Weight gain in Perimenopause and Beyond

Weight gain in perimenopause is a big topic and no it is not all in your head.

I’m going to try to tackle this one from a different angle than what you may be seeing on social media and the like. There is so much information out there and it can be hard to know where to start.

How about starting from a place of love and respect for your body, rather than hate and disgust? How about making small, consistent changes to feel better about yourself; rather than weight loss driven by deprivation and punishment? Why not focus on positive things to ADD to your life rather than everything you need to eliminate?

The goal should be overall HEALTH.

Weight loss is not the same as fat loss. You can chop off a limb and lose weight but I don’t foresee that being a new tiktok trend. We want fat loss done in a healthy and sustainable way, where muscle mass is preserved.

If weight loss is done in a non-sustainable and unhealthy way it usually ends up with the person gaining all the weight back, and then some. This can also lead to disordered eating and other more serious concerns that are beyond the scope of this blog post.

Everybody and “every body” is different. There will not be one blanket approach that will work for everyone but there are some general principles to guide us.

Why can weight gain happen in perimenopause?

From my research, the top culprits are sleep disturbances, hormone changes and muscle loss. As you will see these overlap and influence each other. Basically, it’s one big, complex, tangled web.

Let’s try to untangle it, shall we?

Sleep and weight gain:

There are many reasons for sleep challenges. With hot flashes, cortisol is produced. So it is not only the hot flashes or night sweats causing you to wake up but also the increase in stress. Cortisol can be good when secreted at the right times, but I’m pretty sure in the middle of the night is NOT ideal. It has also been discovered that women who had the most hot flashes actually gained the most weight.

Estrogen also has a direct effect on mood and depressive symptoms, which negatively impacts food choices, sleep and motivation to exercise. Who wants to make good food choices and exercise when you feel like dog poop? Lower estrogen reduces our ability to burn fat, build muscle and affects how we tolerate carbohydrates. Estrogen also impacts where fat accumulates on our bodies. When we have enough estrogen we have more fat on our thighs and hips, but when estrogen falls we gain fat similar to men– in our tummies, not just under the skin, but also around the organs (the most dangerous type!).

Progesterone helps us relax and acts as a sedative. As progesterone lowers, (starting in our mid 30’s) our ability to manage stress also lowers. How convenient, at a time in our lives when we are expected to be superwomen our ability to manage stress is subpar (what the heck mother nature!?).

Hormones and weight gain:

If you thought I was done talking about sleep, you would be wrong.

Prolonged periods of poor sleep can cause other downstream effects. Many hormones get completely out of whack. For simplicity’s sake, we will touch on two related to appetite: ghrelin and leptin.

I think of ghrelin as a hungry gremlin and leptin as a fat little bunny who has had too much to eat (lapin is rabbit in french, you’re welcome for the visual). Ghrelin tells us to eat more and leptin tells us we are full.

Poor sleep causes ghrelin to increase and leptin to decrease. When these hormones are not working properly you are more likely to overeat and less likely to feel full and satisfied. Increased hunger levels make you more likely to crave unhealthy food.

Chronic stress, sleep deprivation and menopause itself can also lower thyroid function and metabolism. Lowered estrogen puts us at increased risk for insulin resistance. Insulin, shminsolin why should you care? First off, it is linked to some serious health conditions that are no joke (e.g heart disease, diabetes and dementia).

We haven’t touched on emotional eating, which can be very common for men and women of all ages. I don’t think this one needs a scientific explanation. I’m sure we have all experienced it and can see how over a period of time it can lead to weight gain and unhealthy habits. Awareness of these habits is the first step to overcoming them! Being mindful and present while eating and observing how certain foods make you feel can make a world of difference.

Muscle loss and weight gain:

Muscle is not just for making us look good at the beach. It is important for strength, bone health, posture, mobility, metabolic health, positive body composition, and fall prevention. Muscle loss for both men and women starts after the age of 30 and only gets worse after the age of 60. Muscle is more metabolically active, meaning you burn more calories just by having it! So don’t “weight” to make resistance training a top priority!

