Menopause is often a time of reflection when many women consider the story of their lives and how they intend to write the remaining chapters. Losing weight sometimes becomes part of a new self-improvement chapter. Some women starting menopausal hormone therapy (HT) believe that they will have difficulty managing their weight because of these hormones. The evidence does not support this assumption.
Menopause and Weight Gain
During the years approaching menopause (perimenopause), when estrogen levels are waning, and after menopause, when the ovaries stop making estrogen entirely, many women may begin to notice the following changes:
- Weight gain and a redistribution of fat around their abdomen
- An increase in the amount of total body fat deposit
- A decrease in lean muscle mass
These changes appear to be related to aging as well as menopause. The decrease in estrogen, the hallmark of menopause, is a key factor in these changes. Evidence shows that with decreased estrogen levels in menopause, instead of storing fat in their lower body (gynoid distribution), women start to store more fat around their belly like men (android distribution), and around their bowels (visceral fat). This visceral fat increases women's risk for diseases such as heart disease and diabetes.
Hormone Therapy and Weight Gain
If you need combined estrogen and progesterone, or estrogen-only hormone therapy (HT, formerly called hormone replacement therapy or HRT) for bothersome menopausal symptoms, you should not have a harder time losing weight than women not taking hormones. Studies show that hormone therapy is not responsible for the weight gain, or the fat redistribution, women may see during the perimenopause or after menopause.
In a study reported in the journal Fertility and Sterility in 1995, 63 early menopausal women on combined HT were compared to 29 untreated women for one year. The results showed that:
- Weight gain and fat increased significantly in both the HT and the non-HT group.
- There was no difference in weight gain between the two groups.
- There was significantly less fat distributed around the waist in the HT group compared to the non-HT group.
- Neither group changed their eating habits during the study period.
These results indicate that combined estrogen and progestin HT did not cause weight gain or fat redistribution in this group of women. In fact, the opposite was true; women on HT gained less fat around their waists than women in the non-HT group. So in this group of women, the changes in weight and fat are likely menopause and age-related.
In another study reported in the journal Gynecologic Endocrinology in 2007, groups of women were treated with three different regimens of HT. In all three groups there was a significant decrease in abdominal fat deposit and waist measurements.
Studies of lab animals also show that loss of estrogen leads to weight gain and a decrease in metabolism.
There are other factors which influence weight gain during and after menopause:
- The body's metabolism naturally slows down.
- The age-related loss of lean muscle mass also slows metabolism.
- There is usually a decrease in physical activities with age.
- The rate at which we use up energy during exercise decreases.
As metabolism slows down and we move less, the pounds can pile on.
Strategy for Losing Weight on Hormone Therapy
Given the changes in metabolism after menopause, take active control and create a plan that will help you maintain a healthy weight and avoid abdominal fat. Whether or not you are on hormone therapy, the strategy for managing your weight is the same and HT will not make it harder:
- Boost your metabolism through physical activity. Just at the time of life you want to take it easier is the time to rev up your exercise effort and endurance level.
- On the other side of the equation, examine your diet and adjust your daily calorie intake so that you consume less than you are using.
Exercise is the key to managing the weight gain and the widening abdomen caused by the changes in metabolism during the menopausal years. Your exercise plan should include:
- Aerobic activities, which will help you mobilize fat. Choose brisk walking, swimming, biking, treadmill or other aerobic activities, for at least 30 minutes a day. Aim for 60 minutes at least 5 days a week to increase the benefits. Just keep moving.
- Strength training, which is critical to helping you build lean muscle mass, which will help improve your metabolism, and help you maintain your strength as you get older.
- Stretching exercises, such as yoga, which will help you maintain flexibility and help your body feel more balanced.
A regular program that includes these exercises will help you lose weight, as well as tone your body and keep you strong and upright.
Ease into exercise gradually if you are not used to exercising, or you are just returning to it. Start with 10 minutes of an aerobic activity a day and gradually increase the time as your endurance improves. Add strength training every other day or three days a week. Add light weights to your strength training to help you build lean muscle. Building lean muscle mass will help you:
- Rev up your metabolism
- Burn off fat, including around your middle
- Decrease your risk for osteoporosis that comes with aging and loss of estrogen
It is also important to pay attention to maintaining your core strength and your balance to prevent falls and the increased risk of fractures as you age.
Balance the calories you use up during exercise with a healthy diet. Choose a diet which is:
- The right amount of calories for your height, age, activity level and weight loss goals
- Rich in fruits, vegetables and fiber
- Adequate in protein, which will help you maintain lean muscle
- Balanced in carbohydrates to meet your energy needs
- Low in empty calories, such as soda and sweets
- Low in fat, especially saturated fat
Do the Hard Work
The best time to prepare for managing the changes in your metabolism and weight that come with age and menopause is to practice healthy habits early in life. If you are already on hormone replacement, don't let that deter you from adjusting your eating and exercise habits to lose the weight you want. It is never too late to start, however, you may just have to work a little harder to adjust for the decrease in your metabolism, whether you are on hormones or not.
Be sure to talk to your doctor about your exercise and eating plans, especially if you have never exercised, or you are planning a big change in your physical activities.