Metabolic changes in menopause you need to know about if you’re concerned with weight gain.

I see women in clinic who are struggling with weight gain during their transition through peri-menopause and into menopause.

Quite often weight changes are put down to decreased activity levels, changes in appetite and a lack of motivation to do the things that they used to do to feel good about their body.

In other circumstances it’s a case of prolonged body dissatisfaction paired with long term restrictive diets and intense exercise regimes resulting in increased stress on the body.

It’s a tough time to be a woman when transitioning through this phase of life when the things that you used to do are no longer serving you and your body seem to be rebelling big time.

As always, when we zoom out to look at the bigger picture there is much more going on than just weight gain and unfortunately the conventional approach of encouraging weight loss without addressing the other factors at play adds enormous amounts of unnecessary pressure and over simplifies the situation.

So what actually changes??

With the reduced oestrogen (E2) levels during menopause we begin to realise the protective nature of this hormone and the implications of it’s reduction on overall health and wellbeing. Oestrogen is protective of cardiovascular health, bone density and brain function therefore it is important to put in place protective mechanisms through diet and lifestyle modifications during menopause to support overall health in the long run.

During menopause there is a sharp decrease in oestradiol (E2) this is the form of oestrogen that governs ovulation. This leads to metabolic changes including altered lipid metabolism and changes to visceral fat distribution. Read on to find out how menopausal changes influence common health issues faced by women later in life.

High Cholesterol

High cholesterol is a common concern during menopausal years, E2 is synthesised using low density lipoprotein cholesterol (LDL-C) in the ovaries. With the reduction of E2 seen in menopause LDL-C is no longer required for E2 production, which leads to higher levels of circulating LDL cholesterol. Additionally oestrogen exerts a protective action over the liver supporting lipid metabolism, therefore when oestrogen decreases higher levels of total cholesterol and triglycerides are reported.

Weight gain around the mid-section

While oestrogen levels decrease during menopause, androgens levels stay the same, changing the oestrogen: androgen ratio. This results in changes to weight distribution moving from subcutaneous fat storage in the gluteal/femoral (upper leg) region to visceral adipose tissue in the central (stomach) region. Oestrogen favours subcutaneous adipocytes (fat cells) and androgens favour visceral adipocytes and so with the reduced concentration of E2 and the increase in bioavailable testosterone (androgen) we see the presentation of increased/stubborn stomach fat during menopause.

Metabolic changes

Due to the reduction of E2 and increase in abdominal fat we see excessive visceral fat breakdown which results in higher levels of free fatty acids. During menopause, genes involved in beta-oxidation are downregulated leading to less efficient fatty acid oxidation, this results in an accumulation of lipids in a state that the body cannot efficiently burn as a fuel source resulting in changes to fat distribution and energy metabolism. As a result there is an increase in conditions related to such metabolic changes including insulin resistance, cardiovascular disease and NAFLD.

What can we do about it?

Consume a balanced diet that includes fat, protein, complex carbohydrates and wholegrains.

Increase intake and diversity of fibre in your diet to support gut health and increase antioxidant intake.

Focus on consumption of adequate protein in each meal of the day, aim for between 1 - 1.2g protein/kg of body weight daily. Split protein intake up throughout the day rather than consuming all in one hit. This could look like consuming 20-30g of protein per meal in a person who weighs 90kg. It is especially important to include protein in your first meal of the day to support blood sugar regulation and satiety, this will have a knock on effect throughout the day.

Increase intake of essential fats to support heart health and assist in reducing inflammation. Include oily fish, walnuts, avocado, hemp seeds, flax seeds, chia seeds and a good quality fish oil supplement.

Incorporate 30 minutes of daily movement, low to medium intensity cardio including walking, swimming, bike riding etc. plus resistance exercise and pilates.

Identify nutrient deficiencies and work towards correcting them with a trusted health professional. Common nutrient deficiencies seen in menopausal women include Vitamin D, calcium, B Vitamins, protein, zinc, Vitamin A and Vitamin E.

Reduce stress levels and avoid skipping meals to support blood sugar regulation.

Suggested further assessments:

Cortisol and DHEA-S, thyroid function, liver function, gut health and homocysteine levels, blood glucose and insulin.

Final note

If you are finding that managing your weight with low calorie, restrictive diets and intense exercise, is no longer working for you, hopefully having an understanding of the complex processes going on internally will help face this period of life with compassion and patience.

Working with a health professional who can look at the bigger picture on your behalf, decipher the research and compile a plan for your individual situation cannot be underrated.

E.A.N.

x

Reference list

Eng, P.E., et al. Non-alcoholic fatty liver disease in women – Current knowledge and emerging concept. JHEP Reports, 2023. doi.org/10.1016/j.jhepr.2023.100835

Ko, S-H., Jung, Y. Energy Metabolism Changes and dysregulated lipid metabolism in postmenopausal women. Nutrients, 2021. doi.org/10.3390/nu13124556

Ko, S-H., Kim, H-S. Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal women. Nutrients, 2020. doi.org/10.3390/nu12010202