The day you can’t button your favorite pants is a sad wake-up call. It seems like you are eating and doing the same things as usual, but your waistline keeps growing. Middle life brings a double-whammy of hormonal changes and slower metabolism that can lead to packing on the pounds, especially belly fat. Are you stuck rather than (meno)paused with this new body shape?
“I am a true believer that a healthy weight is achievable at any age,” says Dr. Laura Robin of Rosa Transformational Health in Medford. “We need to find the missing pieces for the individual to make it possible. You don’t have to accept that weight gain after 50 is unavoidable.”
The big three hormones
When women’s ovaries decide to hang up the “out of the baby business” shingle, they stop producing estrogen, progesterone and testosterone. Often, this process causes surges and dips in hormone levels throughout perimenopause and may last years for some women. Imbalanced and reduced hormones can cause side effects that create new problems, triggering weight gain as a side effect.
“With the hormonal changes, there is a shift to abdominal fat,” says Dr. Ajana Miki, a naturopathic doctor at Ashland Natural Medicine, who explains that fat cells can produce small amounts of estrogen and may be the body’s way of prolonging hormone production.
Low progesterone can also cause sleep disturbance, another contributor to weight gain. Miki explains that sleep disturbance alters other hormones, including ghrelin and leptin, that affect the body’s sense of hunger. “When we don’t sleep well, we have less control over our hunger,” she says.
Spurts and spikes of estrogen throughout menopause also throw off the hormonal ratios, contributing to increased weight in buttocks, hips and thighs.
Robin describes testosterone as “the get off the couch hormone.”
“In both men and women, testosterone influences the ratio of muscle to fat and the ability to form and grow muscles,” she says. “The more muscle we have, the better our metabolism. Getting all these hormones into balance can help with weight maintenance.”
Muscle loss and metabolism
As the level of testosterone declines in menopause, women don’t have the same ability to build muscle and often are less motivated to exercise, Miki says. “When we don’t build muscle mass as easily, our metabolism shifts.”
Robin explains that muscle uses more calories than fat does. “If we are losing muscle and gaining fat, our metabolic rate is going to be down, making it harder to control weight,” she says.
Miki suggests women concentrate on building butt and thigh muscles, because these are the largest muscles in the body. “Exercises like squats and jumps are great for this,” she says.
Strength training will help offset muscle loss, but diet matters too. “The other piece is decreasing our carbohydrate intake,” Miki says. “As we age, we don’t process sugar as well. Carbs breakdown into sugars during digestion. Our insulin levels start shifting, and we become more insulin resistant. Our metabolism slows down, and we can’t burn carbs as efficiently as we could when we were younger.”
Stress and cortisol
Stress is a strong influence on weight gain. “At midlife, there are a lot of things changing in the body and in the life of a person,” Miki says.
Cortisol, produced by the adrenal glands, is the hormone that responds to and increases with stress. Yo-yoing hormones during menopause can affect reactions to stress and cortisol production. Sleep disturbance also affects cortisol. This hormone triggers the production of glucose, Robin explains, so elevated cortisol over long periods can lead to increased blood sugar levels and weight gain.
To get cortisol levels in balance, it’s important to introduce some stress relievers into your daily routines, Miki recommends. “There are all kinds of little hacks to work with the nervous system by stimulating the vagus nerve,” she says. “Singing in the shower, deep breathing, mindfulness and meditation practices – it’s amazing how 10 minutes twice a day of sitting in silence and not focusing on what your mind is doing makes a huge difference for the nervous system. Lying down for five or 10 minutes during the day, even if not sleeping, signals the adrenal glands to take a break.”
Bioidentical hormone replacement
Only recently in human history have women lived decades post-menopause, Robin points out, which means many years without estrogen, progesterone and testosterone to support the body. “So many studies provide evidence that estrogen can be protective for the heart, brain, eyes and bones,” she says. “We also become frail because of lost muscle mass.”
In 2002, a large study on synthetic hormone replacement therapy found a link to a significantly higher risk of breast cancer. Since then, bioidentical hormones have become available, rather than the artificial or animal hormones used in the past. “These are exactly the same as the hormones our bodies make,” Robin says.
Miki said many patients find a lot of benefit with bioidentical hormone replacement. “If someone has a strong family history with dementia or osteoporosis, for example, I might encourage some bioidentical hormone therapy.”
Seeking information for midlife changes
Both providers recommend getting a physical and blood work if it’s been more than a year since your last wellness check. Tests should include level checks for female hormones, thyroid and fasting insulin. Robin notes that not all medical providers have the same philosophy in testing or treating menopausal hormones. Different providers have different approaches, so it may be worth having a conversation at your wellness exam about how your provider views going through menopause gracefully.