Menopause & perimenopause
Perimenopause and menopause weight gain — causes and solutions
by Marcy Holmes, NP, Certified Menopause Clinician
As many women enter perimenopause or approach menopause, they find themselves experiencing
unexplained weight gain — especially around the waists and hips — despite
their best attempts to diet. Often the methods of weight management that worked
for them for years are suddenly ineffective. In fact, weight gain in the abdomen
is one of the most common complaints of perimenopausal women. Yet most women have
been told that an extra 10–20 pounds is simply a rite of passage at this time
of life and they should just accept their “middle-age spread.”
But you absolutely do not have to. There is no reason why you should settle for
anything at this stage of your life, let alone weight gain. Sure, things may get
a little more complicated during perimenopause. Hormonal fluctuations, many years
of exposure to toxins, and your body’s natural proclivity for retaining estrogen–producing
fat cells at this time can result in some extra weight. But it doesn’t mean
you’re stuck with it.
Menopause weight gain
The same metabolic set point holds true for your post-menopausal body as it did
before “the change.” Menopause weight gain is just another symptom resulting
from your system being out of balance. To restore balance, you need to figure out
what is going on at the core of your physiology and emotions.
One of the many joys of menopause is the stripping away of the masking effects of
estrogen. While this process may cause some symptoms, it becomes much easier to
get a handle on what’s not functioning well for you. Many patients have conditions
such as insulin resistance or adrenal fatigue that have been developing for a long
time, but it is only after estrogen levels dip that they are able to notice the
symptoms — and make the necessary changes to fix them.
Why does menopause weight gain occur so universally for women? It depends on the
individual, but there are a few causes that are very common. Your fat cells and
your hormones are part of a system-wide biofeedback network that orchestrates your
appetite, metabolism, heat regulation, digestion, and detoxification. Any chronic
disturbance in the crosstalk among systems has the potential to cause weight gain
(and a host of other menopausal symptoms, like hot flashes and food cravings).
The causes of unexplained weight gain
Each day we discover more about the intricate nature of hormones and weight, but
one vital link is the one between insulin, metabolism and body fat. For years, many
women followed the conventional low-fat, high-carbohydrate diet, with lots of processed
foods (pasta, breads, most snacks, beer and wine, etc). Over time this diet can
create a condition known as insulin resistance. When you are insulin resistant your
body converts every calorie it can into fat — even if you’re dieting.
The result is that while you are gaining weight, your cells are actually starving!
A second basic link lies between stress and body fat. Stress hormones, like cortisol,
block weight loss. This is sometimes called the “famine effect”: despite
adequate food, the body interprets prolonged stress as a famine, and once again
goes into hoarding mode — which it does very effectively.
Stressors can be emotional, physical, or even diet-related. Bingeing, yo-yo dieting,
unaddressed food sensitivities, and severe calorie restriction are all forms of
stress. Most of us are under tremendous amounts of stress — often more than
we realize — and much of it is prolonged and unremitting, which can lead to
chronic inflammation and a metabolic disorder called adrenal imbalance.
These mechanisms all work together — and many of us combine a high-stress
life with a low-fat, high-carb diet. This creates such a powerful hormonal imbalance
that weight gain is almost inevitable. What’s more, high-carb diets cause
neurotransmitter imbalances that lead to food cravings. Because your body can’t
readily maintain optimal blood sugar and serotonin levels, you are compelled to
have snacks and caffeine to make yourself feel better. But they only exacerbate
both insulin resistance and adrenal exhaustion while adding body fat. This is a
For women in perimenopause, another weight gain issue is widely fluctuating estrogen
levels, and for menopausal women, diminished levels of estrogen. As the estrogen
production of your ovaries falls, your body turns to secondary production sites,
including body fat, skin, and other organs. If your body is struggling to maintain
its hormonal balance, body fat becomes more valuable. Often your body is balancing
estrogen loss with maintaining bone mass, for which it needs additional fat cells.
Of course, if you are stressed and on a low-fat diet, your body will struggle to
keep all these balls in the air — and refuse to let go of extra body fat.
Chemicals and toxins add to the problem
Note that artificial sweeteners are not a solution, but part of the problem. They
may lack caloric content, but some mimic sugar so well that the body produces insulin
to metabolize them — contributing to insulin resistance. This can actually
lower your blood sugar level, which is why many of these products contain caffeine
to compensate for the drop in energy. Unfortunately, the caffeine also worsens any
problems you may have with adrenal fatigue.
In addition, adding more artificial chemicals to your body at this time can exacerbate
the “toxic load” you are carrying. By midlife, most women have had years
of cumulative exposure to allergens, pesticides, plastics, chemicals, heavy metals,
bacteria, and other poisons and irritants. Artificial and biological debris that
can’t be eliminated gets stored in our fat cells.
Over time, a woman’s system can get so gummed up by toxins that it just can’t
function well — and it is often the case that the more fat cells she has,
the more toxins she has stored. When a woman begins to lose weight dramatically,
like on a crash diet, these toxins get released into the body in a flood and can
cause miserable symptoms. The body at this point just wants to get back to homeostasis
(even if what it interprets as normal isn’t healthy), and will sabotage even
the best intentions to lose weight.
The toxic load may be just one part of a broader pattern of inflammation —
which often shows up during menopause. Dysbiosis, yeast and food sensitivities,
and an immune system imbalance can short-circuit weight loss. Toxicity triggers
the immune system to be on full alert, as do any unaddressed food allergies. Many
women have been sensitive to certain foods for decades but only realize it after
they lose estrogen’s soothing effect on the digestive tract.
The truth about weight loss during menopause
So the truth is, weight loss is not about willpower or calories in/calories out.
Both are myths given to us by the diet industry that doom us to failure. Fad diets
simply don’t work — over 95% of dieters gain back the weight they lose
and more — because they oversimplify a very complicated process. One that
is more complicated during menopause because of the many factors I’ve described.
The links between hormonal balance, toxicity, inflammation and body fat aren’t
the only factors that block weight loss. Unresolved emotional issues are often the
root cause of unhealthy eating habits — and they can be their own kind of
We have learned that you have to get healthy before you can lose weight and keep
it off. Once you establish baseline health, your body will naturally seek and maintain
its ideal weight. The first step is to follow nutritional and lifestyle guidelines
like those we suggest in our Personal Program.
Menopause is no reason to accept someone else’s idea of what your limitations
are — in fact the opposite is true! There is no better time than now to begin
building a stronger health foundation. This is the time in your life to discover
the best in yourself, including your power to finally deal with the core issues
that may have hindered your earlier weight loss efforts.
Last Modified Date: 08/15/2012
Principal Author: Dixie Mills, MD, FACS