How weight gain in menopause can kill you – and what to do about it!

It was the middle of 2020 deep into the lockdown because of COVID 19. I got a desperate call from my friend Deepa. “I don’t know what to do – this weight gain in menopause is so hard to get rid of! I am so tired all the time and none of my clothes fit. I am sick and tired of going hungry and not eating what everyone else is eating. I want to give up now!” She was in tears.

Deepa was turning 50 and being at home had led to her weight spiraling out of control. She was also diabetic and hypertensive and had heavy periods that left her exhausted and drained.

weight gain in menopause
The weighing scale – a curse of weight gain in menopause

Her self-esteem and confidence had hit rock bottom and she was desperate for a way out of the mess she was in. Her menopause transition had caught her unawares.

Besides this, she hadn’t realised that her weight gain was the cause and the effect of all the problems she had, including her heavy periods. As you read further you will know that the weight gain was preventable too.

Menopause is defined as the time when there are no periods for 12 months and the time around this last period +/- 5 years is called the perimenopause. The perimenopause transition is a difficult one for most women – about 80% of women suffer some symptoms and for 15% they can be intolerable.

Is weight gain in menopause in India getting worse?

Weight gain in menopause can be an average of 1-2 kg and fat distribution can shift from the hips to the waist causing that dreaded menopause belly that doesn’t shift.

For many Indian women, this extra weight is compounded by poor lifestyle choices and lack of exercise. This means they put on much more than the expected 1-2 kg as they go through the menopause.

Common myths at this time mean that they blame their thyroid gland, their metabolism or their parents for this complication in their lives!

In the Indian context, the proportion of overweight/obese women increases from 4% at younger age to 34% at middle and older age which coincides with the menopause transition. (National Family Health Survey NFHS-4, 2015-2016. Mumbai, India)

By 2026 nearly 400 million perimenopausal women in India will develop obesity. At this stage women need to contend with the menopausal symptoms as well as the various complications of being obese.

These complications often impact their entire life beyond the age of 50 and can even lead to untimely death and disability.

The side effects of weight gain in the menopause that can significantly shorten life span and affect quality of life are diabetes mellitus, hypertension and related illnesses like heart disease, kidney disease and dementia. These complications are all associated with a reduced life span and poorer quality of life than those women who do not have these lifestyle diseases. (Rathnayake N et al, 2017)

Simple strategies to lose weight during menopause can reduce the risk of these complications and improve survival and quality of life.

Women want to be fit, slim and sexy but the real advantage is increased energy and vitality, better resistance to infections and an ability to handle life with resilience. Maintaining an ideal body weight through the menopause and beyond really can change their health trajectory.

If Deepa had known this and applied some of the strategies discussed in this article, she could have prevented this excess weight gain as she transitioned through the menopause.

Nonetheless, she did apply them with my help and successfully shed unwanted fat over the following 3-6 months. She has kept the weight off and is happier than she has ever been before.

Is there such a thing as unwanted weight loss in menopause?

Contrary to this was my other friend Mira – she was losing weight, feeling weak and suffering with digestive problems. Her question to me was “Why am I losing weight in menopause?”

We know that estrogen levels in the body decrease as a woman goes through the menopause. This is because of the decreasing number of follicles in the ovary that normally produce estrogen that circulates in the system. Several other hormones like testosterone, progesterone and cortisol that are part of the hormonal system that also get affected during the menopause.

The decreasing levels of estrogen and testosterone contribute to decreasing muscle mass. This is called ‘sarcopenia’ and it is a major reason for deterioration in quality of life as we age. Sarcopenia often results in ‘fraility’ which means an overall weakness unrelated to food intake that results in the person restricting activities. Fraility also means an increased risk of falling and fractures which significantly shorten life span.

Weight loss in the menopause needs to be fat loss and NOT muscle loss.

Unfortunately, the diets that menopausal women follow can often lead to a depletion of muscle mass rather than fat loss. Excessive aerobic exercise can also lead to muscle loss if the nutritional need for increased protein is not met.

A dedicated effort to build and maintain muscle mass is required during the menopause to prevent this condition. This often goes against the common understanding that menopause is only about losing weight.

It isn’t about just losing weight. It is about losing fat and building or maintaining muscle mass.

