MenopauseNews
Menopausal Weight Gain: Diet, Exercise During Perimenopause May Be the Best Strategy to Avoid Excess Weight
Key changes in fat distribution and metabolism begin well before the menopause transition, researchers find.
By Becky Upham
Strength training can help you combat the normal loss of muscle mass that starts happening around age 50.Marco Govel/Stocksy
If you're a woman in your forties or fifties, you probably don't need a mountain of scientific evidence to be convinced that when it comes to midlife weight gain, the struggle is real. But new research suggests that it doesn't have to be an inevitable part of aging.
The study, published on February 28, 2022, in the journal Menopause, suggests that the best way to avoid menopausal weight gain may be to make changes in exercise and calorie intake years before the transition occurs.
Ideally, Women Will Change Their Health Behaviors Prior to Menopause
"Our key findings highlight some existing evidence that perimenopause is a crucial time point to initiate lifestyle changes [that have] the potential to dramatically improve health and quality of life in postmenopause," says Abbie Smith-Ryan, PhD, associate professor of exercise physiology at the University of North Carolina in Chapel Hill and co-author of the study.
Although it's fairly common knowledge that women gain fat mass, particularly abdominal fat, as they age, this is the first study to use a gold standard model to understand the changes and interaction of the change in fat mass, muscle mass, and bone mass, says Dr. Smith-Ryan.
As Estrogen Goes Down, Fat Creeps Up
When a woman reaches menopause (defined as no periods for 12 consecutive months), estrogen levels plummet, which can result in menopausal symptoms such as hot flashes, mood changes, sleep disturbances, and sexual dysfunction, according to the North American Menopause Society (NAMS).
RELATED: Perimenopause and Menopause: What's the Difference?
Midlife Hormone Shifts Trigger Body Composition Changes
Menopause also brings a significant reduction in how many calories a woman needs to maintain her body weight, a gain in fat mass, and a change in the way body fat is distributed, according to a paper published in the July-September 2021 issue of the Journal of Mid-Life Health. Some studies have also shown that menopause can additionally cause a loss of lean muscle mass, as well as bone mass.
This shift doesn't suddenly happen when a woman no longer menstruates; the ovaries gradually begin to make less estrogen throughout perimenopause, which may last between four and eight years prior to menopause, says Stephanie Faubion, MD, internal medicine doctor at the Mayo Clinic in Rochester, Minnesota, and the NAMS medical director (she was not involved in the research).
Researchers Examine Body Composition, Metabolism at Three Stages of Midlife
To evaluate body composition, fat distribution, and metabolism at rest and during exercise, the investigators recruited 72 women between 35 and 60 years old; 24 were premenopausal, 24 were perimenopausal, and 24 were postmenopausal.
Women were considered premenopausal if they were still having regular monthly periods, perimenopausal if they were at least 38 years old and experiencing irregular menstrual cycles (for example, changes in frequency or period length or flow), and postmenopausal if they had not had a menstrual period for 12 consecutive months.
Each group contained equal numbers of women with a healthy weight, as measured by a body mass index (BMI) between 18.5 and 24.9, and women with overweight or obesity (BMIs between 25 and 39.9). Participants were 61 percent white, 18 percent Black, 14 percent Hispanic, 5 percent Asian, and 1 percent mixed race.
Data on the women was collected in three areas.
Body Composition This was assessed with the gold standard, which uses multiple tools to ensure accuracy.
Calories Burned Metabolic measurements were taken to estimate how many calories the women burned while at rest and during various intensities of exercise.
Lifestyle and Medical History Each participant completed a survey to provide information about their exercise habits, food consumption, and gynecologic history.
Body Fat Percentages Start to Change Early, Before Perimenopause
The researchers found that body fat percentage was significantly lower in premenopausal women compared with perimenopausal women, and that the greatest changes in the overall percentage of fat occurred between the premenopause and perimenopause time frames. This suggests that the menopause transition stimulates the changes that later solidify after menopause, according to the authors.
Perimenopause Is When Women Start to Lose Metabolic Flexibility
Investigators also found that the women began to lose metabolic flexibility once they hit perimenopause, and that it continued to get worse in the postmenopausal women. Metabolic flexibility is the ability for the body to use whatever fuel is available and translate it into energy.
Specifically, the women were less able to use fat for fuel compared with the younger, premenopausal women, which could have implications for both fat mass and exercise performance and subsequent fatigue.
There's a Window of Opportunity to Get Ahead of Gaining Menopausal Weight
The authors concluded that perimenopause may be the best window for lifestyle interventions, because this group experienced the biggest changes in fat, lower lean body mass, and a shift toward central obesity.
