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Weight Gain in your 40’s and 50’s: The Role of Shifting Hormones

One very common concern I see from my patients in perimenopause and menopause is bothersome weight gain. “I haven’t changed my diet at all — I eat the same way that I have for the last decade, and yet I’ve gained 10-15lbs. in the past year. I workout, but it’s not coming off. What’s going on??” Does this sound familiar? If you are in your mid-40’s or beyond, the shift in hormones as the menopause transition approaches is one contributing factor to the changes in your metabolism and weight. This is what I want to explain in this article, along with the tests and treatments to consider with your ND. While the female hormones like estrogen are a big player, they aren’t the only factor that is contributing to the changes in weight. Firstly, I want to start by explaining that the shift in hormones starts in your 40’s, and for this reason it’s useful to start having a conversation about hormone support with your Naturopathic Physician early. This way, we can be proactive and support you in making tweaks to your lifestyle and eating habits to help you feel energized, strong and confident throughout this transition time. Secondly, menopause is a normal and natural event. It ushers in a new phase of life, filled with new opportunities, new options, and new adventures. From an energetic perspective, women move through the archetypes of the “maiden” in their youth, to “motherhood” in the 30’s and 40’s, into what I consider the “queen” phase in perimenopause and beyond. This is a time of life to pause, reflect and enjoy the kingdom you’ve created for yourself over the span of your life. While it is an important transition, it is not necessarily a smooth one! For this reason, I’ll tackle weight and metabolism in this article, and other menopause topics in future articles.

Estrogen and Weight Maintenance

Estrogen an important reproductive hormone that predominates the first half of the menstrual cycle (called the follicular phase). In women who have a regular monthly period, estrogen contributes to their reproductive ability but also plays critical roles in other parts of the body. In fact, estrogen has a fundamental role in cardiovascular, bone, and brain health. Further, estrogen plays a supportive role in fat cells and metabolism, too. For women who still have a menstrual cycle, estrogen plays the following roles in supporting healthy weight and fat metabolism.

  • Fat distribution – Estrogen helps to distribute fat to the hips and gluteal area, rather than centrally around the waist. This is important because visceral fat gain around the waist is inflammatory and is responsible for an increased risk of diabetes and cardiovascular disease.
  • Prevention – Healthy estrogen levels help to prevent fat accumulation and inflammation.
  • Blood sugar support – Estrogen improves insulin sensitivity in various parts of the body (fat and muscle) and helps modulate the pancreas, which secretes insulin. This means that estrogen helps to improve your blood sugar control, which in turn helps to control weight.
  • Appetite-suppressant Estrogen has a slight appetite-suppressing effect. In fact, one study showed that on average, women eat about 200-300 fewer calories in the follicular phase of their menstrual cycle when estrogen is higher, and tend to crave less sugar during this time.
  • Energy – Healthy estrogen levels contribute to women feeling energized in the follicular phase of the menstrual cycle. Women walk an additional 1600 steps per day during these weeks, on average. Those little bits of daily activity actually go a long way to support weight management

In short, healthy estrogen levels favorably support weight maintenance and metabolism in a woman’s reproductive years. So then, what happens in your 40’s and 50’s?

Declining Estrogen after Menopause Contributes to Metabolic Changes

Perimenopause typically starts between the ages of 43 and 49 and lasts until one year after the final period ends. Symptoms of perimenopause may include changes to the menstrual flow (heavier, or lighter periods), irregular periods, sleep disturbances, worsened PMS symptoms, changes in mood, hot flashes, decreased libido, and fatigue, in addition to weight gain in some. Specifically, perimenopause occurs when we have fewer and fewer oocytes left in the ovaries to be recruited each month, therefore, estrogen is produced erratically, rather than predictably. As estrogen declines in menopause, once your period disappears, we start to lose the “protective” effect of estrogen on the body and metabolism, as outlined above. As a result of less estrogen, the following occurs that affects metabolism and weight:

  • A shift to weight gain around the mid-section – Previously, estrogen supported weight distribution around the hips, but with declining estrogen, weight gain is directed more to the midsection. Visceral fat gain around the mid-section is more inflammatory and contributes to a higher risk of heart disease.
  • Increase in fat mass overall – By about 1% per year, on average. Healthy estrogen levels help to prevent fat accumulation and inflammation.
  • A decrease in muscle mass overall – By about 5% overall throughout menopause, on average.
  • Reduced insulin sensitivity – Meaning poorer blood sugar control and increased weight gain. In fact, women at this time have a higher risk of developing type 2 diabetes.
  • Cholesterol changes – An increase in the “bad” cholesterol as estrogen declines.
  • Loss of the “appetite-suppressing” effect of estrogen – This means we may tend to eat more than we are aware.

