ORIGINALLY POSTED FEBRUARY 2019, UPDATED AUGUST 2021
Ok, let’s be real. I’m about to turn 51 and most of my pants don’t fit. I am not thrilled with this turn of events. Not because I’m super body conscious per se, but because new wardrobes are expensive! Over the past 5-6 years I’ve noticed a real change in my body, how my weight is distributed, my energy levels and my post-workout recovery time. These are not fun changes. And frankly, I’m a bit pissed off.
As a healthcare professional, you might reasonably think I would have all the answers, but I don’t. And that makes me even more cranky. But rather than just sulking and eating chocolate by the handful, I decided to do my research and try to get on top of all of this. So this is my little love letter to all of you ladies who are also going through the joys of perimenopause (“the menopause transition”) or are recently post-menopausal (e.g. you’ve not had a menstrual period for over a year). Because dammit, people don’t really talk about this enough!
Body Changes & Weight Gain : Seriously, what the hell?
Changes in hormonal levels cause a bunch of cascading reactions in our bodies starting anywhere around ages 45-50, and for some individuals, even earlier. Plummeting (though often, hormones rise higher than normal before making a cliff dive to super low levels) levels of sex hormones estrogen, progesterone, testosterone wreak havoc on myriad issues and tissues in our body.
As hormone levels fall, our body tries to compensate, because estrogen is critical to bone health, managing our cholesterol level and helping to regulate mood, body temperature and libido.
Thus, fat cells become an increasing source of circulating estrogen - especially abdominal fat cells. Yes therein lies part of our midlife, midbody weight gain. And, unfortunately these fat cells are not all that efficient at estrogen production, so fat accumulates in ongoing efforts to compensate and protect our bodies from bone loss, high cholesterol and increased risk for heart disease.
Metabolism also shifts during the menopause transition, though it’s not exclusively linked to hormonal shifts. As we get older, our metabolic rate slowly starts to wane. Our body muscle mass starts decreasing after age 30 (yes, you read that right!), where we lose anywhere between 3-5% of our total muscle mass each decade. Muscle requires a few more calories than fat to maintain, so as we lose muscle, our body’s calorie burning furnaces also slow down. (Note: For some mind blowing new science on the topic of metabolism and aging, check out Abby Langer RD’s August 2021 post on a recent study that sheds new light on the phases of life where our metabolism shifts. It’s not exactly as we once thought!).
It also turns out that in menopause, your body tends to burn less calories and less fat doing the same exercise it used to (truly unfair). And, our body’s rate of fat oxidation (where our body breaks down fat) is also reduced. Additionally, as we age, we often lose flexibility and our recovery time following hard workouts is a lot longer. We just don’t physically bounce back the way we once did. This can mean we exercise less or not vigorously enough to keep the metabolism stoked. This can contribute to body changes.
Sleep issues that accompany perimenopause and menopause (hello nighttime hot flashes) can also affect nutrition and weight. Hormonal changes that result from lack of sleep (decreased leptin, increased ghrelin) can increase hunger and make it harder to make good food choices. Lack of sleep can also affect cortisol levels (which can have a direct affect on belly fat) and blood sugar regulation. Fluctuations in insulin and blood sugar can also cause stress in the body and increase potential for fat storage, and increase the risk for metabolic issues such as type 2 diabetes.
Finally, the hormonal shifts can also affect our emotional and psychological well-being. Anxiety and/or depression can be new issues for some of us at menopause as we fear being less “relevant” as a woman in a youth- and thinnness-oriented patriarchal society (and this is a topic for a whole other blog post!). Medications for these issues can also affect metabolism, appetite and hunger/fullness, which can influence further body changes. Food/eating can also be a very common and normal coping mechanism for many, and there is NO SHAME in this. In fact, certain foods (hello delicious carbs) are critical to mood and emotional well-being, as they help in the process of serotonin (a feel good neurotransmitter) production. So self-care to protect your SUPER IMPORTANT mental and emotional health, can also impact body weight in some cases. (AGAIN: THIS IS OK! “HEALTH” IS NOT HEALTHY WITHOUT GOOD MENTAL AND EMOTIONAL HEALTH).
So it’s not your imagination. Your body IS changing. And it’s not something that we can avoid, though we might some days wish to turn back the clock. Rather than running headlong into aggressively restrictive diets excessive exercise and self-hatred, let’s together take a collective deep breath and try to take care of this one amazing body we have. Because it’s gotta last us for a few more decades!
How to Cope With Menopausal Changes in Your Body
Besides just feeling cranky, there are a few things you can do to help maintain overall health as you grapple with some of these menopausal changes.
See your doctor for a complete physical. Check your cholesterol, blood sugar, blood pressure and hormone levels. Also check things like thyroid, iron and B12 levels, as these are also energy regulators in your body. Make sure there isn’t something that’s off and causing your body to struggle with energy regulation. Thyroid issues can be common during the menopausal transition, so even if you don’t have a history of thyroid disorder, get your levels checked!