The results suggest that there are differences in metabolism that are related to exercise according to menopause status, says Samar R. El Khoudary, PhD, MPH, associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health in Pennsylvania, who was not part of the study.
"The findings are in agreement with data from longitudinal studies showing perimenopause as a critical window for body composition changes compared to postmenopausal women," says Dr. El Khoudary.
"These changes in metabolism and fat distribution are important to pay attention to, in part because they contribute to the increase in cardiovascular risk associated with menopause," says Dr. Faubion.
Perimenopause, the Lead-Up to Menopause, Is the Key Time to Prioritize Health
"We need to be engaging with all women before they start having these adverse changes like weight gain, even before they start having symptoms of perimenopause, such as cycle length irregularity," says Faubion.
Yet, Perimenopause Is a Challenging Time to Prioritize Personal Health
These findings highlight that women in perimenopause need to prioritize their health and well-being, says Smith-Ryan. "This is the point in life when many women neglect themselves, as they are busy with their careers and taking care of everyone else, for example, child-rearing. [Neglect] can have long-term negative health implications, more than what we see for men," she says. What's more, midlife women are especially vulnerable to depression, according to research.
You Can Avoid Midlife Weight Gain if You Cut Calories, Move More
"The classic scenario is that women will come to us during this time and say, 'I haven't changed anything. I'm eating and exercising just like I always have, but I'm gaining weight.' And the response is, 'Exactly! If you don't change anything during this time, you will gain weight,'" says Faubion.
With menopause, there will be inevitable changes in body composition: We can't stop the aging process, says Faubion.
RELATED: 12 Ways to Beat Menopausal Belly Fat
Eat Less, Exercise More, Increase Strength Training
"However, we can avoid gaining 30 pounds in menopause. One way we do that is to increase exercise," Faubion says. That should include not only aerobic exercise but also strength training, which can help combat the normal loss of muscle mass that starts happening around age 50, she says.
"But exercise alone won't do it. Women are going to have to reduce their caloric intake well before they hit menopause in order not to gain weight," she says.
How much the metabolic rate is going to decline will vary, says Faubion. "That's because metabolic rates are not standard across women. Each woman is going to have to work to figure out what she needs to do to avoid gaining weight, but we know it will require a reduction in caloric intake."
The Next Best Thing: There Are No Time Machines, But That's Okay
If you're already past perimenopause, don't let these findings deflate you, says Faubion: "All is not lost. One important message here is that it's never too late to make changes in your diet and exercise habits to improve your overall health and reduce your risk of chronic diseases."
Sign up for our Women's Health Newsletter!
The Latest in Menopause
Severe Menopause Symptoms Linked to Risk of Heart Disease, Study Finds
Women with more severe menopause symptoms were more likely to develop heart disease.
By Carolyn Bernhardt February 8, 2023
7 Ways to Cope with Menopausal Hot Flashes and Night Sweats Naturally
Drug-free strategies for beating the heat during menopause — morning, night, and in between.
By Karen Asp January 26, 2023
What Midlife Women Should Know About Intermittent Fasting
Some popular diet plans for menopausal women recommend intermittent fasting. But is it safe and effective for women over 40?
By Meryl Davids Landau January 4, 2023
Hot Flashes at Work? Here's Why It Matters — And What You Can Do About It
Experiencing vasomotor symptoms at work can not only be a minor inconvenience, but also cause lost productivity and unplanned days off.
What Are Vasomotor Symptoms of Menopause? Symptoms, Causes, Diagnosis, Treatment, and Prevention
By Beth Levine December 19, 2022
What Is Menopause and the Menopausal Transition? Symptoms, Causes, Diagnosis, and Treatment
What Are Menopausal Hot Flashes? Symptoms, Causes, Diagnosis, Treatment, and Prevention
By Cathy Garrard December 14, 2022
The Best and Worst Foods for Hot Flashes and Night Sweats
If vasomotor symptoms of menopause have you hot and bothered, studies suggest you can reduce them by changing your diet.
By Beth Levine December 2, 2022
Fitness After 40: Recommendations for Midlife
A cheat sheet on age-related exercise recommendations for perimenopause and menopause.
By Cheryl Alkon November 9, 2022
7 Surprising Facts About Menopausal Night Sweats
Vasomotor symptoms of menopause can seriously disrupt sleep. Here's what you need to know.
By Beth Levine November 7, 2022
Weight Gain Around Menopause Is Linked to Lack of Sleep
Onset of Menopause Before Age 45 Is Linked to Higher Risk of Dementia Later in Life
Midlife Weight Gain: The Latest Thinking From NAMS 2022