I recently polled a large group of menopausal women with the question:
"If you could wave a magic wand and make your biggest menopause challenge disappear, what would it be?"
More than 450 women answered, and the results surprised me. The number one wish, with about 1/3 of the women responding, was to magically disappear abdominal weight gain.
During the menopause transition, weight increases by about 1.5 pounds per year, leveling out about 2 years after periods have ceased (1). There is also typically a noticeable redistribution of weight from the hips to the stomach.
Let’s delve into the science behind this change, its implications for metabolic health, and how you can manage it effectively.
The Role of Genetics and Estrone Production
During menopause, hormonal fluctuations play a crucial role in weight distribution. One key player is estrone, a type of estrogen produced from fat cells. As overall estrogen levels decline, the body compensates by increasing estrone production from visceral fat, which is stored deep within the abdominal cavity. Estrone is a less potent and more inflammatory form of estrogen than estradiol, which is produced in the ovaries (2). Although this change is most likely an evolutionary adaptation to increase overall estrogen levels in menopause, it is not a welcome one for many people.
High Testosterone Levels in PCOS and Perimenopause
For women with Polycystic Ovary Syndrome (PCOS) or those in perimenopause, elevated testosterone levels can further exacerbate abdominal fat accumulation. High levels of androgens, such as testosterone, are common in PCOS and can lead to weight gain, particularly around the abdomen (3). During perimenopause, the combination of relatively high testosterone and declining estrogen and progesterone levels can cause a significant shift in fat distribution from the hips and thighs to the abdomen.
What Does "Meno Belly" Mean for My Metabolic Health?
The increase in visceral fat during menopause has significant implications for insulin sensitivity and metabolic health. Visceral fat is metabolically active and can exacerbate insulin resistance, leading to higher blood sugar levels and an increased risk of type 2 diabetes (4). Additionally, the redistribution of fat to the abdomen is associated with a higher risk of cardiovascular diseases, as it contributes to a more atherogenic lipid profile (5).
Does Sleep Impact Menopausal Weight Gain?
Sleep disturbances, which affect up to half of individuals during perimenopause and menopause, can significantly impact weight management. Poor sleep increases levels of ghrelin, a hunger hormone, and decreases levels of leptin, a satiety hormone, which can lead to increased appetite and weight gain (6). Ensuring adequate, quality sleep is crucial for maintaining a healthy weight and overall well-being during menopause.
The Importance of Sleep Hygiene
Good sleep hygiene is essential for maintaining overall health and well-being. It involves adopting habits and practices that promote consistent, uninterrupted sleep. Here are some key tips to improve your sleep hygiene:
Consistent Sleep Schedule: Go to bed and wake up at the same time every day, even on weekends. This helps regulate your body’s internal clock.
Relaxing Bedtime Routine: Develop a calming pre-sleep routine, such as reading a book, taking a warm bath with lavender aromatherapy, or practicing meditation, to signal to your body that it’s time to wind down.
Sleep-Friendly Environment: Ensure your bedroom is cool, dark, and quiet. Consider using blackout curtains, earplugs, or a white noise machine to minimize disruptions.
Limit Screen Time: Avoid electronic devices at least an hour before bed, as the blue light emitted can interfere with your ability to fall asleep.
Mind Your Diet: Avoid large meals, caffeine, and alcohol close to bedtime. These can disrupt your sleep cycle and prevent you from getting restful sleep.
Stay Active: Regular physical activity can help you fall asleep faster and enjoy deeper sleep. Just be sure to finish exercising at least a few hours before bedtime.
By incorporating these practices into your daily routine, you can improve your sleep quality and wake up feeling refreshed and energized.
Does Menopausal Hormone Therapy (MHT) Cause Weight Gain?
Contrary to popular belief, Menopausal Hormone Therapy (MHT) does not inherently cause weight gain. In fact, studies have shown that MHT can help mitigate some of the changes associated with menopause, including weight gain and the redistribution of body fat (1). MHT can support metabolic health by maintaining more stable estrogen levels, reducing the accumulation of visceral fat, improving sleep, and improving insulin sensitivity (1).
The Interaction of GLP-1 Medications and MHT
The taboo surrounding medications for weight loss has begun to lift. Although not the right choice for everyone, the combination of GLP-1 (Glucagon-Like Peptide-1) medications like Ozempic and MHT can be particularly effective for postmenopausal women struggling with weight gain and metabolic issues. When combined with MHT, GLP-1 medications can enhance weight loss and improve metabolic health by regulating blood sugar levels and reducing appetite (7). Although some believe that users must stay on GLP-1 medications forever, many people have successfully weaned off of GLP-1 medications without significant weight gain, as long as healthy habits are maintained.
Other effective medications for weight loss include phentermine-topiramate extended-release (ER) and naltrexone-bupropion sustained-release (SR) (8). Your local weight loss or Endocrinology clinic can discuss which of these options might be a safe choice for you.