Avoid restrictive diets. Calorie cutting, watching your macros, keto, paleo, intermittent fasting, WW, Whole 30, Noom, Dukan, South Beach, these are all restrictive diets (don’t be fooled by the “it’s a lifestyle” claims…) and can affect your overall bone health and further crash your metabolism. Studies have shown that severe calorie restriction can cause major deficits in lean body and bone mass in postmenopausal women (and honestly, cyclic dieting in general is a big negative on our bodies. More on this in a future post). We need this lean muscle mass and these strong bones now more than ever in this time of life - please don’t sacrifice them for a smaller pant size!
Eat regular meals versus snacking and grazing. Every time you eat something your body goes through a cycle of producing insulin to help shuttle newly-ingested glucose from your bloodstream into your cells. As we get older, sometimes the pancreas may struggle to properly match insulin release with incoming glucose from meals, leading to overproduction of insulin (and possibly, insulin resistance) and/or challenges with low blood sugar. Low blood sugar can then lead to increased hunger and cravings for sweet or high carb/high fat foods. Eating 3 squares per day can help keep this cycle from getting further out of whack. (For athletes and active women, a snack or two pre- or post-workout can also be important to ensuring sufficient energy levels).
Consider a lower carb diet. No, this doesn’t mean you need to cut out all carbs (especially NOT fruits and veggies and whole grains!) or go keto, but there is some scientific evidence that a lower carb diet can help with blood sugar and hormonal regulation that may get a bit out of whack with the arrival of menopause. Aiming for 30-45g of carbs per meal and 15-30g per snack is a good rule of thumb. *Note: If you are very athletic and exercise more than 30 minutes daily, you will likely need more carbs to feel and perform you best.
Make sleep a priority. Practice good sleep hygiene by keeping a cool bedroom at night, going to bed at the same time every night, keeping screens and smart phones out of the bedroom (or at the very least, off for an hour or more before bedtime), limiting alcohol intake and avoiding caffeinated beverages past noon. If you struggle with things like reflux/GERD, also make sure to eat your last meal no later than 3 hours before bedtime. Nighttime heartburn isn’t the key to good sleep.
Exercise regularly. 150 minutes per week is the minimum recommendation for good health, and more can definitely be helpful as our metabolism starts to lag. Aim for a variety of activity that includes cardiovascular exercise, strength or resistance training and flexibility training. I find I don’t recover well anymore after hard CrossFit or HIIT workouts, so I aim for 3 days per week of that, plus 2 days of yoga or cycling and 1-2 days of walking or running. And if I’m really tired and wrung out, I just walk. Elevated stress from working out too hard can lead to a high cortisol response and a trend toward fat accumulation. PRO TIP: If you’re not already doing strength training, now is a good time to start to help ward off aging-related loss of muscle or bone mass. Lift heavy s*it regularly! It’s great for your body, your bones and your mobility and it makes you feel like a badass!
Eat lots of fruits and veggies! Rather than focusing on a fad diet or a list of foods you need to cut out, I recommend tracking your daily fruit and vegetable intake. I find that by getting at least 6-7 servings of fruit and veg daily, plus my daily bowl of morning oats, I get my fiber intake in, which keeps me full, keeps my gut happy, and ensures I don’t have a lot of room for snacks and other not-so-healthy foods. Now don’t get me wrong, I still eat chocolate. Daily. But by aiming for high fiber intake, along with moderate fat and protein intake, I don’t have as many sweets cravings as I used to during times of low sleep or hormonal fluctuations.
Tune into your body and get curious. As our body changes, our nutritional needs and our ability to undertake certain types of activities may change. If you’ve always been doing a certain type of exercise or sport, and now you feel slow and sluggish, I hear you! But maybe now is a great time to explore something new that feels even better (and fun!). Fighting our body causes us angst and frustration. Get curious: What foods make you feel energetic and vital? Which ones make you feel cranky or slow? Try to notice and stay open to what your body is telling you.
Focus on TOTAL health. Dial in your exercise, sleep, nutrition, and stress management, get regular medical checks, supplement vitamins or minerals as appropriate, and live a full and happy life. While there can be health risks associated with too much weight gain during menopause, we also can’t set the clock backwards. We’re in the phase of life we’re in. And really, aren’t you glad you’re not 20 anymore? Also, as previously noted, stressing about weight is contrary to overall good health.
Talk with your doctor about hormone replacement therapy. It’s definitely not right for everyone, but it can make a world of difference, even at very low doses, for some individuals in terms of energy, better sleep and weight management. (p.s. Check out this great podcast on Menopause Hormone Therapy for some great research on this topic. It’s not as scary as we may have been led to believe by popular media).
Before taking any vitamin, mineral or herbal supplements, talk with your doctor. There are a lot of supplements out on the market that claim to help “balance hormones,” relieve hot flashes or increase metabolism, but there is very limited science to support this. The few that have some reasonable evidence include black cohosh, soy isoflavones and red clover extract (and of course, calcium and vitamin D for bone health), but some of these may cause interactions with other medications or medical conditions, so it’s important to chat with your healthcare provider first before taking them.
Enjoy life! This is another new phase of life, and one where there’s not a lot you can do to change how the body naturally functions. You are not your body. Your body is just the package that takes you along for this great adventure called life. Try to enjoy the ride! (Yes, I’m still working on this one too!). ❤️
Yours in good health and stretchy jeans,
Diana