To make matters worse, perimenopausal symptoms such as poor sleep and poor mood exacerbate the weight gain problem. People tend to eat more carbohydrates, sugary foods, and high-calorie foods when they are sleep deprived and unhappy. This is important to recognize, because there are LOTS of ways that naturopathic medicine can help to improve sleep and mood, thus indirectly supporting weight maintenance or weight loss. I can’t stress enough how important it is to have quality sleep in order to be successful with weight loss goals. I know this sounds like the cards are stacked against you, but stick with me a little longer, we’ll delve into what you can do to support your hormones during the menopausal shift!

Weight gain: it’s not all bad news…

This may not be a popular opinion, but for many women, a little bit of weight gain as we age is not all bad. For women who have had normal or low body weight for most of their life, a few extra pounds in menopause are actually good for your bone health. One study showed that women who lost 5% of their body weight after age 50 were at higher risk of hip fractures later in life. Conversely, weight gain of 10% or more provided protection from hip fractures. For this reason, it’s important to work with your health care provider when you embark on a weight loss program at this time of life.

Blood Testing in your 40’s and Beyond: Metabolism Markers

When women start having symptoms of perimenopause, I recommend the following screening tests to check in on her metabolic health, and re-test these every 1-3 years, depending on her risk factors.

  • Thyroid Stimulating Hormone – We’ve discussed estrogen and metabolism, but we can’t neglect our master metabolism gland, the thyroid. If weight gain is occurring, it’s critical to get this tested. The thyroid is slightly more likely to “go awry” during periods of hormone transition, for example, post-partum or during menopause.
  • Fasting glucose, insulin, and HbA1c. These are markers of your blood sugar control. If they are sub-optimal, this can contribute to weight gain and increased risk of metabolic syndrome.
  • Cholesterol panel and liver function tests – These help us understand your metabolism and risk factors.
  • Vitamin D – This vitamin is important for bone health, mood, and weight – more on this later.
  • Hormones: FSH, estradiol, progesterone – These may be tested by your ND to understand your hormone status during perimenopause.

How to Support your Hormones, Naturally

So, how can we help to mitigate the impact of the changing hormones on our weight in perimenopause? While targeted weight loss programs or diets can be beneficial and effective for some, in my experience, small incremental changes to your daily habits is what really create long term, sustainable weight loss. I love working with women at this time of life to help educate them with healthy changes to their habits, diet, and lifestyle to have them feel energized and empowered through this life transition. Here are a few of the topics I delve into with my patients.