Nutrition and Lifestyle Recommendations
Managing abdominal weight gain during menopause involves a holistic approach that includes both nutrition and lifestyle changes:
Balanced Diet: Focus on a diet rich in whole foods, including plenty of fruits, vegetables, whole grains, and lean proteins. The Mediterranean diet is often recommended for its balanced approach and health benefits. Other healthful diets that can be maintained long-term include the DASH diet and (my personal favorite) the MIND diet.
Regular Exercise: Engage in regular physical activity, combining aerobic exercises with strength training to maintain muscle mass and boost metabolism. Activities like walking, swimming, and yoga can be particularly beneficial.
Stress Management: High stress levels can increase cortisol production, which promotes fat storage in the abdominal area. Both mindfulness and hypnosis have been found to improve the effectiveness of weight loss programs by improving self-acceptance and body image while limiting cravings and emotional eating (9).
Hydration: Staying well-hydrated is essential for overall health and can aid in weight management. Aim to drink plenty of water throughout the day.
By understanding the underlying causes of abdominal weight gain during menopause and adopting a comprehensive approach to manage it, you can navigate this transition with confidence and maintain your health and well-being.
Feel free to reach out to Phases Clinic for more personalized advice and support on your menopause journey. 🌿✨
Disclaimer: Always consult with a healthcare professional before making any health-related decisions.
Sources:
“The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-794. doi: 10.1097/GME.0000000000002028. PMID: 35797481.
Diaz-Ruano AB, Martinez-Alarcon N, Perán M, Benabdellah K, Garcia-Martinez MLÁ, Preda O, Ramirez-Tortosa C, Gonzalez-Hernandez A, Marchal JA, Picon-Ruiz M. Estradiol and Estrone Have Different Biological Functions to Induce NF-κB-Driven Inflammation, EMT and Stemness in ER+ Cancer Cells. Int J Mol Sci. 2023 Jan 7;24(2):1221. doi: 10.3390/ijms24021221. PMID: 36674737; PMCID: PMC9865376.
Dumesic DA, Akopians AL, Madrigal VK, Ramirez E, Margolis DJ, Sarma MK, Thomas AM, Grogan TR, Haykal R, Schooler TA, Okeya BL, Abbott DH, Chazenbalk GD. Hyperandrogenism Accompanies Increased Intra-Abdominal Fat Storage in Normal Weight Polycystic Ovary Syndrome Women. J Clin Endocrinol Metab. 2016 Nov;101(11):4178-4188. doi: 10.1210/jc.2016-2586. Epub 2016 Aug 29. PMID: 27571186; PMCID: PMC5095243.
Usui C, Asaka M, Kawano H, Aoyama T, Ishijima T, Sakamoto S, Higuchi M. Visceral fat is a strong predictor of insulin resistance regardless of cardiorespiratory fitness in non-diabetic people. J Nutr Sci Vitaminol (Tokyo). 2010;56(2):109-16. doi: 10.3177/jnsv.56.109. PMID: 20495292.
Neeland IJ, Ross R, Després JP, Matsuzawa Y, Yamashita S, Shai I, Seidell J, Magni P, Santos RD, Arsenault B, Cuevas A, Hu FB, Griffin B, Zambon A, Barter P, Fruchart JC, Eckel RH; International Atherosclerosis Society; International Chair on Cardiometabolic Risk Working Group on Visceral Obesity. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019 Sep;7(9):715-725. doi: 10.1016/S2213-8587(19)30084-1. Epub 2019 Jul 10. PMID: 31301983.
van Egmond LT, Meth EMS, Engström J, Ilemosoglou M, Keller JA, Vogel H, Benedict C. Effects of acute sleep loss on leptin, ghrelin, and adiponectin in adults with healthy weight and obesity: A laboratory study. Obesity (Silver Spring). 2023 Mar;31(3):635-641. doi: 10.1002/oby.23616. Epub 2022 Nov 20. PMID: 36404495.
Hurtado MD, Tama E, Fansa S, Ghusn W, Anazco D, Acosta A, Faubion SS, Shufelt CL. Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause. 2024 Apr 1;31(4):266-274. doi: 10.1097/GME.0000000000002310. Epub 2024 Mar 5. PMID: 38446869; PMCID: PMC11209769.
North American Menopause Society. (2023). Menopause Practice: A Clinician’s Guide (6th ed., p. 28). North American Menopause Society.
Pellegrini M, Carletto S, Scumaci E, Ponzo V, Ostacoli L, Bo S. The Use of Self-Help Strategies in Obesity Treatment. A Narrative Review Focused on Hypnosis and Mindfulness. Curr Obes Rep. 2021 Sep;10(3):351-364. doi: 10.1007/s13679-021-00443-z. Epub 2021 May 29. PMID: 34050891; PMCID: PMC8408071.
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