How to maintain a healthy weight during menopause
For many women, menopause is something barely noticeable with few side effects, while for others it can be a taxing time, with physical and mental symptoms leaving them drained, confused, and fed up. Fortunately, more investigation into HRT since the early ‘00s has proved it to be largely safe for most women, and for those women experiencing menopausal symptoms it can provide a huge amount of relief and even eradicate side effects all together.
One common fear around the time of menopause, and a side effect that unfortunately isn’t likely to be solved with HRT, is weight-gain. While societal pressures on women to be thin don’t disappear with age, the metabolism slows down, and hormonal changes combined with the ageing process mean that gaining a few pounds, particularly around the waist, is a fairly common occurrence.
For the most part, gaining a few pounds is completely normal and unlikely to cause any harm whatsoever, so it isn’t something you should worry about if you are otherwise healthy. But why exactly does weight gain occur during this time and is it really inevitable? And how best can you ensure you maintain a healthy body weight while also negotiating all the other changes that occur during menopause?
Many of the symptoms associated with the menopause actually occur during the perimenopause phase, the five or so years prior to the menopause. During this period the fluctuating levels of oestrogen and progesterone can cause the well-known vasomotor symptoms such as night sweats and hot flushes. The association between menopause and weight gain, however, isn’t quite as clear cut. “Quite frankly, there is no direct correlation,” says Dr. Magdala Chery, a US-based physician and professor of medicine. “Weight gain seen during menopause is influenced by many factors, especially age. Overall, previous studies have found that a steady midlife weight gain of about 0.5kg is really due to age than menopause itself.” It is likely, however, that hormone fluctuations during the perimenopausal phase may be the dominant factor to increase abdominal fat and obesity.
Indeed, animal studies have shown that central fat accumulation is a consequence of oestrogen deficiency. “Oestrogen typically decreases the activity of fat absorption within a cell and increases the activity of an enzyme that helps break down fat,” Dr. Chery says. So, as a woman’s levels of oestrogen start decreasing, this fat burning activity appears to slow down. This may lead to an increase in body fat, as well as redistribution of fat to the abdomen. Dr. Chery adds that a 2013 study found that fatty acid storage in subcutaneous fat was greater in postmenopausal women than in premenopausal women, and that insulin and triglyceride levels were higher in postmenopausal women.
A 2012 study reviewed all the research looking into the correlation between menopause and weight gain. “In this article it is again reiterated that the midlife weight gain seen in postmenopausal women is likely related to age more than menopause itself,” says Dr. Chery. “But it does also acknowledge that hormone levels are coming to play in regards to body fat composition and distribution as a direct effect of oestrogen deficiency.”
The mental toll of menopause can also lead to weight gain. Interruptions in the sleep cycle, mood changes, and sexual dysfunction can all increase the risk of depression, which in turn can lead to weight gain. “More research is being done to look at the impact of menopause-related sleep fragmentation on metabolic biomarkers of body fat gain,” says Dr. Chery. “The study will be looking into the change in leptin levels after fragmented sleep compared with change in leptin level after unfragmented sleep. Leptin is a mediator of long-term regulation of energy balance, suppressing food intake and thereby inducing weight loss.”
GP Dr May Jay Ali adds that menopausal women coming to her surgery complaining of bloating and weight gain is extremely common. Like Dr. Chery, Dr. May Jay agrees that age is the likeliest contributor to weight gain, but highlights that it isn’t a definitive body change and there are lots of factors which contribute to it. “As time goes on, people generally tend to become less active,” Dr. May Jay says. “The more active you are, the less weight you are likely to gain. As ladies get older, some of them find maintaining their usual weight is harder than it was before. Age generally can cause loss of muscle mass, which lowers a person’s resting metabolism, making it easier to gain weight.”
If it is quite easy for women to gain weight during menopause and their postmenopausal years, what are the implications of this with regards to health? Can it be dangerous to carry a bit of extra fat around the middle?
Firstly, avoiding weight gain, or losing weight if you are overweight, does seem to lead to an improvement in vasomotor symptoms. “Multiple studies have concluded that during menopause symptom flares and weight gain are correlated,” says Dr. Chery. “So this is one incentive for women to work hard to combat weight gain, and therefore make the transition more tolerable.”
On top of this, fat itself operates like an endocrine organ. So, fat cells themselves are not harmless, but rather they impact hormonal function, and are implicated in conditions such as insulin resistance, metabolic syndrome, and type 2 diabetes. “As women gain more weight, a variety of alarming health concerns become apparent, including increased risk of a range of chronic illnesses such as hypertension, type 2 diabetes, and cardiovascular disease,” says Dr. Chery. “In addition, it is important to note the impact that being overweight or obese can have on someone’s self esteem and quality of life.”
Dr. May Jay adds that the risks of weight gain are well known. “There is high blood pressure, heart disease, stroke, diabetes, and of course the general feeling of shortness of breath on exertion,” she says. “Some cancers such as colon cancer and breast cancer have also been linked to obesity. Gaining fat around the middle has been shown to be more important in causing these health risks than weight generally.”
So, if there are many factors making it a bit easier for women to gain weight around the time of menopause, is there anything specific that women can do to prevent this? Or is it simply a case of more exercise and less food?
For women of menopausal age, prescribing exercise can sometimes be tricky, according to Dr. Chery. “You have to take into account many factors including the overall individual health of a person, and any limitations that may be present, for example cardiovascular disease or hypertension,” she says. However, in general, the best advice she could give menopausal women would be to have a varied exercise programme, with a combination of endurance exercise, strength training, and balance exercises. “The goal is to improve conditioning, strength, and overall flexibility and fitness level, all while building and maintaining bone density and mass,” she adds. However, women with severe osteoporosis should not include activities where a fall is likely, and should not do too much high impact exercise. In general, menopausal women should aim for around 150 minutes or more of moderate intensity exercise a week.
Dr May Jay also highlights the importance of exercise when it comes to maintaining a healthy weight. “Current evidence shows that patients who do at least 30 minutes of brisk exercise (that is, exercise that makes you feel breathless) a day have a waist circumference of at least six inches less than people who do not,” she says. Brisk walking, cycling, and swimming are all great forms of brisk or cardio exercise – you don’t need to join a gym. “You may only have previously needed to do exercise once or twice a week to maintain your usual weight,” Dr. May Jay adds. ‘As time goes on, and your hormones change, we all have to exercise more frequently to get the same effect.”
When it comes to fancy diets, Dr. May Jay advises it is best to avoid faddy diets and just keep things simple, eating plenty of unrefined grains, fruits, vegetables, pulses and fish, and reducing consumption of meat and sugar. “A lot of packaged foods and drinks contain a lot of added sugar, which goes straight to the waist,” she adds. “Some of my patients have had fantastic weight loss results just by cutting out their fizzy drinks.”
Finally, Dr May Jay stresses that it is important not to forget the calories in alcohol if weight gain is a concern for you. “Many of my patients come and tell me that their alcohol intake has gradually increased as they reach retirement and have more time to enjoy meals out and holidays,” she says. “Often they haven’t even realised that they are getting through so much alcohol. A lot of central weight gain is due to the calories and sugar in alcohol and drinking in excess can add the pounds to your waistline.”