Something that gets a common mention in clinic is “since hitting menopause I just cannot shift the weight”.
Most people associate peri menopause with hot flushes, mood changes and night sweats. But, what often doesn’t get a mention is the hormone changes also have an impact on your metabolism and the way your body stores fat.
Hormonal drivers of weight gain
Declining estrogen and progesterone often happens before the development of symptoms such as hot flushes and night sweats. The degree to which this affects you is multifaceted and genetics, diet and lifestyle factors play part in this.
The role of Estrogen
Estrogen suppresses appetite You may have noticed your appetite increases before your period. That’s when oestrogen naturally is at its lowest. When oestrogen is low, the neurotransmitter serotonin declines, and this can impact on your mood. You may crave foods high in carbohydrates.
Oestrogen suppresses appetite through interactions with the appetite hormones leptin and ghrelin. This is one of the reasons why some women gain weight on hormonal contraception.
Estrogen increases energy expenditure
Estrogen’s actions on insulin and your thyroid boost metabolism. With less estrogen, your metabolic rate can drop. Lower estrogen also means you burn less fat during exercise and sleep. Decreased estrogen levels also change your fat balance from subcutaneous fat (just under your skin) to visceral fat (around your organs). This kind of fat contributes to inflammation which is in itself a factor in weight gain.
The role of progesterone
The other primary reproductive hormone, progesterone is made when you ovulate. As a woman progresses through peri-menopause, she may not ovulate every cycle, or if she does, less progesterone is produced. Non-reproductive functions of progesterone include boosting metabolic rate and creating the calming neurotransmitter GABA. Low levels of GABA are linked to anxiety. Progesterone also supports sleep and if you are not resting and recovering well, this is also detrimental to weight loss.
Whats more is, decreasing amounts of estrogen and progesterone during menopause can slow down the process of food passing through the GI system. When the digestive process takes longer, more water is reabsorbed back into the bloodstream, which can lead to constipation, increased gas and bloating which I often find gives people aversions to a lot foods and they end up skipping meals or eating far less to avoid this happening. Furthermore both menopausal changes have been noted to enhance dysbiosis by reducing microbiome diversity and increasing the Firmicutes to Bacteroidetes ratio.
You may read more about the impact of that on weight loss in my blog:
The role of cortisol
Numerous studies have shown an association between stress, an increase in cortisol and abdominal fat distribution. Stress is exacerbated by intense exercise and dieting, which is the most common approach I hear women taking when going through menopausal changes.
Intense prolonged exercise and restrictive eating patterns such as fasting and low carbohydrate diets may raise cortisol. Sustained periods of high levels of cortisol increase insulin, encourage fat storage especially around the abdomen and lowers immunity.
Cortisol also has a relationship with your thyroid. High cortisol blocks the activity of your active thyroid hormone (T3) and reduces your metabolic rate.
Cortisol, estrogen and progesterone share molecule called pregnenolone as a building block. There is only a limited supply of pregnenolone, and your body will preferentially use it to make cortisol at the expense of other hormones.
DHEA and Testosterone Other hormones are involved in menopausal weight gain in addition to estrogen and progesterone. DHEA and Testosterone can be major players in the metabolism changes that occur during these years, and it is essential that they are both assessed and addressed if necessary. DHEA is also intimately involved in healthy adrenal function and can be depleted when we demand more work from those glands.
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