Weight Gain in your 40s
You’re eating the same as you always have, still getting the same amount of exercise… but your pants are suddenly tight.
Surprise! It’s menopause to blame… again.
Of course there are the night sweats, hot flashes, and mood swings, but gaining weight in menopause (or the 10 years leading up to it!) is one of the most common (and dreaded) signs of this massive hormonal change.
But like any other sign of menopause, just because it’s common, doesn’t mean it has to happen to you.
The first step to preventing or reversing weight gain in peri-menopause is to understand why it happens on a chemical and hormonal level.
From there, we can focus on holistic changes that don’t just make you drop a few pounds - they create an overall feeling of well-being, happiness, and health so you can thrive in this new season of life. Menopause doesn’t have to suck - I promise!
Why Do Women Gain Weight in Menopause?
Menopause isn’t just the end of your period - it’s a massive hormonal shift in your body, only comparable to puberty or pregnancy. As women, hormones are the ruler of almost everything that happens with our bodies, from our energy level to weight to mood.
For a complete explanation of the hormonal changes that occur during menopause, read this blog.
Those hormone changes interact with the various mechanisms that control weight. (Yes, weight is about a lot more than just “calories in and calories out!”)
Here are just some of the mechanism involved in weight changes:
- Gut Microbiome Dysbiosis
- High cortisol (adrenal/nervous system issues)
- Chronic inflammation
- Thyroid disease
- Insulin resistance and fatty liver
- Medications
- Lack of movement
- Mitochondrial dysfunction
- Hormonal changes
In menopause, the major hormonal change is first fluctuating and eventually lower levels of estrogen and progesterone. Those changes impact everything from glucose regulation to sleep, and those, in turn, impact weight.
In particular, the hormone changes of menopause can lead to increased belly fat. That increased belly fat can then fuel excess estrogen progesterone, intensifying the fluctuations that can lead to symptoms.
Sleep, Menopause, and Weight Gain
One well-known side effect of menopause are sleep problems - from trouble falling asleep to waking suddenly with night sweats. Research suggests that the sleep disturbances caused by menopause may also be at least partly to blame for the weight gain common in menopause.
The fluctuating estrogen levels common during the menopausal shift can trigger increased appetite, hot flashes, and night sweats, impacting sleep quality. The late-night combination of increased hunger and inability to sleep is also a perfect set up for late-night binge eating.
Even if your eating hasn’t changed, lack of sleep makes it harder to lose body fat, increases hunger and cravings for carbohydrate foods, and even inhibits muscle gain. Simply sleeping less may impact your body’s ability to manage glucose (blood sugar), promoting weight gain. In one observational study of over 150,000 women, those who had night sweats and hot flashes for a longer period of time (and therefore a longer period of disrupted sleep) also had a greater risk of developing diabetes - as much as 18% higher.
But it’s not just disturbed sleep that can cause issues with glucose levels - the normal hormonal changes of menopause can wreak havoc on your blood sugar as well.
Blood Sugar and Gaining Weight In Menopause
For women, estrogen and progesterone levels impact how we maintain healthy blood sugar levels. Changes in your hormone levels can impact blood sugar and may even contribute to insulin resistance.
Insulin resistance is when the body becomes desensitized to insulin, the hormone that controls blood sugar levels by acting like a key and “unlocking” cells so they can absorb sugar from the bloodstream. When insulin resistance occurs, the “key” stops working, and no matter how much insulin is present, it is unable to do its job. This creates a state of chronic elevated blood sugar, and can even lead to diabetes over time. Signs and symptoms of insulin resistance include weight gain (especially around the midsection), high triglycerides and LDL cholesterol, hypertension, gout, skin tags, and androgen excess, including PCOS.
Estrogen also plays a major role in the production of insulin, and can contribute to both insufficient and excess levels of insulin that contribute to insulin resistance. Estradiol, one type of estrogen, increases glucose sensitivity by enhancing the ability of the mitochondria to turn glucose into energy. Lower estrogen levels may then decrease glucose sensitivity, as well as impair the cells’ ability to convert glucose that has been absorbed into energy, causing a temporary energy crisis, even if enough glucose is being consumed. For you, this can feel like always being hungry, especially for carbs and sweets.
Progesterone, which has an anti-androgen effect, may also be protective against excessive insulin levels, as excess androgens stimulate the production of more insulin. (Overproduction of insulin is one aspect of insulin resistance.) When progesterone levels drop during menopause, this anti-androgen effect is lost. This is why hormone specialists like myself consider progesterone to be a weight loss hormone (just not artificial progestins, which can have the opposite effect).
These hormonal changes can result in elevated blood sugar and insulin resistance. In one study, hormone change symptoms like hot flashes were linked to both increased insulin resistance and higher blood sugar levels. In other research, women were less likely to experience hot flashes when blood sugar was elevated above normal, and more likely to experience them when fasting, showing the extremely complex relationship between menopause symptoms and blood sugar.
