Menopause Metabolism

As a female physician who specializes in weight management, weight gain during menopause and perimenopause are the most common conditions I treat.

So many women share the history of never having had to worry about weight until all of a sudden, with perimenopause or menopause, a switch has turned off and somehow their metabolism has changed. The history a typical patient will give to me sounds something like, “I have always needed to work on my weight--eat the right things and exercise--and I still do. But now everything I used to do to control my weight no longer works. Instead, I am gaining weight despite being more careful, exercising more and eating less. Help! I am so frustrated.”

Where am I in this “Change of Life”?

First, let’s define what menopause actually involves. Menopause is officially designated when a women has stopped having menstrual periods for one year or when blood tests show that there are very high levels of pituitary hormones called gonodatropins. Gonoadotropins are hormones that are released by the pituitary gland in the brain to signal the ovary to mature and release an egg each month. The hormone levels have a patterned rise and fall each month during a woman’s reproductive years. Levels become very high once the ovary is no longer able to respond to these hormones and ovulation no longer occurs.

Perimenopause is the term given to the years that lead up to menopause. In these years, the ovary is starting to decline in function and an egg is no longer released consistently each month. Sometimes months go by without a normal ovulation. If hormone levels are checked in these years, the gonadotropins can be normal to mildly elevated. The associated symptoms can be hot flashes, night sweats, fatigue, mood changes and weight gain. Perimenopause may last for years.

The symptoms of hot flashes and night sweats can be explained by the erratic fluctuations in hormones that occur in these years. Physicians have been able to treat women who seek relief from these symptoms with hormone replacement therapy.

But It’s Not Just A Hormonal Change.

Many women will do whatever it takes to try to correct hormonal issues to lose weight. It is typically not an issue of taking HRT (hormone replacement therapy) or not. I let women know that there is no evidence that taking hormones or not taking hormones affects a woman’s ability to control her weight with perimenopause or menopause. The studies show that during the years after menopause, the average woman will gain thirty pounds. Women who take hormones may experience less initial weight gain, but several years later; women on hormones have gained a similar amount of weight compared to women who have never used hormones. Obviously it is not just a hormonal issue.

Hormone replacement therapy has long been controversial and has been more so since the Women’s Health Initiative trial published in 2002 showed that women who took the synthetic hormone Prempro were more likely to experience heart attacks or strokes. Prior to this study, the prevailing thought was that hormones protected a woman’s heart because women experience more heart attacks and strokes after menopause compared to men. Since this study, hormone replacement therapy is still prescribed, if needed, during peri-menopause if the physical symptoms are unbearable. Typically physicians try to use hormones for as short a time frame as possible.