So, why do women gain weight in menopause and what causes weight gain in menopause?

The problem of obesity is rising at an alarming rate, with a greater number of women affected than men. This trend is particularly noticeable in women going through the menopause. It is attributed to all the hormone heavy stuff that the female body is exposed to i.e.  pregnancy, lactation, and menopause.

International studies also show that almost 39% of women undergoing menopausal transition are either overweight or obese.

There are a number of hormonal changes, such as decreased levels of estrogen and increased levels of circulating androgens, that lead to weight gain, particularly in terms of visceral fat. Visceral fat is the fat that surrounds the organs such as the heart, liver, kidneys, spleen and intestines.

As women go through menopause their visceral fat increases by 44%. This leads to that typical appearance where the woman seems to lose her waist and feminine shape.

Many additional factors like reduced physical activity, ready convenience food, fast food, carbonated sweet drinks, emotional eating, depression and anxiety contribute to increased body fat and loss of muscle mass. Additional contributors are alcohol consumption and smoking.

what causes weight gain in menopause
Junk food, carbonated drinks, convenience food, fried food causes weight gain in menopause

Women often ignore their own health in favor of caring for family members. They don’t seek help until they are too unwell to work or care for their family. This also means that they are less likely to be committed to their weight loss goals and the consequent health problems arising from the resulting obesity.

What hormones cause weight gain in menopause?

Menopause is characterized by a decrease in estrogen levels. Additionally, progesterone, testosterone and cortisol play an important role in the changing balance of hormones in the system.

The role of the liver in the metabolism of these hormones as well as the effect of these hormones on the hunger hormones has been the subject of intense research in the past 20 years.  

The androgen group of sex hormones – testosterone in particular – increases the deposition of abdominal fat – leading to that typical apple shape and loss of the feminine waist. Post-menopausal women have a 4.88 fold higher risk of developing abdominal obesity compared to premenopausal women. That’s a huge increase.

In women, abdominal fat acts like an endocrine organ and converts androgens into various forms of estrogen. Unfortunately, these byproducts don’t protect the woman from developing diabetes or heart disease.

Why do women gain weight in menopause
Waist circumference greater than 35 inches is a risk factor for Diabetes mellitus, hypertension, heart disease, cancers and dementia

Estrogen and weight gain in menopause

Estrogens allow women to keep deposits of fat under the skin on the thighs and buttocks. 

Fatty tissue in women also plays an important role in determining how hungry a woman feels through a number of unique hormones called adipokines. One such important hormone is Leptin. Leptin inhibits appetite. Estrogen increases the activity and receptivity of Leptin. As women go through the menopause estrogen levels fluctuate so do leptin levels.

That’s why there is so much difficulty following low calorie diets. The body’s biology doesn’t allow hunger to go unnoticed and will power doesn’t work very well.

Contributing factors to obesity in menopause

Physiological factorsHormonal factorsLifestyle factorsPsychological factors
Aging
Decrease in basal metabolic rate
Decrease in muscle mass
Secondary causes (hypothyroidism, polycystic ovaries etc.)
Musculoskeletal disorders
Low estrogen
Higher androgens  
High caloric intake
Low dietary fiber
Sugary drinks
Processed and convenience food
Erratic meal times
Large portion size
Vitamin D deficiency
Low physical activity
Irregular sleep
Smoking and alcohol
Depression
Anxiety
Mood disorder
Irritability
Emotional eating
Table showing causes of weight gain in menopause

Physiological factors

As women age, they gain approximately 0.5 kg per year. While this is happening, women are losing muscle mass unless they intentionally exercise to build muscle.

Muscle mass is directly correlated with basal metabolic rate. A slow metabolic rate decreases the ability to burn calories effectively. So, it is easy to see how both in combination result in weight gain in menopause.

Other problems that crop up like thyroid disorders also contribute to weight gain in menopause.

Psychological factors

Almost 30% of women suffer with depression for the first time as they go through menopause. This and other negative mental states like anxiety, stress, tension, mood disorders, sex and relationship difficulties, sleep disturbances and problems with body image contribute to emotional distress. This leads to over eating, poor food choices, low will power and general difficulty sticking to a diet plan.