In addition, as estrogen and progesterone levels decrease, it can lead to a state of testosterone dominance, which can also contribute to insulin resistance.
Ketones, Menopause, and Your Brain
Weight gain isn’t the only potential consequence of these changes. The brain’s primary fuel source is glucose, and the brain alone consumes more than 20% of the glucose in your bloodstream.
Because estrogen plays a role in the cells’ ability to burn glucose, when estrogen levels drop, cells must switch from burning glucose for fuel to burning ketones, and this may have an impact on brain function if the switch between the two fuel sources isn’t smooth. You might feel this as brain fog, forgetfulness, and fatigue.
To navigate this transition, the brain needs to get better at using ketones. And to do that, you need whole body insulin sensitivity and metabolic flexibility. Let’s talk about how you can achieve those goals.
How To Stop Menopause Weight Gain
The causes of weight gain in menopause are complex, so the solution needs to be multi-faceted. Here are just some of the suggestions I work with my own clients on:
Do Exercise You Love and Build More Muscle
Aim for 3-4 hours per week of muscle-building activity, as well as a mix of high intensity and steady state cardio. For a bonus, incorporate up to two fasted workout sessions per week. After you’ve exercised, refuel with 20-40 grams of protein in the hour after training.
Optimize What You Eat
I recommend a blood-sugar balancing diet, which typically involves lowering carb intake or rotating a keto-style diet with a moderate-carb-intake, mediterranean-style diet rich in above-ground veggies, polyunsaturated and unsaturated fats like olive oil, nuts and seeds, avocado, and leaner proteins. In general, your food should be anti-inflammatory and plant-forward, with a lot of veggies at every meal. Avoid liquid calories.
Optimize When You Eat
A 10-12 hour eating window (followed by at least a 13 hour fast), and 3 meals without snacks is ideal for insulin sensitivity. Focus on eating protein at your first meal, and have it no later than 10 AM. Research suggests eating the biggest meal of the day at breakfast (instead of dinner) can also help promote weight loss.
Test For Food Intolerances
While not a factor for everyone, sometimes removing foods you’re intolerant of can reduce inflammation and clear the path for effortless weight loss. After testing revealed an intolerance, just removing eggs from my diet allowed me to lose 6 pounds without any other changes.
Find Your Carb Sweet Spot
In general, menopausal women need fewer starchy foods than they did when they were younger. (I know, it isn’t fair!) Each individual has their own “sweet spot” for carb intake depending on activity levels and metabolism. Choose complex carbs, and aim for 30+ grams of fiber daily. Eat the bulk of your carbs during your most active part of the day or right after you exercise.
Test For & Treat Insulin Resistance
Signs of insulin resistance include:
- Waist measurement over 33 inches/85 CM
- Elevated C-Reactive Protein (CRP)
- High triglycerides and LDL
- HBA1c above 5.6%
- Continuous Glucose Monitor readings high (above 140)
- HOMA-IR index
- Fasting insulin above 5, especially above 10
For treatment, I like to use organic acid testing with my clients to personalize nutrients that influence insulin sensitivity, such as ALA, magnesium, chromium, bitter melon, cinnamon, and gymnema. Magnesium is one supplement I recommend to almost everyone. My favorite form is magnesium glycinate, which helps calm the brain and promotes better insulin sensitivity.
Stabilize Estrogen
Test your estrogen levels and then use supplements like DIM, CDG, IC3, and phytoestrogen-rich foods like ground flaxseed to stabilize levels if estrogen is high. If estrogen is low, and you’re in perimenopause or early menopause - consider bioidentical replacement.
Use Hormone Replacement Therapy Strategically
Learn about the safety and efficacy of hormone replacement therapy, plus how I use it successfully with my clients, in this blog post.
Get Enough Sleep
Make 7.5-8 hours of sleep a night a priority. If you’re struggling with insomnia, I can help with strategies for increasing melatonin and decreasing nighttime cortisol. Some easy places to start: turn off screens at least 1.5 hours before bed, and consider wearing blue-blocking glasses, too.
Support Your Liver, Thyroid, and Gut
The liver and gut both play a major role in clearing out used estrogens. Lower estrogen levels can also negatively impact the gut microbiome and increase intestinal permeability. Check for signs of fatty liver, and if you aren’t pooping daily, let’s fix that. Test your thyroid function and support it with adequate levels of iodine, which also helps with hormone processing.
Get Expert Help for Gaining Weight in Menopause
Advice to just eat less and exercise more to lose weight gained in menopause misses the mark. Between fluctuating hormone levels, impaired sleep, and blood sugar changes, the causes of weight gain are complex. What you need is a holistic plan that addresses all aspects of weight gain so you can lose weight without starving yourself or feeling miserable.
I mean it when I say that menopause doesn’t have to be a miserable process. Helping women navigate menopause while looking and feeling their best in my passion. If you’d like support, book a free consult with my team. We’ll start with a deep dive into your health history so we can understand the full picture of you. Then, we’ll develop a customized plan for supporting your health goals, and be with you every step of the way.
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