrupt our hunger hormones which can lead to increased appetite and cravings for higher fat and sugar foods.  

Over time, all these factors will be exerting their effect on our bodies.  We are all different, so the symptoms we experience and the way we respond to them will determine if and how much weight we gain. 

Does the weight gain affect my health?

The weight we gain tends to be around the middle [8].  Fat can be laid down both sub-cutaneous (under the skin) and viscerally (around our organs within the abdomen).  The lowering of oestrogen levels during the perimenopause, can lead to the build-up of visceral fat in the abdomen. 

This abdominal weight gain can also play a role in insulin resistance.  Insulin is a hormone, which acts as a key, to unlock cell doors and allow glucose (sugar) to move in and be converted to energy.  Insulin resistance means that the ‘lock’ on the cells becomes ‘faulty’, therefore responding less to the insulin (‘key’) and so the body just keeps releasing more insulin to finish the job.  As insulin is a storage hormone, we don’t want lots of it floating around, as it will keep laying down more fat, making weight loss harder.   

Unfortunately, this type of fat around our middle, coupled with insulin resistance, increases our risk for certain conditions such as type 2 diabetes, high blood pressure, high cholesterol and other cardiovascular conditions [6]. 

It’s not just physical health either, weight gain and body shape changes can have a real knock-on effect on our body image, self-esteem, confidence and motivation. 

What about HRT?

Hormone Replacement Therapy (HRT) is available in a variety of forms to help symptoms of the perimenopause and menopause and improve your quality of life and future health.  There is currently no evidence to suggest that HRT causes weight gain.  So, speak to your doctor for advice on whether this is the right option for you [7].

So, how do I manage my weight during the menopause?

If you’re coming to the menopause with years of ‘yo-yo’ dieting (repeated periods of energy restriction, followed by rapid weight regain as we return to our normal eating patterns) then you’ll probably have a lower muscle mass to start with.  This type of weight loss plays havoc with our body composition as muscle is broken down to be used as energy, when usual sources are low. 

Therefore, I urge you not to embark on an over-restrictive plan to beat menopausal weight gain.  This will only lower that muscle mass further and mess with the metabolism which is already vulnerable due to hormone changes.  This is a time in our lives to nourish and protect our future health [8]. 

So, embrace the shape change, apply some compassion, and focus on the ‘why’ and ‘how’ you eat whilst making small, sustainable tweaks to your current diet that can help support your body through the menopause.

Top Tips

• Eat well – try keeping a food diary to see if you’ve got a balance of the 5 main food groups.  In general, we should be aiming for plenty of fruits, vegetables, wholegrains, nuts and seeds.  Take care with the number of processed foods you consume.  Focus on a few small changes each week so that you don’t feel overwhelmed.
• Portion sizes – this can help keep weight gain in check, however, be careful not to over restrict as this can lead to cravings and binges later on.  
• Protein – aim to include at every meal to help combat muscle loss and make meals more satisfying.  Choose lean animal or plant sources.
• Stay hydrated – ensure you drink enough non-caffeinated, fluids to support alertness and gut health. 
• Meal planning – this can help keep the week on track, especially if you’re busy and feeling tired.
• Eat mindfully – slow down and pay attention to the food you’re eating.  It really helps us tap into our hunger and fullness cues.
• Keep moving – it can be hard when you don’t feel like it, but moving gently as often as possible can boost mood.  Focusing on weight-bearing exercise or strength training can help you feel strong, protect bone health and muscle loss.  Walking, yoga or pilates all count too [12] – the key is finding something you enjoy and can add to your routines. Exercise can also help symptoms such as hot flushes [11]. 
• Stress – find ways of managing the stress of the day.  Stress raises cortisol levels which are likely already fluctuating with reduced hormones, so make time for yourself to unwind and ‘rest and digest’.
• Sleep – such an important one! Try to prioritise your sleep to help alleviate mood changes and include other things you find relaxing, such as reading or meditation [14].

So, is weight gain inevitable?

Not necessarily!  Remember to think about the ‘how’ and ‘why’ you eat as well as the ‘what’. 

If you’d like to explore this more, do get in touch.  I’d love to hear from you.

References

1. NHS, 2022. Menopause, Accessed 23rd March 2023, Online, available at: https://www.nhs.uk/conditions/menopause/
2. Weiss G. Menstrual irregularities and the perimenopause. J Soc Gynecol Investig. 2001 Jan-Feb;8(1 Suppl Proceedings):S65-6.
3. Mayo Clinic, 2023. Perimenopause, Accessed 22nd March 2023, Online, available at: https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
4. Kapoor E, Collazo-Clavell ML, Faubion SS. Weight Gain in Women at Midlife: A Concise Review of the Pathophysiology and Strategies for Management. Mayo Clin Proc. 2017 Oct;92(10):1552-1558
5. Silva TR, Oppermann K, Reis FM, Spritzer PM. Nutrition in Menopausal Women: A Narrative Review. Nutrients. 2021; 13(7):2149
6. Davis SR, Castelo-Branco C, Chedraui P, Lumsden MA, Nappi RE, Shah D, Villaseca P; Writing Group of the International Menopause Society for World Menopause Day 2012. Understanding weight gain at menopause. Climacteric. 2012 Oct;15(5):419-29.
7. The Menopause Charity, 2023. Types of Hormone Replacement Therapy (HRT) Accessed 22nd March 2023, Online, available at: https://www.themenopausecharity.org/2021/10/20/types-of-hormone-replacement-therapy-hrt/
8. Juppi HK, Sipilä S, Fachada V, Hyvärinen M, Cronin N, Aukee P, Karppinen JE, Selänne H, Kujala UM, Kovanen V, Karvinen S, Laakkonen EK. Total and regional body adiposity increases during menopause-evidence from a follow-up study. Aging Cell. 2022 Jun;21(6):e13621
9. Noll PRES, Campos CAS, Leone C, Zangirolami-Raimundo J, Noll M, Baracat EC, Júnior JMS, Sorpreso ICE. Dietary intake and menopausal symptoms in postmenopausal women: a systematic review. Climacteric. 2021 Apr;24(2):128-138
10. British Dietetic Association (BDA) 2019, Menopause and Diet: Food Fact Sheet. Accessed 22nd March 2023, Online, available at: https://www.bda.uk.com/resource/menopause-diet.html
11. Berin E, Hammar M, Lindblom H, Lindh-Åstrand L, Spetz Holm AC. Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms. Climacteric. 2022 Jun;25(3):264-270
12. Nguyen TM, Do TTT, Tran TN, Kim JH. Exercise and Quality of Life in Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Environ Res Public Health. 2020 Sep 26;17(19):7049
13. Bacciottini L, Falchetti A, Pampaloni B, Bartolini E, Carossino AM, Brandi ML. Phytoestrogens: food or drug? Clin Cases Miner Bone Metab. 2007 May;4(2):123-30
14. Garcia MC, Kozasa EH, Tufik S, Mello LEAM, Hachul H. The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study. Menopause. 2018 Sep;25(9):992-1003