*Stay tuned for an upcoming blog post by fitness experts specifically for men and women over the age of 50! I’m pumped!*

Action Steps: What can we do about all of this

Sleep:

-Improve sleep, which is easier said than done! I know from personal experience how hard insomnia can be. But if we can improve sleep, we can regulate some hormonal changes that sabotage our efforts and make it even more difficult to lose weight.

So please reach out to us to see if hormone replacement therapy (HRT) may be the thing that improves your sleep and other symptoms!

*Stay tuned for a future post about sleep, stress and insomnia. It is sure to be a goodie.*

Exercise:

-Calories in and calories out is not the only thing that matters. There are many hormonal changes that can lead to muscle loss and fat gain. Exercise is an important piece of the puzzle. As I mentioned earlier, muscle is very important so weight training should be part of the plan and will look different for everyone– based on their health status and baseline fitness levels. The guest exercise post will go into more detail, but I just want to emphasize that muscles are our friends! Walking and other exercises to increase mobility and decrease stress are also great. Extra bonus points if it can be done outside or with friends 🙂

-Ditch the scale and focus on other indicators that show you’re making positive progress. How are your energy levels, stress, and sleep, how do your clothes fit, is your strength increasing in the gym or how consistent have you managed to be? The same 80/20 rule I talked about previously still applies here. Don’t let perfection be the enemy of good.

Diet and lifestyle:

Yo-yo dieting is bad. It is not sustainable and actually makes the problem worse. We want to feed our bodies nutritious food. Calorie restriction and excess cardio will only add more stress to the body, leading to poor sleep, added stress and stubborn weight stalls or gains. We want to nourish our bodies as they deserve! There are so many different diets out there and everyone will respond differently to different types of food, but there are some basic principles to guide you.

What to focus on:

-Eat WHOLE foods, meaning avoid processed foods that come in a box. Eat balanced meals with a protein and veggie serving, with a carb or fat. Make healthy swaps. If you like french fries, make your own at home and pair them with a protein and veggie side. Love something sweet after dinner? Maybe have some greek yogurt and berries with some cinnamon instead of a bowl of ice cream…

-Focus on protein as it will help with muscle maintenance, bone health, blood sugar control and appetite. Also, try to eat it first as it is most satiating. Recommendations vary for how much protein to aim for but one trusted expert encourages 100 grams of protein a day minimum or 1g/lb of ideal body weight. Most people under-consume protein. FYI if you’re eating one egg at breakfast that is only 6 grams of protein! If you make your first meal protein heavy you have less catching up to do later.

What to avoid or swap out:

-Avoid sweetened beverages. There is so much sugar in pop, juice and specialty drinks that can be costly for more reasons than just their price tag. So try reducing or cutting them out and see how your palate adjusts and your body responds.

-Watch caffeine intake especially later in the day and see my last post about alcohol considerations.

-Try to shorten the time period when you’re eating. Giving your body a break from consuming food all the time can help lower insulin and inflammation. This, in turn, can help with weight, metabolic and mental health. This doesn’t need to be extreme; I’m talking about stopping eating 2-3h before bed to help with sleep and aim for a minimum of 12h between your last meal and first meal the next day. Start here if this concept is foreign to you.

HRT can help:

–HRT is a valuable tool in our toolkit that should not be overlooked. If low estrogen and progesterone are the reasons for your sleep issues and other symptoms, then giving the body back what it needs makes sense. Even if the scale doesn’t show weight loss when estrogen is started, many women notice positive changes in their belly fat when menopausal symptoms are under control. Others say that their appetite is more controlled when estrogen levels are adequate. Those are two big wins in my book.

Conclusion and takeaway:

Even when women are doing all the “right things” we can still struggle. We’re expected to just keep functioning at superhuman levels despite enormous changes happening to our bodies, brains and hormones. We all want to feel and look our best but optimal health should be the top goal. That’s where Prosper would love to help you get back to living your best life!

