Weight Gain during the Menopausal Transition
What is the deal with weight gain during the menopausal transition? Is this due to aging in general or due to menopause and hormones specifically? Do we really know what causes this phenomenon? While more studies do need to be done, here is what we do know….
Increased Fat and Decreased Muscle– The SWAN study (Study of Women’s Health Across the Nation) showed that during the menopausal transition (2 years prior to the final menstrual period through 4 years after the final period), fat mass (% body fat) increases and lean mass (muscle mass) decreases. Weight also increased throughout the menopausal transition remaining stable in postmenopause (starting about four years after the final period). This is not dependent only on age, but directly related to the decrease in estrogen levels surrounding menopause.
Average weight gain – Most women gain about a pound per year during the menopausal transition. However, up to 20% of women gain as much as 10 pounds or more during this time.
Meno Belly – This is the term for the fat accumulation around the mid-section that can happen with menopause. Estrogens are generally responsible for fat deposition around the hips and thighs. However, androgens (male-type hormones) are responsible for fat deposition around the mid-sections. When estrogen levels decrease during the menopausal transition, there is a tendency for women to start storing fat around the mid-section, and this can also be associated with a higher risk of cardiovascular disease (especially when waist circumference exceeds 35 inches).
Less Fidgeting – One study showed that women during the menopausal transition do not consume considerably more calories, but spontaneous activity (not intentional activity such as exercise, but spontaneous activity such as fidgeting) dramatically decreased when estrogen levels fell around menopause. This resulted in increased weight and increased body fat percentages.
Can Weight Gain and Meno Belly Be Prevented?
Is there anything we can do to prevent our bodies from turning into something we don’t recognize as we age or is menopause just dooming us to fat around the mid-section and inevitable weight gain? The good news is that there are things we can do to help!
Preventative Lifestyle Changes – One study showed that women who started a diet and exercise program during perimenopause successfully prevented weight gain during the menopausal transition. This lifestyle intervention consisted of a reduced calorie diet and moderate exercise.
Increase Protein Intake – While you don’t need to eat keto (and that is often not sustainable and cuts out many healthy foods like fruits), studies do show that adequate protein intake can prevent muscle loss and help maintain better body composition. Some researchers think that our bodies need extra protein during the menopausal transition. When we don’t get this protein, we start craving other things (read: carbs). Eating 0.8-1g of protein per kg of body weight can help prevent weight gain and body composition changes associated with menopause. (Take your weight in pounds and divide by 2.2 to get your weight in kg. That is how many grams of protein your should try to eat per day).
Add Resistance Training – Most of us know that we need cardio to burn calories and keep our hearts in shape. But, we also need to add in resistance or strength training at least 2-3 days per week. This keeps our muscles strong, which prevents the lean or muscle mass loss that can come with menopause. It also increases metabolism which keeps us burning calories all day long (even when we’re sleeping!)
MHT– While Menopausal Hormone Therapy does not cause weight loss, it may help prevent some of the tendency of fat to accumulate around the mid-section. This effect is small and should not usually be the main reason to start hormones. However, if you are young and healthy and otherwise a good candidate for hormone therapy, it could be something you can discuss with your doctor.
What if I am Overweight or Obese Before Menopause?
Women who are already overweight or obese before the menopausal transition may have more difficulty preventing weight gain during this time. They may also struggle to lose weight and keep it off. Obesity is a chronic medical condition that is treated as such. If this is you, the good news is that there are medications to treat obesity that are very effective and can be used at any time, including during the menopausal transition! Talk to your doctor if you think you may be a candidate for these. (Anti-obesity medications are generally for women who have a BMI >30 or >27 who also have a medical condition related to their weight AND who have previously tried to lose weight with diet and exercise and have been unable to do so OR have lost weight and have been unable to keep it off.)
Have questions or comments? Have an idea for my next blog post? Send me a question or leave me a comment!
Best,
Jackie Stone, MD
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