**Disclaimer** Before we start talking about this stuff, I want to acknowledge that weight is an emotional topic. So to get it all out in front: Your size is unimportant to me. It doesn't change what I think is possible for you, or how I address your problems, or who I think you are. I will not be size-shaming or recommending weight loss in this article. I do recommend avoiding future weight gain (unless you are underweight), because based on research, this will probably give you the best chance at a long and healthy life. **
So. Bad news up front: Peimenopause, menopause and aging in general are associated with weight gain. It's perplexing to my patients in the menopause transition because it seems to happen overnight, and for no reason they can divine. It's hard to understand what has shifted. For most of us, it's not something we did; menopause is like that! A small amount of weight gain, often in the belly, is common and even expected in the menopause transition*, but that doesn't mean it's neutral. Increasing weight comes with increasing health risks. So it's smart to notice, and ask what to do about it.
Weight gain, to me, generally means something is out of balance, and your body is noticing. When we pay attention to that weight gain, we can get curious about what needs adjusting. As we solve what's out of balance, we can improve your long term health and usually the weight gains stops too.
It turns out, a lot is happening that might affect metabolism for people around the menopause transition. Here's a quick look at the "big three"… as well as the fourth one that sometimes gets left out of the conversation:
Hormonal changes affect the gut
Shifting hormones will change the bacteria that live in our gut, part of our "microbiome". There is strong research evidence showing that which bacteria make up the microbiome affect whether we gain weight. These bacteria are affected by melatonin, estradiol and progesterone to name just a few, and in general, the shifts in these hormones as we approach menopause change the bacteria in a way that promotes weight gain. The bacteria that are not associated with weight gain have a strong preference for high fiber foods (plants!). If you'd like to slow or stop weight gain, then at every meal be sure to include a couple high fiber foods, like whole grains, veggies, and fruits, to feed those friendly bacteria!! Remember, they can't feed themselves!
Disrupted sleep patterns
A well-known symptom of perimenopause is disrupted sleep - particularly early morning wakings. As if not sleeping wasn't bad enough already, it turns out that when we don't get enough sleep, hormone signaling changes to promote obesity. People who sleep 7-8 hours a night are less likely to have weight gain than those who sleep 6 or less hours per night. Improving sleep deserves a post of its own but some important aspects are: being out in the daylight in the brightest parts of the day, getting regular physical activity, reducing alcohol intake and avoiding bright lights and screens in the evening hours.
Decreased lean body mass
Losing muscle mass as we age will mean our body uses up energy more slowly. Muscles burn more energy throughout the day than fat. So over time, taking in the same amount of calories will result in weight gain because there's less muscle inside to use up that energy. Regular physical activity will help you keep the muscle you have, so it can keep your metabolism steady. Strength training with a certified trainer is particularly helpful for maintaining or rebuilding muscle mass as we age. Research shows that people tend to do less physical activity as they age, and especially fresh out of a pandemic, if your exercise habits aren't where they used to be, you're human.
And the fourth one
Maybe you learned a little in the paragraphs above, but I'm guessing none of it was a surprise. You don't need me to beg you to sleep - you love sleep. You don't need me to tell you physical activity is good for you. And this isn’t the first article you've read that suggested that some good old fashioned veggies would help you. So let's go a little deeper here and I'll tell you how it looks to me…
Unexpected weight gain is usually because women don't have what they need. What do I mean? Well sometimes they don't have what they need in their bodies, and that's messing with their metabolism. Or, sometimes they don't have what they need in their lives. For instance,
· Depression symptoms are associated with weight gain.
· Weight gain can happen with thyroid dysfunction.
· It feels hard to make healthy dinners when you're ferrying the kids to activities all evening.
· It feels hard to exercise when you work 10 or 12 hour shifts.
· You're too tired to exercise if you're anemic.
· It's challenging to eat healthy when the people you cook for complain about it.
· Anxiety might be keeping you from sleeping
· If urine leaks when you exercise, you might not exercise as much.
· It feels hard to turn off the TV if this is the main way you connect with your partner.
· You don't want to set down your phone screen if this is the only way you connect with your friends.
I could go on and on. You're the one who knows where the friction points are in your life. I'm just here to say, I know that sleep/exercise/healthy food equation doesn't solve itself. And I also think that when you're ready, you can start solving it.
I love midlife women. We are pivotal in our communities, in our families, in our organizations. We get stuff done. We have power, and expertise and the wisdom of decades in our pockets. Many of us have slowly learned to do a little more, and a little more, and also this other thing, as we expanded our capacity and awareness. Imagine me looking you in the eye right now: I am sure I would be amazed if I knew all you have achieved, all you have healed from, all that you do in your corner of the world to keep it healthy and thriving.
And I want to take a deep breath with you and ask - do you have what you need?
It's ok if you don't have an answer. Or if the answer is that your eyes sting. What I see, is that if you're not getting sleep and good food and activity it's often because there's something in the way. So when you are ready to sit and write for a minute, I invite you to journal. Write down, without knowing what you're going to say, your thoughts about these questions:
· What do you need to feed yourself well?
· What do you need to do that physical activity you enjoy?
· What do you need to sleep better?
Maybe you're not sure what you need - in that case, please see a healthcare provider (like me!). But maybe you find out you don't even need me. Maybe what you need is to shift some family rhythms that are no longer serving you. Or some work expectations. Or some self expectations. A big part of the internal menopause transition, the way I see it, is noticing where our focus has been solely on others, and moving some of it back to ourselves. Noticing that we have needs, and naming them, and getting them met. In the coming years, you will be giving of yourself from a stronger place when your own needs are met. Deeply met. When you do get your sleep, when you do have the nourishing food and the movement your body craves. That's some midlife magic, and in the end, if you've got that, then the weight is not important. Let me know if I can help you get there.
*there are a lot of websites out there that will say otherwise but they are usually trying to sell something