How does the menopausal transition impact weight management?

A particularly challenging time for weight management for many women is the menopausal transition – which, by the way, can last up to 10 years. Why is it so hard to manage weight during this time?

First, let’s talk about what happens to our hormones in the menopausal transition, as the reproductive function of the ovaries gradually wanes and eventually stops. During the transition years, our hormone levels fluctate between normal reproductive ranges (the range of which itself is quite wide) and menopausal levels. When the menopausal transition is complete, levels of estrogen, progesterone, and testosterone naturally become low or absent. For women having typical menopausal symptoms at the normal age of menopause, it’s not typically required to do lab work to confirm it. If lab work is done, the main hormonal indicator of peri/menopause is called FSH, which comes from the brain, though it fluctuates between reproductive and menopausal ranges during this tranasition time. It’s not typically helpful to check estrogen, progesterone or testosterone levels for signs of perimenopause, as these hormones are highly fluctuant during the normal reproductive cycle and likely won’t settle out to menopausal levels consistently until menopause is fully established.

Now let’s talk about what happens to weight regulation during and after the menopausal transition.

Estrogen actually contributes to our sense of satiety (fullness), so loss of estrogen can result in more hunger and food consumption. Loss of progesterone as well as hot flashes caused by lack of estrogen can cause difficulty sleeping, and we know that poor sleep can contribute to weight gain. Women with obesity have a higher risk of having hot flashes as well. With loss of testosterone, body composition changes happen which favor an accelerated increase in fat mass, and decrease in muscle mass. Having less muscle and more fat decreases our resting metabolic rate, because muscle burns about 3 times more calories at rest than fat. These changes in hormones also make our bodies prone to deposit fat as ‘visceral’ fat, which is fat surrounding the abdominal organs. Visceral fat is the metabolically dangerous fat (as opposed to fat under the skin, called subcutaneous fat), being associated with a higher risk of developing insulin resistance, diabetes, high blood pressure, high cholesterol, and heart disease.

So in summary, the hormone changes that happen in menopause can create the perfect storm of increased appetite, deterioration of sleep, and changes in body composition that slow our metabolism and favor metabolic disease.

So what can we do about this? Are there any specific lifestyle strategies can help? What effect does hormone replacement therapy have? Are there medications that can prevent weight gain in menopause? Stay tuned to find out – another blog post on this is coming up! Subscribe (top right) to make sure you don’t miss out.

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