Lifestyle related factors

A sedentary lifestyle combined with energy dense processed foods leads to weight gain. As they get older, women are more likely to prefer lower energy activities. This combined with poor muscle mass leads to weight gain. Convenience food, takeaways, lack of home cooked food and erratic meal times also pose problems for sticking to a healthy eating plan. 

Side effects of weight gain in menopause

Overweight and obese menopausal women have a higher risk of suffering with diabetes mellitus, abnormal lipid profile, heart disease, hypertension, osteoporosis, cancers and dementia.

Excess weight can lead to back pain, joint pain, knee related issues, poor coordination, falls and fractures. Pain with movement affects activity levels, which then affects metabolic rate and the vicious cycle is set.

Obesity and abdominal fat deposition are risk factors for cancer of the breast, endometrium and uterus. It is also a risk factor for complications like chronic kidney disease, chronic liver disease (fatty liver), obstructive sleep apnea, and sexual problems.

side effects of weight gain in menopause
Weight gain in menopause is associated with increased risk of heart disease and hypertension

Estrogen deficiency also affects a woman’s blood pressure and the possibility of high blood pressure increases at the menopause. Estrogen is responsible for keeping the blood vessels flexible and allowing them to relax. When estrogen levels decrease through the menopause this relaxing effect is lost and hypertension results. At the same time abdominal obesity contributes to high blood pressure.

These harmful effects reduce survival and drastically affect quality of life. Being able to maintain a healthy weight and a normal waist circumference (less than 35 inches) can play a significant role in altering these risk factors. 

How to lose weight during menopause without giving up – identify the pitfalls

A lot of conditions can prevent women from managing their weight as they go through the menopause. Sometimes they cannot keep up the effort long term and slide back to gain all the weight they lost and some more. An ideal strategy will not allow this to happen.

Some conditions that get in the way of effective weight management are:

  • Existing diseases like diabetes or heart disease
  • Poor joint health or pain
  • Psychological and behavioural problems
  • Poor relationships and lack of social support.

Menopause itself favors fat deposition and muscle loss so it is much harder to lose weight during the menopause without a structured plan. Menopause symptoms can also make it difficult to comply with weight loss instructions.

If women fail to lose weight on a plan, they often blame themselves and their self-esteem suffers even more. Therefore, it is important to set up the plan for successes that can be celebrated and failures that can become stepping stones rather than a cause for punishment.

The menopause is a time when most women do find some time to dedicate to their own interests, improve their physical activity and reflect on their own needs and desires in life. This feeling of being in control can help them to implement the strategies that can prevent long term complications of diabetes, hypertension and heart disease.

It makes sense to have a comprehensive plan for weight loss that includes behavioral training, mental assessment and support in addition to targeted exercise and high-quality nutrition.

How to lose weight after menopause

Here is my system to lose weight after menopause naturally:

Phase 1 – Mindset Training

Step 1 – Identify the starting point. Measure waist circumference.

 If it is more than 35 inches pledge to bring it under that number by sticking to the plan until the goal is achieved. Every success story begins with a decision. Tony Robbins says “your destiny is made in your moments of decision”. Success at weight loss could be as simple as just deciding to do it.

Do a meditation to project to a date several years in the future. Look back at the present self to identify the action steps, beliefs necessary to become that healthy, vibrant and slim woman. Write them down and schedule the action steps to be taken today, this week, this month, three months, six months, all year.

Step 2 – Identify the beliefs about weight, ageing and sexual expression that are the obstacles for implementing the nutrition and exercise plan. Use a technique like Emotional Freedom Technique, The Lefkoe Method or Hypnotherapy to eliminate limiting beliefs.

Step 3 – Pledge to love and appreciate yourself as you are now.  A mirror exercise in expressing appreciation and love is very helpful. Marisa Peer suggests writing “I am enough” on the mirror wall. This has certainly helped me a lot.

Step 4 – Learn to breathe deeply – systematic and rhythmic breathing allows the body to reset its sympathetic / parasympathetic system. This lowers stress and therefore cortisol levels. This decreases abdominal fat deposition and improves hunger management.

