Article Content 14 min read
Any conversation about losing weight or preventing weight gain during menopause must include a focus on hormones. Women, far more than men, deal with ongoing hormone fluctuations throughout their lives. With perimenopause and menopause, it’s not uncommon for women to gain between 12-15 lbs after the age of 40.
Menopausal weight gain, or hormonal weight gain, is a true struggle for many women. However, rarely do medical professionals talk about it or emphasize the associated health risks. More likely than not, a healthcare provider will suggest that diet or a decrease in exercise are the culprits. Those may be operative, but during the menopause transition (MT), the key factor in weight gain and redistribution is a decrease in hormones that regulate the metabolism.
Nurturing your body during this vulnerable time is paramount. It’s understandable to wish for a more youthful body, but the best way to work toward that is to understand what has changed and remedy the underlying causes. To this end, addressing hormonal weight gain is just one of many health goals you can set for yourself as you move through your MT.
Supplementing estrogen, progesterone, and testosterone via hormone replacement therapy (HRT) is one of the most effective, natural ways to lose weight at this stage. In this article, we will also explore other lifestyle changes that can help. By understanding the source of what is occurring at this time, women can gain access to effective solutions and begin feeling empowered and in control of their health and happiness.
Risks of Hormonal Weight Gain
Weight is correlated to health. People often assume that menopausal weight gain is natural, and in some ways, it is. But “natural” does not necessarily mean healthy or desirable. Throughout the reproductive years, women may notice weight gain around their hips and thighs. However, at menopause, women tend to gain weight around their abdomen and upper back. This shift in fat distribution is also due to the hormonal changes of menopause. This excess weight, especially around the midsection, is called “visceral fat.”
Visceral fat cells can create inflammation reactions in the body and increase insulin resistance. Chronic inflammation in particular can lead to many long-term health risks and diseases. In a cyclical fashion, visceral fat increases with depression and stress, poor sleep, smoking, and drinking sugar-sweetened beverages, and as visceral fat accumulates, depression and sleep disruptions are likely to increase.
Visceral fat puts women more at risk for the following:
High blood pressure
Cancer - specifically colon, breast, uterine, esophageal, kidney, and pancreatic
Type 2 diabetes
In addition to these more serious concerns, excess hormonal weight gain tends to lead to vaginal changes and lower libido, reduced energy and mobility, poor self-image, and more.
Say goodbye to hormonal weight gain
The Relationship Between Hormones and Weight Gain
Menopausal weight gain is directly related to the decrease in the production of hormones and how different systems work together in the body. A delicate balance is required to maintain a healthy weight, and even small shifts in hormone levels can have significant effects.
Estrogen and progesterone are called “sex steroid hormones” and are involved in the function of the metabolism, as well as the accumulation and distribution of fat. 1Estrogen regulates feelings of hunger, keeping the pace of the metabolic rate and monitoring the accumulation and distribution of fat. 1,17-25At appropriate levels, estrogen can regulate and reduce food intake.1
Progesterone acts as a natural antidepressant and can enhance mood and relieve anxiety. It stimulates the ‘feel-good’ center of the brain. If progesterone levels drop, anxiety and depression can follow. 11-17Progesterone starts to drop when a woman is in her 30s, and the levels sharply decline during perimenopause. Research has shown that supplementing with progesterone helps to relieve anxiety, irritability, and nervous tension.17,18,19
Symptoms of low estrogen & progesterone include the following:
Insomnia and night sweats
Vaginal dryness and thinning
Moodiness or irritability
Dry and sagging skin
Cortisol is known as the “stress hormone,” or the “fight or flight” hormone, and at too high of levels, it can cause visceral fat deposits. 10When the mind perceives stress, cortisol is released into the bloodstream. If too much cortisol is released, it can lead to overeating and weight gain, especially in the midsection. 6Cortisol has a direct interplay with other hormones related to weight, sleep, and mood. High cortisol is also linked to depression, food addiction, and sugar cravings.14
While meditation and exercise are great ways to reduce stress, sleep is also critical for stress reduction. If sleep is disrupted, like when night sweats occur, cortisol levels shoot up. High levels of cortisol will deplete the “happy brain chemicals” serotonin and dopamine, leading to depression or mood swings. People with depression often have very high cortisol. 17Eating a balanced diet, managing stress, and sleeping at least 7 hours per night can help normalize cortisol production.
Insulin regulates fat storage - specifically how much fat to store, where to store it, and how much to use as energy. Insulin imbalances can lead to weight gain, obesity, and eventually type 2 diabetes. This is age-related and at least in part due to lower circulating hormone levels.
