The peri-menopause weight creep: These 3 things are keeping you stuck

December-2023

I am passionate about treating menopause. Menopause is, without a doubt, one of the most under-supported areas of women’s health. A tissue box sits prominently on my desk for the teary conversations about the loss of sleep, worsened PMS, brain fog, weight gain, and the hundred other body changes that happen at this stage of life. It is a familiar resemblance to my new post-partum life in my late 30s, both myself and patients in parallels of hormonal changes as we try to navigate through this new transition of hormone-hood.

Perimenopause starts as early as 8-10 years before cessation of the menstrual cycle. The average age of menopause in Canada is 51, so this means people who menstruate can start to experience perimenopause symptoms in their early 40s, and sometimes earlier. 

Loss of skeletal muscle mass starts in our early 30s with a continued loss of 3-5% per decade. Perimenopause is a vulnerable period for the loss of muscle mass because estrogen plays a vital role in regulating muscle growth and repair. It is precisely this decrease in estrogen levels that can directly result in a reduction in lean muscle mass.

1. Shifts in muscle and fat composition

This is why many menopause experts have said, “You have to run where you used to be able to walk.” The efforts and strategies that you previously employed just don’t work as well. 

Fat distribution changes in menopause. Visceral fat — the fat around organs deep in the abdominal cavity — increases. The location of where subcutaneous fat is deposited shifts and leads to abdominal fat accumulation. We see a domino effect due to this shift in tissues, including an increase in LDL, cholesterol, and triglycerides; changes to insulin; and an increased cardiovascular risk profile [1]. It can feel like a tsunami of changes.

These shifts in fat and lean muscle mass respond best to resistance training, fibre, and adequate protein. If walking was your preferred form of exercise before, adopting high-intensity intervals in combination with strength training will increase lean muscle. This muscle mass is metabolically active and increases resting energy expenditure by burning more calories at rest. This is one of the most effective ways to combat menopausal-related weight gain. Resting energy expenditure is by far the most important determinant of total energy expenditure [2].

A recent systematic review published in October of 2023 found that estrogen replacement therapy (i.e., menopausal replacement therapy) increases resting energy expenditure by up to 222 calories per day [2]. This suggests a preventative effect of estrogen administration on weight gain and obesity development.

Indeed, hormone replacement therapy (also known as HRT, an outdated term, now known as menopausal hormone therapy) is the GOLD STANDARD for the treatment of many menopause symptoms. As MHT is within my scope of practice to prescribe to patients in Ontario, MHT has been a game changer in my practice for my menopausal patients who have experienced significant quality of life changes due to menopause. 

2. You feel like crap

Simply put, you may just have less energy to do the things you used to do. You may not be sleeping well which affects everything the next day from hunger cues to fatigue levels. It’s not uncommon to be part of the “sandwich generation” when you’re in your 40s and 50s — you’re taking care of aging parents and still raising kids, and you’re tired as hell because you’re busy doing “all the things.”

Your kids may be a bit older and there is less running around after them, or perhaps you’re at the peak of your career which may mean longer hours sitting in front of a computer or in meetings. There is an inverse relationship between aging and “NEAT” activity, where we tend to see less “non-exercise activity thermogenesis” (aka NEAT activity) in our 40s [3]. This refers to the energy expended outside of sports-like exercise, sleep, and eating. So, activities like doing the dishes, picking up toys from the floor, yardwork, and walking to lunch with coworkers become less frequent. Over time, this impacts our BMI.

3. You may experience dietary changes

There are changes in the production of hunger hormones, ghrelin and leptin, that occur in menopause. Less estrogen causes a decrease in leptin (the satiety hormone, or our natural appetite suppressor). Similarly, poorer sleep quality or just less sleep in general can impact the production of ghrelin, a hormone that promotes hunger. These hormonal shifts are coupled with point #2 above, which is that when we’re just too busy taking care of everyone else, we’re more likely to skip breakfast, to snack rather than have a sit-down meal, and consequently to overeat in the evening because we under-fuel earlier in the day and eat too little protein at our earlier meals.

Embracing the changes that come with menopause is perhaps a way to improve mental health during this transition to post-period. You may already be doing everything within your control to support your weight. Just as bounce-back culture is the most ridiculous, unrealistic, exhausting pressure for new moms to “return” to their pre-baby body, such is the same for a person in menopause. The societal expectation that our weight and shape should be the same as it once was before perimenopause is totally senseless and offensive. Our bodies change. They shift to support us as we age. What more can you give it but love?

References:

[1] Opoku AA, Abushama M, Konje JC. Obesity and menopause. Best Pract Res Clin Obstet Gynaecol. 2023 Jun;88:102348. doi: 10.1016/j.bpobgyn.2023.102348. Epub 2023 May 6. PMID: 37244787.

[2] Weidlinger S, Winterberger K, Pape J, Weidlinger M, Janka H, von Wolff M, Stute P. Impact of estrogens on resting energy expenditure: A systematic review. Obes Rev. 2023 Oct;24(10):e13605. doi: 10.1111/obr.13605. Epub 2023 Aug 6. PMID: 37544655.

[3] Chung N, Park MY, Kim J, et al. Non-exercise activity thermogenesis (NEAT): a component of total daily energy expenditure. J Exerc Nutrition Biochem. 2018;22(2):23-30. doi:10.20463/jenb.2018.0013

Dr. Dominique Vanier is a naturopathic doctor in Burlington, Ontario with a focus on digestive health and hormones. As a regulated health provider, she is registered to see patients in Ontario both virtually (online) and in person.