Menopause Affects Your Waistline.

Menopause affects your waistline. There is almost no doubt about it. The ‘how’, the ‘why’ and the ‘how can we change this’ is where it gets murky. Ageing, sedentary lifestyle and oestrogen all get blamed for the weight gain, and rightly so, but what about leptin, ghrelin, sleep, your microbiome, muscle mass and of course your diet? These are all excellent suspects but unfortunately this is not a straightforward game of cluedo; the ‘weapon’, location and ‘who’ changes from person to person (and it may even change again and again with time).

Let’s get the obvious out of the way; sex hormones change. It’s part in parcel with menopause. Your sex hormones tend to go up and down and a little crazy to start with (perimenopause), then they settle down, and reduce significantly as the ovaries retire (menopause). When you have a strong level of oestrogen (think of PMS) you can get fluid retention or sweet cravings, leading to weight gain. On the flip side, when you have too little oestrogen (think of menopause) you lose your oestrogen protection against weight gain.

Interestingly, oestrogen has been identified as playing a significant and positive role in the regulation of appetite, energy expenditure, body weight and fat distribution[1]. Yet when most people are people are faced with the decision to start oestrogen, they become concerned about weight gain.

Yet if we really start to think about it – menopause, lack of sex hormones, weight gain – it starts to make sense that oestrogen is involved somehow in keeping weight under control.

And what do you know, the research backs this up. Oestrogens and their receptors have been shown to regulate various aspects of glucose and lipid metabolism[2]. Oestrogen works in the brain by increasing glucose transport into the cells and by aiding ATP (energy) production. It also works in the central nervous system by regulating food intake, energy expenditure, and body fat distribution[3]. If we stop, pause and think about that, we can agree that those actions are complex, important and numerous, and we have only scraped the surface of looking at what oestrogen can do (and yes, too much of a good thing is bad).

Without this oestrogen action, our appetite and satiety levels, as well as our energy levels, as well as our response to certain foods, all change. This is where I have found a lot of people are caught out.

I am often told ‘I haven’t changed my diet, and I am now gaining weight’. Even though you may not have changed your diet for the last 5, 10, 15 years, your body changes the way it responds to certain foods. You may find that the diet you were stable on, now makes you gain weight. Big bummer.

To explain why this occurs, we must recognise that there is an inverse correlation between oestrogen levels and fasting insulin in menopausal women. This means that the lower your oestrogen levels, the higher the fasting insulin – this higher level can lead to an insulin resistance diagnosis and a myriad of metabolic issues from there on. Whether or not this change is directly linked to oestrogen or linked via oestrogen’s role in fat distribution is debatable[4]. Regardless, low oestrogen has been linked to high insulin, and when oestrogen is re-introduced, a reduction of insulin has been noted[5]. (Interesting – reread that sentence!). Unfortunately, this relationship negatively changes the way your body responds to certain foods; namely sugars and carbohydrates (meaning they are not so forgiving anymore!).

The middle-age-spread, menopausal waist or abdominal fat gain is also widely debated in menopausal women. Many suggest this change simply comes with age, others show it as the result of the hormonal changes that come with menopause[6]. Again, oestrogen is the star suspect. Interestingly, and again, if we sit and think about it, at puberty (when sex hormones like oestrogen become key players) your fat distribution and body shape changes – your hips widen, your thighs increase, and your breasts develop. When menopause occurs and your sex hormones (namely oestrogen again) significantly reduce, we lose the shapely waist, hips and thighs curve and gain back that almost prepubescent up and down figure (losing your waistline), and just generally being a little more ‘plump’ or ‘apple’ shaped.

If you haven’t noticed it yet, oestrogen is pretty important in keeping your weight under control. Of course, outside factors like diet, exercise and free-will can overrule your oestrogen effect, but it is still quite impressive and vast to consider the effects oestrogen has over the body. One last function of oestrogen that I want to highlight is fat deposits. Oestrogen is heavily involved in choosing where fat cells are deposited in the body[7]. A lack of oestrogen rearranges fat, leading to the middle-aged spread, or abdominal fat. Unfortunately, this type of fat is significantly unhealthy and can lead to metabolic syndrome, cardiovascular issues, Alzheimer’s, inflammation, obesity and sadly too many other unhealthy outcomes[8]^,[9].