Step 5 – Plan rewards such as building connections with close friends or relatives, visiting a favorite cinema or music program, indulging in a massage or bath. When these rewards are in place it is much easier to choose them than just eat whatever can be found in the kitchen

Phase 2 – Food and Nutrition

Step 1 – Drink sufficient water. Not too much. 2 litres is enough. Try to finish the quota before 6 pm so that sleep is not disturbed by toilet visits.

Step 2– Take a food audit in the kitchen and systematically remove all processed, sugary and junk food or drinks. Make it easy to make good choices. Either dispose off unhealthy food and drink or make it difficult to access. plan the weeks meals in advance so that being hungry is not an excuse to eat anything that is available

Step 3 – Choose to eat a large amount of fresh and gently warmed or cooked vegetables -up to nine or ten portions a day. Include vegetables, legumes, sprouts. If eating meat or chicken or fish ensure it is organic and chemical contamination is low.

Step 4 –Embrace being in ketosis for part of the time and cycle between being in a fed state and a state of ketosis. This allows the pancreas to get some rest. Avoid loading up on protein as this can also trigger an insulin release and sabotage weight loss. A good menopause diet is a ketobiotic diet that allows a reset of the gut microbiome and also allows for ketosis to happen. Typically, the carbohydrate load is low and preferably from root vegetables and plants. Fruit is restricted to occasions.

Food to include:

Green leafy vegetables, nuts and seeds, beans for bone health. The intake of red meat, carbonated beverages, and certain foods high in phytates needs to be avoided as it hinders calcium absorption.

menopause diet
A diet rich in vegetables is the foundation for fat loss

Iron-rich food (gluten free cereal, pulses, lean meat, egg, spinach, nuts, and seeds) for heavy menstrual bleeding and magnesium (green leafy vegetables, nuts and seeds, legumes) can be consumed for relieving menopausal symptoms such as hot flushes, insomnia, palpitations, and irritability.

Most vegetarians need vitamin B12 supplementation and most women need Vitamin D3 supplementation. It is best to get Vitamin D from exposure to the morning sunlight.

Spicy food, alcohol, and caffeine are best avoided or consumption limited for relief from hot flashes.

Although popular, eating soy products, calcium supplementation, or lifelong fish consumption hasn’t shown consistent results in relieving menopausal symptoms.

Step 5 – Restrict the feeding window – this can be 12 hours, 10 hours, 8 hours, 2 hours or even just 1 hour when food is consumed. When fasting, keep it a clean fast.

Step 6 – Make eating a ceremony without distractions of TV or news. Express gratitude before the meal. Identify the food dialogue that makes eating too fast a habit, and then program it out with a more helpful dialogue.

Phase 3 – Physical activity

Step 1 – Physical activity is best done on an empty stomach – it could be a walk, a gentle run, dancing etc. Exercise needs to include warm up, stretching, strength training, aerobic activity, balance and coordination, and spatial awareness. It is important to do some exercise everyday rather than just on the weekend.

Step 2 – Yoga helps build core strength, flexibility and coordination. It also has advantages in managing various menopause symptoms like hot flashes.

How to lose weight after menopause
Yoga helps build core strength, flexibility and coordination

Step 3 – Muscle building exercises to be restricted to feeding days. Have a plan to increase the intensity and strength training over time.

How to lose weight after menopause
Muscle building exercises prevent sarcopenia and maintain metabolic rate

Step 4 – Weight bearing exercise is necessary for bone health. Walk, jump, skip, or run to reap the benefits

Phase 4 – Build self-esteem and resilience

Step 1 – Sleep hygiene needs careful attention. If sleep is disturbed or inadequate all efforts can get sabotaged.

Step 2 – Meditate or practice quiet reflection in silence. Calming the mind helps to reset the parasympathetic system and cortisol

lose weight after menopause naturally
Meditation and breath work help to reset the parasympathetic / sympathetic system

Step 3 – Get an oxytocin fix – call a friend, stroke the pet, walk in nature, chant, indulge in a hobby, enjoy soup as comfort food, play with kids, play sport, sing, dance, paint or draw.

how to fight weight gain in menopause naturally
Get an oxytocin boost by engaging in a hobby of your choice

Step 4 – Get a support network ready for when its needed. Call a friend, get family to be on your side. Find a colleague or friend to work with.

