Understanding menopause weight gain: What causes it and how to lose it

Q: Why is it harder to lose weight as you approach menopause? Is there any proven way to curtail weight gain in perimenopause and menopause?

A: Losing weight is incredibly hard for everyone. But it's especially difficult for middle-aged women, who are up against genetics, lifestyle, hormonal changes and just plain aging.

That being said, it's important to take steps to curtail weight gain during this time.

Changes in fat distribution in the body and increases in weight during perimenopause and menopause can increase your risk of serious health outcomes, including cardiovascular disease, the leading cause of death among postmenopausal women.

Focus your goals on improving your well-being. Changing the way you eat, optimizing the way you sleep and ramping up your physical activity can all help improve your overall health.

Perimenopause, or the menopausal transition, usually begins in your 40s and lasts about five years. This life phase is characterized by hormonal fluctuations that can disrupt menstrual cycles, cause hot flashes and alter your metabolism. (Menopause occurs 12 months after your last period.)

Largely because estrogen drops during perimenopause, women tend to lose their lean mass, or muscle, while gaining fat mass, especially around the midsection. You might have heard of this being referred to as the "middle-age spread."

These changes make your joints weaker and physical activity more difficult. And because fat is less metabolically active than muscle, they also make it even harder for menopausal women to burn calories and maintain weight loss.

Women are also fighting other factors: increased insulin resistance, which can occur as a result of the gains in fat mass, and certain medications, such as antidepressants and beta-blockers, that are commonly prescribed during menopause and can promote weight gain. Estrogen therapy — used to manage some of the symptoms of menopause, such as night sweats — doesn't appear to influence weight gain.

Despite the real challenges, there are some scientifically backed methods to try.

Eat whole foods. Scientists have not found a one-size-fits-all diet for perimenopausal women, and calorie-restrictive diets are often not an effective long-term solution. Instead, focus on eating whole, unprocessed foods. The Mediterranean diet is adaptable to many palates and is frequently recommended for its long-term health benefits, while a 2006 clinical trial found that a low-fat diet — high in vegetables, fruits and grains — can curtail weight gain during menopause.

Get a good night's sleep. Easier said than done when you wake up every night drenched in sweat, right? But sleeping well is critical, since women who consistently sleep more than seven hours each night are less likely to gain weight. For obese women, though, it's something of a vicious cycle: Good sleep would help them lose weight, but they’re prone to more-frequent hot flashes that can disturb their rest.

Besides night sweats, it's also a good idea to talk to your physician about other issues keeping you from sleeping well, including obstructive sleep apnea and insomnia — both of which are more common in perimenopausal women.

Start moving more. Exercise can help prevent weight gain, yet only a fraction of middle-aged women meet the weekly goals for moderate activity recommended by the National Institutes of Health (at least 150 minutes per week). A study of over 3,000 U.S. women in the menopausal transition found that higher levels of physical activity — whether in sports or as part of a daily routine like walking to work — were associated with lower weight over time. The reverse was found for activities like watching television.

It's valid to feel frustrated about losing weight. It's also important to be upfront with your doctor about your concerns. Many people wait until the end of a clinic visit to bring up the real reason they came — usually issues they feel intimidated or embarrassed to talk about, like weight gain. Don't save these concerns for last. By then, your doctor might be pressed for time and the problem may not get the attention it needs.

Meet the doctor: Trisha S. Pasricha is a physician at Massachusetts General Hospital, an instructor in medicine at Harvard Medical School and a medical journalist.

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