This is partly because fat, especially abdominal fat, functions as an active gland (just like the thyroid and the ovaries function as active glands).

Once your fat cells are present and if you have an increased amount of fat cells, particularly around your abdomen, it’s not so easy to shake it off. Unfortunately, you have few things working against you.

Fat cells secrete multiple hormone-like substances including leptin, resistin and adiponectin. These substances play a large role in appetite and energy levels, and thus they can influence your weight struggles. To simplify, leptin is considered positive for weight control as it reduces appetite, but unfortunately in a study of 634 postmenopausal women[10], it was found that low oestrogen (menopause) is associated with low leptin levels – reducing the hormone-like level of appetite control. Resistin, another hormone-like substance produced in fat cells, is still relatively new and its function hasn’t really been agreed upon. However, it is found to be linked to insulin resistance and increased inflammation. And finally, adiponectin, the other hormone-like substance produced in fat cells has thankfully been found to improve insulin resistance. Unfortunately, adiponectin reduces with menopause[11].

If leptin, resistin and adiponectin are new words to you, you are not alone. Weight loss after menopause is hard. In this instance, preventative measures are best (if you don’t have the abdominal fat cells to begin with, you don’t have the increased barrier to losing weight).

I am sorry to keep going, but there is more.

Another way menopause affects the waistline is indirectly through poor sleep. Hot flushes, night sweats, anxiety and insomnia are classical symptoms of menopause and all of these impact sleep. These symptoms not only create a barrier for weight loss, but they actually encourage weight gain. A study looking at the effects of just one bad nights sleep (and by ‘bad’, I mean only 33% less sleep than normal) found a significant increase in hunger and cravings which resulted in the consumption of larger meals and more sweets[12]. Several other studies have found similar results with the general consensus being that there is an increased risk of obesity in short sleepers[13]. This risk seems to, in part, come from the development of insulin resistance and reduced glucose tolerance (when sleep is limited to 5.5hrs only)[14]. Additional factors include an increase in afternoon and early evening cortisol levels, a decrease in leptin levels and an increase in ghrelin levels[15]^,[16].

Interestingly, melatonin (the hormone that helps you sleep, and may be lacking in those with sleep issues) can contribute to weight loss[17].

Other factors to consider include the thyroid, metabolism, inflammation, cortisol, and of course your microbiome (gut bugs). Weight gain is complex, and weight gain in menopause is even more so complex. (We will cover these factors in another article – this one is getting long!).

But don’t worry, it’s not all doom and gloom. Here are some ways you can help yourself.

• Exercise. Too many studies are suggesting that menopausal weight gain is because women are becoming sedentary with age. If you can exercise, do it. If you have injuries, speak directly to an exercise physiologist or to your doctor to get a referral to an exercise physiologist so that you can learn how to exercise with the injury. This needs to become a priority. The weight that often comes with menopause is difficult to lose and easy to become unmanageable.
  • Also, exercise helps improve insulin sensitivity, decrease leptin and increase ghrelin[18] – all the important factors that menopause negatively affects.
• Limit or eliminate sugars and refined carbohydrates[19]. These are the foods that require insulin function and if we remember, menopause is a time of insulin vulnerability, leading to increased risk of insulin resistance, weight gain and diabetes. Sugar includes your table sugar and sweet items (chocolate, lollies, golden syrup, honey, etc.) and refined carbohydrates includes bread, pasta, pastry, crackers and biscuits.
• Aim for protein at every meal¹⁹. Protein helps with your appetite signals (which can become significantly distorted in menopause). Protein includes meat, tofu, eggs, seafood etc.
• Load up on vegetables. Each meal should be predominantly vegetables. This means that you are getting your nutrients, fibre and bulk, leaving you satisfied, full and ideally healthy. Aim for a rainbow of colours at every meal, and a variety of vegetables throughout the week.
• Hormones – namely oestrogen and progesterone. Speak with the medical team at the Australian Menopause Centre to see if hormone therapy can help you.
• Be mindful. Mindful eating can help you become aware of internal, rather than external cues to eat. This can be a significantly helpful approach to binge eating or emotional eating.
• Write down your goals. Be accountable, monitor your changes. Weight loss only works if you want to work it.
• Be positive. The power of positive thinking is real.
• Seek help if you are feeling overwhelmed, vulnerable or out of control. Nutritional support, medical support, and mental support is available from the Australian Menopause Centre. Speak with the team to get started.