Conclusion

Weight gain in menopause can shorten the life span of women and significantly affect their quality of life.

It is possible to use good nutrition, programmed exercise and supported activities for mental health to improve overall health and physical fitness.

Muscle strengthening exercises help to keep the metabolic rate up and prevent excessive fat deposition.

Optimal plant-based nutrition helps reverse diabetes, hypertension, heart disease and dementia.

Handling the mental objections and challenges and having a backup reward and plan goes a long way in preventing sabotage or relapse.

Let me know what you liked about this article and which tips you will be implementing. Write to me at masterthemenopause@gmail.com. I look forward to hearing from you.   

References

National Family Health Survey NFHS-4, 2015-2016. Mumbai, India: International Institute for Population Sciences; 2017. International Institute for Population Sciences-IIPS/India and ICF. http://rchiips.org/nfhs/nfhs-4Reports/India.pdf

Latest evidence on using hormone replacement therapy in the menopause Shagaf H Bakour MD FRCOG, Jennifer Williamson MB BCh BAO FFSRHb. https://elearning.rcog.org.uk/sites/default/files/Management%20of%20climacteric%20problems/Bakour_et_al-2015-The_Obstetrician_&_Gynaecologist.pdf

Prevalence and Severity of Menopausal Symptoms and the Quality of Life in Middle-aged Women: A Study from Sri Lanka. Rathnayake N, Lenora J, Alwis G, Lekamwasam S. Nurs Res Pract. 2019; 2019():2081507.

Body mass index and age at natural menopause: an international pooled analysis of 11 prospective studies. Zhu D, Chung HF, Pandeya N, Dobson AJ, Kuh D, Crawford SL, Gold EB, Avis NE, Giles GG, Bruinsma F, Adami HO, Weiderpass E, Greenwood DC, Cade JE, Mitchell ES, Woods NF, Brunner EJ, Simonsen MK, Mishra GD. Eur J Epidemiol. 2018 Aug; 33(8):699-710.

Obesity in menopause – our negligence or an unfortunate inevitability? Jarosław Kozakowski,corresponding author Małgorzata Gietka-CzernelDorota Leszczyńska, and Agnieszka Majos https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509974/. Prz Menopauzalny. 2017 Jun; 16(2): 61–65. Published online 2017 Jun 30. doi: 10.5114/pm.2017.68594

Lifestyle intervention can prevent weight gain during menopause: results from a 5-year randomized clinical trial Laurey R Simkin-Silverman 1Rena R WingMiriam A BorazLewis H Kuller. https://pubmed.ncbi.nlm.nih.gov/14644697/

Weight Management Module for Perimenopausal Women: A Practical Guide for Gynecologists. Sakshi ChopraK. Aparna Sharma,1 Piyush Ranjan,2 Anita MalhotraNaval K. Vikram,2 and Archana Kumari. J Midlife Health. 2019 Oct-Dec; 10(4): 165–72.doi: 10.4103/jmh.JMH_155_19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947726/

Guidelines for dietary management of menopausal women with simple obesity. Anna Brończyk-Puzoń 1Dariusz Piecha 2Justyna Nowak 1Aneta Koszowska 1Karolina Kulik-Kupka 1Anna Dittfeld 3Barbara Zubelewicz-Szkodzińska 1 Prz Menopauzalny. 2015 Mar;14(1):48-52.  doi: 10.5114/pm.2015.48678. Epub 2015 Mar 25. https://pubmed.ncbi.nlm.nih.gov/26327888/

Weight gain during menopause. Is it inevitable or can it be prevented? Simkin-Silverman LR, Wing RR.Postgrad Med. 2000 Sep 1;108(3):47-50, 53-6. doi: 10.3810/pgm.2000.09.1.1204.PMID: 11004935 Review.

Mediterranean diet as tool to manage obesity in menopause: A narrative review.

Pugliese G Dr, Barrea L Dr, Laudisio D Dr, Aprano S Dr, Castellucci B Dr, Framondi L Dr, Di Matteo R Dr, Savastano S Prof, Colao A Prof, Muscogiuri G Dr.Nutrition. 2020 Nov-Dec;79-80:110991. doi: 10.1016/j.nut.2020.110991. Epub 2020 Aug 28.PMID: 32979767 Review.

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