Let’s Talk About Menopause and Weight Gain

Let’s face it, the women who came before us avoided talking about menopause whenever possible and, if it was absolutely necessary to mention this totally natural process of the female body, they’d avoid using the word “menopause,” instead referring to it in cryptic euphemisms like “The Change.” Thankfully, we now live in a time when women can talk about important health issues without whispering or turning to fake names, but it’s easy to see why “The Change” became code for “menopause” for several generations of women.

The fact is, when women reach a certain age (typically their mid-to-late 40s, though perimenopause can begin as early as the mid-30s and, if medically induced, at any age), hormone levels fluctuate, ushering in a wave of changes. In our body-obsessed society, one of the few things many women think they know about this time of life is they will gain weight. Which in our opinion, isn’t the most important thing to focus on during this transition. While it may happen, it’s part of a complex process that involves aging, sleep, changing activity levels, metabolic processes related to BOTH aging and hormones, as well as nutrition. We advocate thinking about your changing body in a holistic, health-oriented, loving way, thinking about the ways you can keep it healthy so you can enjoy it, and all of life it allows you to enjoy, for years to come.

We know that’s a big ask: In a society that uses thinness as a proxy for both beauty and health, getting older — and sometimes squishier — can be emotionally difficult for some of us. So before we talk about this, we want to encourage you to take some time to think about what it might mean to you to have a body shape that’s bigger, differently proportioned, or not the cultural ideal. If you are cool with where you are — FANTASTIC. If it feels charged, we really encourage you to explore ways to make the relationship with food and your body feel better, connecting with a therapist who focuses on these issues, exploring the body neutrality and positivity movements, filling your social media feed with beautiful images of a diversity of body types. Also important to remember: It is completely possible to be healthy in a larger body and unhealthy in a thinner body — thinness does not equal health, and fatness does not equal unhealthy!

Why Is It Easier to Gain Weight (and Harder to Lose It) During Menopause?

While it’s associated with menopause, many women actually begin to notice significant changes to their bodies’ relationship to food and fitness earlier, during perimenopause. Research suggests that the average amount of weight gained during the perimenopausal transition is 2–5 pounds. Part of what makes the weight gain associated with menopause so noticeable is that it’s accompanied by a loss of muscle mass, meaning that, even though the number on the scale may not go up very much, your body can feel significantly different. You may notice that the way your body processes sugar, high carbohydrate food, and alcohol changes, or that your exercise needs are different. Around 40, our ability to build and maintain muscle mass decreases, and if we aren’t doing strength training on a regular basis, the proportion of muscle in our bodies can decrease. Muscle uses more energy than other tissues in our body, so if we have less of it, our need for energy intake (in the form of food) decreases. As a result, if we don’t eat less, we may gain fat. Also, the changes in hormone ratios during menopause can lead to a change in body composition, leading to a redistribution of fat, with more around the belly.

The truth is that, during perimenopause, hormone levels change — specifically, progesterone levels decline steadily over time while estrogen levels begin to seriously fluctuate, sometimes greatly within the same day. Early in this stage, the signals between the ovaries, hypothalamus and pituitary gland get out of whack, causing the ovaries to go into overdrive producing estrogen.

These elevated estrogen levels could be to blame for the weight gain many women experience beginning with perimenopause. Before menopause, high levels of estrogen are already associated with higher levels of body fat and some studies have suggested that the temporary spikes in estrogen as it fluctuates during perimenopause could promote weight gain — and, more specifically, fat gain.