Reference

1. Dirks, A. J., & Leeuwenburgh, C. (2007). Hormone therapy and sarcopenia: the role of estrogen. Menopause, 14(2), 256-263. https://journals.lww.com/menopausejournal/Abstract/9900/Menopause_hormone_therapy_and_sarcodynapenia__the.123.aspx
2. Hoyt, J. R., & Trott, J. (2018). The role of oxidative stress in menopause-associated morbidities. Frontiers in pharmacology, 9, 1186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718648/
3. Huberman, A. (Host).(2023, January 30). How to optimize female hormone health for vitality and longevity with podcast guest Dr Sara Gottfried [Audio podcast episode]. https://hubermanlab.com/dr-sara-gottfried-how-to-optimize-female-hormone-health-for-vitality-and-longevity/
4. Ferris, T. (Host). (2023, January 21). All things sleep with Dr Matthew Walker. The Tim Ferris Show (No. 650), [Audio podcast episode] https://tim.blog/2023/01/21/matthew-walker-sleep-transcript/
5. Jiang, W., et al. (2021). Modulation of lipid metabolism by menopausal hormones: insights and perspectives. Frontiers in endocrinology, 12, 642651. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373626/
6. Kalanick, B. (Host).  (2023, February 16). Weight loss, calories, macros and hormones. Dr Brooke Show (No. 311), [Audio podcast episode] https://podcasts.apple.com/ca/podcast/dr-brooke-show-311-weight-loss-calories-macros-hormones/id1124755635?i=1000599838368
7. Kim, S. W., & Lim, H. (2006). Effects of menopause on body fat distribution and insulin resistance. Obesity, 14(8), 1433-1439. https://pubmed.ncbi.nlm.nih.gov/16918589/
8. Knight MG, Anekwe C, Washington K, Akam EY, Wang E, Stanford FC. (2021). Weight regulation in menopause. Menopause. May 24;28(8):960-965. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373626/
9. North American Menopause Society (1999). Impact of Hormone Replacement Therapy on the Body. Menopause, 6(4), 315-327. https://journals.lww.com/menopausejournal/Abstract/1999/06040/Impact_of_Hormone_Replacement_Therapy_on_the_Body.7.aspx
10. O’Connor, C. (n.d.). Help! I’m heading for the menopause and I can’t control my weight. [Blog post]. Retrieved from https://www.balance-menopause.com/menopause-library/help-im-heading-for-the-menopause-and-i-cant-control-my-weight/
11. Pitsavos, C., et al. (2008). The impact of menopause on body mass index and waist circumference in healthy women: the ATTICA Study. Maturitas, 59(3), 220-225. https://pubmed.ncbi.nlm.nih.gov/18407440/
12. Ruan, Q., Ren, Y., & Chen, Q. (2022). Metabolic effects of menopause: a cross-sectional study. Menopause, 29(4), 390-397. https://journals.lww.com/menopausejournal/Abstract/2022/04000/Metabolic_effects_of_menopause__a_cross_sectional.3.aspx
13. Streicher, L. (Host). (2022, May 15). Menopause and weight gain– Why it happens and 12 tips to take it off. (No 19). [Audio podcast episode]. Dr Streicher’s Inside Information: THE Menopause Podcast. https://audioboom.com/posts/8083859-menopause-and-weight-gain-why-it-happens-and-12-tips-to-take-it-off
14. What causes women to gain belly fat in midlife? (2022). [Newspaper article]. The New York Times. Retrieved from https://www.swanstudy.org/wps/wp-content/uploads/2022/01/NewYorkTimesArticle-WhyDoWomenGainBellyFatInMidlife.pdf
15. Winona, B. (2022). Intermittent fasting and menopause. [Blog post]. Retrieved Jan 31, 2023 from https://bywinona.com/journal/intermittent-fasting-and-menopause
16. Volpi, E. Nazemi, R. & Fujita, S. (2004). Muscle tissue changes with aging.  Curr Opin Clin Nutr Metab Care. 2004 Jul;7(4):405-10 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804956/
17. Feature photo by Jeremy Thomas on Unsplash