Leptin is a hormone made by fat cells that can decrease appetite. Leptin signals the brain that a person is full. When working correctly, leptin will send signals to thebrainthat the body has enough energy stores (body fat) and doesn’t need to eat again. Some call it the “satiety hormone.” If leptin fails to send the right signals, or if the amount of leptin released isn’t accurate, a person will not feel full and is likely to then overeat. 6This doesn’t occur when leptin levels are balanced and there is good communication between leptin and the brain.Regulating leptin is one of the roles estrogen plays in the metabolism. Too little estrogen then means too little leptin, and this can lead to leptin resistance: chronic sensations of hunger and potential obesity.1
Ghrelin, sometimes called the “hunger hormone,” increases appetite and also plays a role in body weight. It is released from the stomach, communicates with the brain, and signals hunger. Ghrelin is what helps the body identify that the stomach is empty. It plays a big role in determining how quickly hunger returns after eating (generally about three hours). When in balance, ghrelin levels are low after a meal, and they increase as the stomach empties.6
The Thyroid Gland plays a major role in mood and regulating how many calories a person burns i.e. the metabolism. 17If thyroid hormones are low, or not working properly, weight gain, fluid retention, hair loss/thinning, and depression can all result. Estrogen helps regulate thyroid cells and directly impacts the metabolism.15
Testosterone plays just as important a role in menopausal symptoms as do estrogen and progesterone. Testosterone is typically identified as a male hormone, but women produce and need it too. Testosterone helps maintain muscle and even partners with other hormones to regulate fat distribution and base metabolic rate. 22-23Similar to estrogen and progesterone, testosterone peaks when women are in their early 20s, starts to decline in their 30s, and sharply drops during the menopausal years. On average, testosterone levels fall by about 50% by the mid-50s.23-25
Women with lower testosterone tend to gain weight more quickly because they have a lower metabolic rate. Women with more lean muscle mass burn more calories at rest than women with lower muscle mass - even at the same body weight. When testosterone replacement is given at normal levels, it can help with weight loss and prevent weight gain.
Lifestyle Changes to Prevent & Reverse Menopausal Weight Gain
Improve Quality of Sleep: Night sweats can create an endless cycle of fatigue, and without enough sleep, people snack more and consume more calories. 3When the body is sleep-deprived, it produces higher levels of hormones that increase your appetite (ghrelin and cortisol). 7If sleep is regularly disrupted, cortisol increases and weight gain is inevitable. Using a fan, a cooling pillow, and even a white noise machine are all great options for improved sleep.
Address Mental Health: Women in menopause have an increased rate of anxiety and depression, and suicide rates are at their highest for women in their menopause years. 10Research shows that those who suffer from depression and anxiety are more likely to gain weight over time and become obese than those who don't. Sadly, societal stigmas still shame people out of seeking treatment for mental health, but it is of paramount importance.
Get Moving: Whether menopausal women move less due to a lack of energy, embracing a slower pace of life, or not having kids to chase after, many are sitting for the majority of the day. This sedentary lifestyle makes losing weight difficult, and sitting too much has been compared to smoking with regards to its adverse effect on overall health. Walking for a few minutes or simply getting up from the desk can make all the difference. Movement does not necessarily have to be a special event set aside at a certain time of day. Because overuse or injury and aging bones and joints may preclude women from doing the same kind of exercise they used to do when they were younger, being active might look different now. Short bursts of energy throughout the day are considered effective in preventing weight gain. Even moving while talking on the phone or just taking a break every hour from sitting can be helpful; some people call this ‘exercise snacking’. 25Exercise snacking several times a day can lead to meaningful gains in fitness and overall health. It can be taking the stairs every time you go to work, or choosing to park your car farther from the store for some extra walking.
Switch Workouts: If formal exercise is your thing, vigorous physical activity for 4 hours a week can mitigate the health risks of a sedentary lifestyle. Not only does exercise burn calories, but it also increases muscle. However, the body burns calories less efficiently with age. For example, you won’t burn as many calories from walking on the treadmill for 30 minutes at age 55 as you did at say 35. The same effort just doesn’t reap the same rewards. Changing up the kind of physical exertion you ask of your body may help overcome a workout lull and boost your metabolism and muscle mass.
Pay Attention to the Metabolism: Women naturally lose bone and muscle as they age, which causes the body to significantly reduce its resting metabolic rate (RMR). RMR is the number of calories the body needs to complete simple daily activities. When muscle mass decreases, a woman in her MT can burn 500 fewer calories per day. At that rate, intaking the same amount of calories as before, a person would gain 1 lb per week, or 52 pounds in just one year! Starting at age 30, women naturally lose about half of a pound of muscle mass per year. By age 50, that can be 10 lbs of lost muscle, and likely fat has replaced muscle. Eating fewer calories encourages the body to burn stored fat, resulting in weight loss. However, if all of the stored fat is used, the body will start to burn protein for energy - this is when the body starts to break down muscle. It is important to find the sweet-spot of calorie intake, where your body is burning fat, (not storing it), but not burning protein.