  • Adjusting the Diet – The shift in metabolism necessitates a shift in diet. This is an excellent time to examine the foods that make you feel good, the foods that creep into your routine, and which foods are outright making you feel worse and contribute to weight gain. I often recommend tracking your diet for 5-7 days for a little “check-in” to what you’re eating. Most women are surprised to realize how some eating habits are actually more of a crutch for poor energy or low mood rather than real fuel for your body. With this information, I work with patients to make small, sustainable adjustments to the dietary routine to support weight loss. Did you know that one research study demonstrated that the entire obesity epidemic could be due to a simple excess of 200-300 calories per day, over a decade? Simply removing a few snacks, or a few ingredients from your daily shake, help to tip the caloric balance more towards weight loss. Our wonderful nutritionists can also help you create a specific weekly meal plan to help you with these goals.
  • Intermittent Fasting – Fasting overnight for 14-16 hours is a simple and useful tool for supporting weight loss. Studies indicate that intermittent fasting is supportive of weight loss and normalizing insulin, glucose, and cholesterol markers.
  • Specific Foods – This varies from woman to woman, depending on her body type, diet style, and metabolic demands.
  • Support the stress response – A notable hormone I haven’t yet addressed is cortisol. Cortisol is another hormone that is responsible for weight gain around the midsection. For many women in their 40’s and 50’s balancing work, kids, partners, not to mention perimenopausal symptoms, stress and cortisol are often an issue. As part of a comprehensive treatment plan, I’ll often make recommendations for specific herbs and supplements to help support the stress response. Stress management techniques such as meditation, low-intensity exercise, yoga, and working with a Registered Clinical Counselor are excellent ways to help support your body’s stress response.
  • Get good quality sleep – Getting enough quality rest is critical for weight loss success. If you’re sleeping less than 7 hours per night, you are more likely to: overeat, have more sugar cravings and take longer to feel full (thus overeat, again). Further, people who are sleep deprived while on a diet are more likely to lose weight from muscle instead of fat – that is, if they are able to lose weight at all. Since sleep is often a problem for perimenopausal women, I really emphasize correcting this for my patients.
  • Specific Exercise – High-intensity interval training (HIIT) such as spin classes or boot camps are the best form of exercise for fat loss. Additionally, I recommend incorporating resistance training practices to help build and maintain muscle. The more muscle you have, the more your body is burning calories at rest. While these are my top recommendations, I always tailor exercise prescriptions to a patient’s unique body, needs, childcare situation, and finances.
  • Specific Supplements – The research on specific supplements for weight loss support is limited (although a quick Google search might have you thinking there is a panacea out there. Don’t be fooled!) Here are a few supplements that have some research to support weight loss; however, these should “supplement” a weight loss plan, and not be the primary treatments.
    • Vitamin D – One small study showed that more fat loss and better insulin sensitivity occurred in women with normal vitamin D levels, compared to women with sub-optimal vitamin D levels. This is one reason why I recommend vitamin D testing.
    • Inositol – Inositol supports blood sugar regulation in women with PCOS or diabetes. Optimizing blood sugar control contributes to weight loss.
    • Fish oil – In one study, subjects taking 1800mg EPA/DHA experienced improved mood and an additional 3-4kg of weight loss compared to the group not taking fish oil.

Bio-identical Hormone Therapy (BHRT)

Hormone Replacement Therapy (HRT) or BHRT is commonly offered to women experiencing moderate to severe hot flashes, night sweats or other menopausal symptoms; however, its supportive role for weight management is seldom discussed. We know that a woman’s risk of cardiovascular disease, diabetes, osteoporosis, and cognitive changes increase with the loss of estrogen in menopause, so for some women, estrogen therapy (with progesterone) is a safe and effective way to help reduce these risk factors (more on this in a future article).

During perimenopause, using progesterone can be incredibly helpful to help balance your hormones and diminish the symptoms that are arising as a result of erratic estrogen production (poor sleep, anxiety, moodiness, weight gain). This is a safe and effective treatment for many women; speak with your ND to see if it might be useful for you. As it pertains to weight after menopause, the 2017 Menopause Society Position Statement acknowledges that “hormone therapy may help attenuate abdominal adipose accumulation and the weight gains that are often associated with the menopause transition.” For this reason, and for all the other reasons that estrogen therapy is supportive of long-term health, I recommend having a thorough discussion about this option with your ND. Is estrogen safe for all women? No, some women are not good candidates for this therapy, which is why a thorough health review is warranted during this discussion. If it is a safe option for you, it can help to support healthy body composition and long term health.

I hope this article helped to explain why you may be experiencing your symptoms and illustrate treatment options you can discuss with your Naturopathic Physician to help attain a healthy weight for you and support you through the menopause transition. If you have any questions or would like to book in for a visit to discuss, find the booking link above.

Yours in health,
Dr. Kathleen Mahannah

References

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Arch Intern Med, 156(9): 989-94. Leeners, B., Geary, N., Tobler, P. N., & Asarian, L. (2017). Ovarian hormones and obesity.

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Mauvais-Jarvis, F. et al. (2013) The Role of Estrogen in Control of Energy Balance and Glucose Homeostasis. Endocr Rev, 34(3): 309-38.

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Scott, D., Joham, A., Teede, H., Gibson-Helm, M., Harrison, C., Cassar, S., … de Courten, B. (2016). Associations of Vitamin D with Inter- and Intra-Muscular Adipose Tissue and Insulin Resistance in Women with and without Polycystic Ovary Syndrome. Nutrients, 8(12). https://doi.org/10.3390 /nu8120774

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