The Real Reasons Women Gain Weight During Menopause

In an excerpt from his new book, The Canyon Ranch Guide to Weight Loss: A Scientifically Based Approach to Achieving and Maintaining Your Ideal Weight, Stephen Brewer, MD, Medical Director of Canyon Ranch, discusses how the medical condition of menopause impacts weight gain.

I feel I could write a lengthy book on this topic alone. Over my years of private practice, and now in my position as Medical Director at Canyon Ranch, I have been around many menopausal women, both personally and professionally. I have seen their frustration about suddenly being heavier and their dismay at the unwelcome reshaping of their bodies, including the redistribution of fat from the hips to the midline that occurs during menopause. The startling scientific fact is that over 40 percent of women ages 45 to 60 are not just overweight but considered obese.

So what’s going on here? Let’s look at the scientific facts about this time of life for women. Studies have shown that starting around two years before menopause, women’s physical activity decreases and remains this way after they have gone through menopause. There are various psychosocial reasons for this. This is often the sandwich phase in their lives when many women are taking care of parents on one end and on the other end are helping out demanding older children and young grandchildren. This is also when many women try to juggle the demands of a booming career. With so many things pulling at them from different directions, the thought of finding time to exercise five days a week is often not in the cards. So when this happens, that old mathematical equation again comes into play: energy consumption minus energy expenditure = weight gain or loss. When you don’t burn up that consumed energy, the simple response is gaining a few or a lot of pounds.

Some women barely have enough time to do cardio exercises (running, fast walking, swimming, cycling, rowing, etc.), let alone have time for weight training. When we don’t spend time pumping iron, we lose muscle mass. This is a deadly sin because, as discussed more in the exercise chapter, we must maintain—or in some cases increase—our muscle mass to burn calories. Remember, our muscles are the calorie-burning factories of the body, and the more muscles you have, the more calories you can burn.

Loss of Estrogen

The other obvious elephant in the room is the reduction of estrogen during this perimenopausal time. Sex hormones play an essential role in regulating appetite, eating behavior, and energy metabolism. Estrogen appears to suppress a woman’s appetite and the distribution of adipose tissue, a name for body fat. There is a direct effect of estrogen on the hypothalamus, which suppresses a woman’s appetite. Estrogen also appears to increase the production of leptin. Leptin is a hormone produced in the body that is one of the body’s strongest appetite suppressants. Therefore, leptin levels will also decrease when estrogen levels decrease with perimenopause. Another factor that increases a woman’s appetite is that levels of the “hunger hormone,” ghrelin, are significantly higher among perimenopausal women compared to premenopausal and postmenopausal women.

With this increased appetite, studies have shown that women’s dietary protein, carbohydrates, and fiber intake is significantly higher three to four years before menopause. In addition to the increased appetite and increased food intake during this time, fat oxidation (the ability to break down fat) appears also to be affected by a women’s hormonal changes. Fat oxidation was decreased by 32% in women who became postmenopausal.

The metabolic effects of menopause on a woman’s body are:

1. Increasing central obesity (that midline bulge) with changes in the fat tissue distribution from the hips to the belly.
2. Potential increase in insulin resistance. Insulin is not as effective, so the body must make more insulin to transport glucose into the cells. As already stated, higher insulin levels cause more fat storage.
3. Changes in serum lipid concentrations (cholesterol levels) seem to be associated with increasing weight.
4. There appears to be an association between menopause and hypertension.

Another common problem with perimenopausal women is poor sleep, which is commonly associated with weight gain. There are two hormonal causes for not having a good night’s sleep. One is a lack of estrogen. This causes hot flashes, and when this occurs at night, it can disrupt sleep. The second is progesterone. When ovulation stops or is infrequent, progesterone production is lowered because it originates from the corpus luteum, which forms in the ovary after ovulation. This hormone is helpful for women to fall asleep and stay asleep. The effects of poor sleep will be discussed in the next section, but suffice it to say that not having enough sleep often makes us more hungry than usual the next day.

Because much of a woman’s weight gain is a result of female hormone depletion, hormone replacement therapy may be of some benefit. It can certainly help sleep and may decrease appetite and increase metabolic rate. It may also improve insulin sensitivity. This discussion needs to be held between you and your doctor, however. If there is a strong family history of female cancer or a personal experience with cancer, the use of hormone replacement may not be a good recommendation.

Lack of Sleep and Weight Gain

The rise in obesity has coincided with a decline in the number of individuals who regularly obtain the recommended seven to nine hours of sleep. Many people are sleeping fewer than six hours a night. Insufficient sleep is a risk factor for weight gain and obesity. There are many causes of insufficient sleep. One area encompassing a lot of sleep problems is “disordered sleep.” This includes such problems as sleep apnea (stopping breathing for more than ten seconds in an episode), insomnia (not being able to fall asleep or stay asleep), shortened sleep time, restless leg syndrome, and, as discussed in the previous section, disrupted sleep (such as having a nighttime of hot flashes common with menopause. The mechanisms associated with insufficient sleep and weight gain include; changes in satiety and hormones that alter food intake and EE (Energy expenditure). Insufficient sleep is associated with decreases in the satiety hormone leptin and increases in the hunger-stimulating hormone ghrelin. It has also been hypothesized that a chronic lack of sufficient sleep reduces EE (Energy expenditure), leading to weight gain. Does this make sense since who wants to exercise when they are tired?

An interesting study that specifically looked at sleep loss and weight gain showed that the total daily food intake, especially carbohydrates, was greater during times of poor sleeping. That additional intake of food was usually seen in the evenings after dinner. The consumption of carbohydrates, protein, and fiber calories after dinner in that study was 42 percent higher during sleep loss. This study also pointed out that participants often ate smaller breakfasts in the morning after insufficient sleep. These food changes result from a person’s delayed circadian timing of eating, which can occur with insufficient sleep. The importance of eating breakfast and meal timing will be discussed later under the section on weight loss maintenance.

Increased food intake during periods of not sleeping well appears to be a physiological adaptation to provide the body with the energy needed to sustain extended wakefulness. However, when exposed to the modern weight-gaining environment of readily accessible food, those pounds start adding up because food intake is more than necessary to offset the energy cost of sleep loss. This weight gain can be exacerbated if physical exhaustion reduces physical activity in the work–home environment. Even with studies showing increased hunger with loss of sleep, it does not completely explain the amount of overeating observed in scientific studies. For that reason, the sleep scientific world feels something else happening, most likely in the brain, that can explain the excess overeating seen when we don’t get enough sleep.

So when should you suspect that you have a sleep disturbance you are not aware of? The first clue is how you feel when you get out of bed in the morning. Do you feel well-rested, or do you feel like you could go back to sleep for another couple of hours? If you don’t feel rested, you could have some form of sleep disturbance. The second clue is how you feel during the day. Are you often tired? Do you fall asleep easily during the day while watching TV or sitting as a passenger in a car? A third major clue can come from the person’s bed partner, who, more often than not, can tell you if you are not sleeping well. They may observe their partner having excessive leg or arm movement, called restless leg syndrome, or having episodes of prolonged pauses in their breathing, called sleep apnea. These apneic episodes are often immediately followed by a gasping for air that may or may not wake that person up. If you have any of these clues, please discuss them with your doctor. Your physician will decide if any further studies should be done to determine if you have a true sleep disturbance that may be contributing to your weight gain.

This was excerpted from The Canyon Ranch Guide to Weight Loss: A Scientifically Based Approach to Achieving and Maintaining Your Ideal Weight ($24.95; SelectBooks). Reprinted with Permission by the publisher, SelectBooks, Inc. Find it here.