Eat More Nutritiously: To reduce calories without skimping on nutrition, choose more fruits, vegetables, and whole grains, particularly those that contain more fiber. Fiber swells and makes you feel full with less food. Alcoholic beverages add excess calories and increase the risk of gaining weight. It’s harder to metabolize alcohol in menopause, and many women say that drinking makes mood swings, hot flashes, and insomnia worse. Doctors warn that alcohol can also be more dangerous overall as women age.24
Tune in to Taste: The ability to perceive taste on the palette is influenced by blood hormone levels, and sensitivity to taste changes with menopause. For example, the ability to taste sweetness decreases when estrogen levels drop, and the sensitivity to bitterness decreases with lowering progesterone. 3Each human is born with nearly 10k taste buds, but as women age, the number of taste buds decreases and the remaining taste buds shrink in size. Women also produce less saliva as they age, which we need to emulsify/break down our food and help the taste buds sense the incoming taste. Decreased sensitivity to flavor often leads to eating more to feel satisfied. Choosing foods high in butter and salt will yield more flavor, but they are more caloric. Drinking sugar-sweetened beverages like juice, energy drinks, flavored water, and sweetened coffee and tea is a tempting remedy for a decreased sense of taste, but those beverages account for an excess of empty calories that can increase weight gain.
Intermittent fasting: A hot topic of late, intermittent fasting is choosing not to eat within certain time limits. Some choose to eat normally most days of the week and fast on weekends. Others designate windows of eating and not eating within 24 hours e.g. 16 hours of fasting and 8 hours within which to eat. Even another approach is fasting every other day. While many swear by it, there is no evidence to prove the effectiveness and sustainability of intermittent fasting, and we have little data on long-term repercussions. So, proceed with caution - the jury is still out.
Say goodbye to dryness. For Good.
Why Take Hormone Replacement Therapy?
While the genetic factors related to weight and fat distribution can’t be altered, menopausal weight gain can be prevented and reversed with a proactive approach that deals with the natural decreases in the hormones estrogen, progesterone, and testosterone. Lifestyle changes are a great start, but HRT gets to the underlying cause and helps regulate and balance the interplay of hormones in the body that affect the ability to maintain weight.
When menopausal women start taking HRT, they tend to have less body fat, especially around the abdomen.3HRT has been proven to decrease blood levels of ghrelin, so you don’t feel hungry as frequently or as strongly.7 HRT has far reaching effects on many menopausal symptoms, and it has been shown to reduce night sweats more effectively than any other treatment, allowing for restful sleep, decreased anxiety, and ultimately weight loss.3
There are natural ways to lose weight during menopause, but the best and most effective way is to pay attention to and remedy the hormone fluctuations that are occurring in the body at this time. HRT is a great natural option for weight loss and maintenance, because it directly addresses those declining levels of estrogen, progesterone, and testosterone.
In addition to weight management, HRT can improve myriad other symptoms you may be experiencing as a result of hormone fluctuations. These can include, but are not limited to, fatigue, sugar cravings, bloating, trouble sleeping, hot flashes, vaginal and urinary changes, anxiety or irritability, and persistent stress.
Some companies charge high fees for blood, urine, or saliva testing for hormone levels. However, because your hormones can fluctuate daily at this time, these tests are largely unreliable and unuseful. The best indicator of where you are in your MT is assessing your own symptoms. While that assessment is straightforward, hormone regulation is complicated. The body’s hormones are all interconnected, and hormone systems must work in harmony and continually rebalance in response to physical and emotional events.
Winona is not just a place to get a quick prescription. At Winona, we strive to provide our patients a unique experience. Winona’s healthcare platform is a place to safely and privately connect with a healthcare provider to receive care and to ask difficult and maybe even embarrassing questions. The decision to treat, and whether to prescribe a product available through Winona, is up to the patient and their Winona-affiliated providers, all of whom are licensed, board-certified, and never financially motivated to prescribe.
Winona is proud of our doctors, providers, and scientists who work tirelessly to treat symptoms of menopause in the most effective ways. That treatment might be a prescription, or it could be one of our many over-the-counter options, but it will be the plan that the patient and their doctor devise together. We pride ourselves on our personalized service to our patients, and Winona is here for you 24/7 for treatment, guidance, and support.
“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”
Glaser, Rebecca and Dimitrakakis, Constantine, “Testosterone Therapy in Women: Myths and Misconceptions.” Maturitas, Vol 74, issue 3, 2013, 230-234
3. Davison, S.L., et. al, “Androgen Levels in Adult Females: Changes with Age, Menopause, and Oophorectomy.” The Journal of Clinical Endocrinology & Metabolism, Vol 90, Issue 7, 2005, 3847-3853