Weight gain and menopause – What is happening?

 

So, what is actually happening when we hit the perimenopausal years and beyond, with our body shape and weight gain?  It is well reported that women experience weight gain in menopause and that it can be quite distressing while dealing with the other symptoms of menopause at the same time. Although our weight is complex and influenced by many factors, weight gain during menopause is influenced by more than diet and physical activity levels.

 

Studies have shown that weight gain at midlife of approximately 0.5kg per year is due to age rather than the hormonal changes during menopause. However, animal and human studies have shown that the decreasing oestrogen levels triggers an increase in follicle stimulating hormone (FSH), resulting in an increase in visceral fat and weight gain around the middle.

 

Oestrogen and Follicle Stimulating Hormone – What do they do?

 

Oestrogen and FSH are sex hormones and there are three types of oestrogen produced in the body, each at different phases of life:

• the childbearing years, Oestrodiol produced by the ovaries
• pregnancy, Oestriol produced by the placenta
• menopause, Oestrone produced by fatty tissue and adrenal glands

 

Oestrogen enters the bloodstream via our endocrine system, the glandular system by which hormones are produced. Oestrogen is important for:

• puberty
• menstruation
• pregnancy
• bone and heart health (maintains cholesterol levels)
• helps with muscle tone
• the lining (endometrium) of the uterus

 

Follicle Stimulating Hormone is produced and released from the pituitary gland in the brain, into the bloodstream. Its job is to increase oestrogen production in the ovaries, stimulate the growth of the follicles in the ovary, before an egg is released at ovulation each month.

 

During pre- and peri- menopause, oestrogen levels begin to fluctuate, and once the final period has been experienced, at menopause, oestrogen is no longer produced by the ovaries. There are less follicles to be stimulated, resulting in increased FSH. As a result, there is insufficient oestrogen to turn off FSH production in the brain. In fact, one way to confirm menopause in combination with symptoms experienced is to have a blood test for FSH levels.

 

How does lower oestrogen contribute to weight gain?

 

Studies have shown that lower oestrogen influences fat metabolism, and changes the fat distribution in the body. Pre-menopausal women tend to carry fat in the lower half of the body (typical pear body shape) whereas menopausal women tend to carry fat around the abdomen (typical apple body shape). The decreasing levels of oestrogen in combination with higher levels of FSH cause a redistribution of subcutaneous fat from the lower half to visceral fat at the waist, increasing the risk of metabolic syndrome and associated diseases such as type 2 diabetes, high blood pressure, heart disease and cancer. Decreasing levels of oestrogen do not cause weight gain per say, but it does cause a redistribution of the type of fat in the body.

 

What is visceral fat and why should we be concerned?

 

There are different types of body fat, and visceral fat is the type that is stored in the abdominal cavity. This means that it is located close to the abdominal organs, including the stomach, liver, pancreas and intestines. Visceral fat can also build up in arteries. It is a type of fat that can’t be seen, different to subcutaneous fat, which can be seen in arms and legs, as it is stored just under the skin. Proteins known as adipokines, important in cell signalling, are secreted by visceral fat cells in response to inflammation, but they also promote inflammation in the body. The more visceral fat there is, the more inflammatory adipokines secreted. For this reason, visceral fat is sometimes known as “active fat”, as this cell signalling by adipokines can have a negative effect on our health, contributing to metabolic diseases.

 

A study by Lovejoy et al over 4 years observed changes in weight gain, total body fat distribution and changes in body composition in 156 peri-menopausal women. What they found was that subcutaneous fat increased in all women regardless of the stage of menopause, however, total body fat and visceral fat increased substantially only in the women who became post-menopausal in follow-up.

 

What can you do to stay healthy?

 

It has been shown that metabolism and physical activity levels tend to decrease in women going through menopause. This can make it difficult to maintain exercise levels, as the menopause years can cause tiredness.

 

Mostly eating a healthy diet consisting of whole, fresh foods, including all food groups will ensure that your body is getting all the nutrients needed to stay healthy.

 

Exercising most days of the week will keep you fit and strong. It is important to find exercise you enjoy, that will ensure that you will continue to do it because it makes you feel good.

 

Decrease your stress levels and slow down, including mindful eating practices where you are eating not distracted, ensuring that you are chewing your food properly and that your are not stressed while eating, making digestion more efficient.

 

It is important to note that the changes in weight and body composition during menopause are normal. It can be a challenging time, but embracing the changes, loving and appreciating your body for what it can provide for you will help shift attention away from weight and more towards health. Self care couldn’t be more important at this time in a woman’s life.

 

If you have any concerns about your health during the menopausal transition, always see your GP for advice.

 

References

1  Davis JR et al. 2012. Understanding weight gain at menopause. Climacteric. 15, 419-429

2  Diabetes.co.uk, The global diabetes community. Visceral Fat (Active fat). Available at www.diabetes.co.uk 

3  Health direct. Oestrogen. Available at www.healthdirect.gov.au. 

4  Healthline. Visceral fat. Available at www.healthline.com. 

5. Jean Hailes for women. About menopause. Available at www.jeanhailes.org.au. 

6  Jean Hailes for women. Midlife weight gain: what’s really going on? Available at www.jeanhailes.org.au. 

7  Lee CG et al. 2009. Adipokines, Inflammation and Visceral Adiposity across the Menopausal Transition: A Prospective Study. J Clin Endocrinol Metab 94(4):1104-1110

8  Lizcano F & Guzman G. 2014. Estrogen Deficiency and the Origin of Obesity during Menopause. Biomed Research Int. Available at http://dx.doi.org/10.1155/2014/757461

9  Lovejoy JC et al. 2008. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes June 32(6):949-958

10  Protietto J. 2017. Obesity and weight management at menopause. The Royal Australian College of General Practitioners. Reprinted from AFP, Vol46, No 6, June

11  You and Your Hormones, An education resource from the Society of Endocrinology. Follicle Stimulating Hormone. Available at www.yourhormones.info. 

12  You and Your Hormones, An education resource from the Society of Endocrinology. Ovaries. Available at www.yourhormones.info.