Later, during perimenopause and menopause, estrogen levels fluctuate, but typically dip overall, which could also impact the function of leptin and neuropeptide Y, two hormones responsible for controlling feelings of fullness and appetite. In other words, women in these stages may gain weight because they feel hungry more often and are, as a result, consuming more calories. But also hunger, satiety, our bodies — LIFE — are all super complicated. If hot flashes due to perimenopause are waking you up at night, or you’re just not sleeping well generally, we KNOW that poor sleep dysregulates our metabolism and can increase our appetites, especially for higher sugar and carbohydrate foods. If your brain fog is making work stressful (or maybe it’s just the global pandemic?), we know that increased stress levels also bump up our cortisol levels, which changes our blood glucose levels, the way we eat, and the way we store fat. And all the responsibilities you have right now — maybe kids and aging parents, maybe work, etc — may be getting in the way of your ability to exercise and manage your stress levels. That can ALSO impact the way you eat and how much energy your body needs, thus impacting your weight.

One study found that levels of ghrelin (also known as the “hunger hormone”) were significantly higher in perimenopausal women than in women who were premenopausal and postmenopausal, offering further evidence that women in perimenopause and menopause may experience changes in their appetite that are associated with weight gain.

But, Wait — How Much Should I Really Worry About Menopausal Weight Gain??

Perimenopause and menopause are an excellent time to make sure you are optimizing heart and bone health, both of which are heavily influenced by our activity levels and nutrition. You can assess your genetic and personal risk factors with your health care provider and approach accordingly. We do know that an increase in abdominal circumference (often associated with fat around the organs, and which may show up around this age) is associated with metabolic syndrome — a cluster of hormonal and physiologic changes that include high blood pressure, increased blood sugar levels (pre-diabetes and type 2 diabetes), and negative changes to our cholesterol levels that can increase our risk of heart attacks, strokes, and complications from diabetes, if not addressed. Osteoporosis is a disease of low bone density and associated with the drop in estrogen, low body weight, smoking, and the risk can be mitigated by quitting smoking and engaging in appropriate nutrition and activity levels.

Focusing on some of the healthy nutrition and activity practices mentioned below can decrease your risk for these undesirable health outcomes. While there are general practices that can be helpful for most people, it’s hard to recommend a way of eating that works for every person, and connecting with a nutritionist who is a certified menopause practitioner could be a good place for individualized support. You might also lose some body fat, which we know can have a big impact on the control of blood pressure and blood sugar, if hypertension or diabetes are an issue for you. But if your numbers are good, you are meeting the general guidelines for exercise, sleeping reasonably, and following a healthful diet plan; you can be perfectly healthy in a body that’s bigger than it used to be — or just as big as it has always been.

Is Weight Gain During Menopause Inevitable?

While your body will almost certainly undergo changes during perimenopause and menopause, there are definitely steps you can take to promote your metabolic health during these stages, including following a Mediterranean-style diet (focusing on lots of fresh vegetables and fruit, healthy fats, some legumes, some meats and fish), limiting sugar and highly-processed carbs to minimize metabolic problems, increasing fiber intake, making sure you are at least meeting the minimum recommendations of exercise (150 minutes of moderate intensity exercise per week, though you may need closer to an hour daily to decrease or maintain weight loss, if that is your goal) while modifying your workout routine to include more strength training, which will help you maintain lean muscle, and prioritizing sleep, which promotes metabolic health.

While there are many, many specialized diets marketed to us for “optimal” health, nutrition is notoriously hard to study, and recommending a particular “diet” that works for everyone is impossible. As we mentioned, your body’s energy needs may decrease, so learning to be in tune with your body’s hunger and satiety cues (practicing mindful eating), eating in a way that meets your body’s nutritional needs (with minimally processed foods) can help you not to consume more energy than your body needs. Making sure you are getting enough dietary fiber can be a great way to shift your nutritional plan for the better, as it will naturally lead you to eating more vegetables, legumes, and whole grains, which can help you “crowd out” less optimal foods. This can lead you to feel more satisfied when you eat, prevent constipation, reduce the risk of certain types of cancer, improve your cholesterol levels, and may impact your estrogen levels over time.

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Medical Disclaimer

The information provided on StateOf and On Pause is not intended and should not be construed as medical advice, treatment, or diagnosis. Always seek the guidance of a qualified healthcare provider with any questions or concerns regarding your health.