[1] Roepke, T. A. (2009). “Oestrogen modulates hypothalamic control of energy homeostasis through multiple mechanisms.” J Neuroendocrinol 21(2): 141-150.

[2] Coyoy, A., et al. (2016). “Metabolism Regulation by Estrogens and Their Receptors in the Central Nervous System Before and After Menopause.” Horm Metab Res 48(8): 489-496.

[3] Coyoy, A., et al. (2016). “Metabolism Regulation by Estrogens and Their Receptors in the Central Nervous System Before and After Menopause.” Horm Metab Res 48(8): 489-496.

[4] Marchand, G. B., et al. (2018). “Increased body fat mass explains the positive association between circulating estradiol and insulin resistance in postmenopausal women.” Am J Physiol Endocrinol Metab 314(5): E448-e456.

[5] Munoz, J., et al. (2002). “Fat distribution and insulin sensitivity in postmenopausal women: influence of hormone replacement.” Obes Res 10(6): 424-431.

[6] Ambikairajah, A., et al. (2019). “Fat mass changes during menopause: a metaanalysis.” Am J Obstet Gynecol 221(5): 393-409.e350.

[7] Frank, A. P., et al. (2019). “Determinants of body fat distribution in humans may provide insight about obesity-related health risks.” J Lipid Res 60(10): 1710-1719.

[8] Razmjou, S., et al. (2018). “Body composition, cardiometabolic risk factors, physical activity, and inflammatory markers in premenopausal women after a 10-year follow-up: a MONET study.” Menopause 25(1): 89-97.

[9] Park, J. K., et al. (2013). “Body fat distribution after menopause and cardiovascular disease risk factors: Korean National Health and Nutrition Examination Survey 2010.” J Womens Health (Larchmt) 22(7): 587-594.

[10] Karim, R., et al. (2015). “Association of endogenous sex hormones with adipokines and ghrelin in postmenopausal women.” J Clin Endocrinol Metab 100(2): 508-515.

[11] Sieminska, L., et al. (2006). “The relation of serum adiponectin and leptin levels to metabolic syndrome in women before and after the menopause.” Endokrynol Pol 57(1): 15-22.

[12] Yang, C. L., et al. (2019). “Increased Hunger, Food Cravings, Food Reward, and Portion Size Selection after Sleep Curtailment in Women Without Obesity.” Nutrients 11(3).

[13] Cappuccio, F. P., et al. (2008). “Meta-analysis of short sleep duration and obesity in children and adults.” Sleep 31(5): 619-626.

[14] Nedeltcheva, A. V., et al. (2009). “Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance.” J Clin Endocrinol Metab 94(9): 3242-3250.

[15] Copinschi, G. (2005). “Metabolic and endocrine effects of sleep deprivation.” Essent Psychopharmacol 6(6): 341-347.

[16] Morselli, L., et al. (2010). “Role of sleep duration in the regulation of glucose metabolism and appetite.” Best Pract Res Clin Endocrinol Metab 24(5): 687-702.

[17] Walecka-Kapica, E., et al. (2014). “The effect of melatonin supplementation on the quality of sleep and weight status in postmenopausal women.” Prz Menopauzalny 13(6): 334-338.

[18] Kang, S. J., et al. (2018). “Effects of 12-week circuit exercise program on obesity index, appetite regulating hormones, and insulin resistance in middle-aged obese females.” J Phys Ther Sci 30(1): 169-173.

[19] Ford, C., et al. (2017). “Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women’s Health Initiative Observational Study.” Br J Nutr 117(8): 1189-1197.