For many women, weight gain becomes a significant health concern during midlife, particularly around menopause. While weight gain itself is primarily a result of aging rather than menopause, the hormonal changes during menopause can significantly impact body composition, leading to increased abdominal fat. This review explores the connections between menopause, weight gain, and overall health, providing insights into effective strategies for managing weight during this life stage.

The Role of Aging vs. Menopause in Weight Gain

Research shows that the steady annual weight gain of approximately 0.5 kg during midlife is primarily due to aging, not menopause. Factors like reduced physical activity, changes in metabolism, and lifestyle contribute to this trend. However, menopause triggers a distinct shift in fat distribution, with women experiencing an increase in abdominal fat. This transition from a "pear-shaped" (gynoid) fat distribution to an "apple-shaped" (android) pattern is linked to declining estrogen levels.

Impact of Abdominal Obesity

Abdominal obesity is associated with several health risks, including cardiovascular disease, type 2 diabetes, and metabolic syndrome. Visceral fat, which accumulates around internal organs, acts as an endocrine organ, releasing inflammatory markers and other substances that contribute to these conditions. In addition to physical health risks, abdominal obesity negatively affects psychological well-being, self-esteem, and sexual function.

Hormonal Therapy and Weight Management

Contrary to popular belief, menopausal hormone therapy (MHT) does not cause weight gain. Studies indicate that estrogen and estrogen-progestin therapies can reduce overall fat mass, improve insulin sensitivity, and decrease the risk of developing type 2 diabetes. Hormonal therapy may also help prevent the redistribution of fat to the abdomen, mitigating one of menopause's most visible changes.

Strategies to Manage Weight Gain

1. Lifestyle Modifications:

• Physical Activity: Regular moderate-intensity exercise, such as walking or cycling, can help manage weight and reduce abdominal fat. Resistance training is especially beneficial for preserving lean muscle mass during weight loss.
• Dietary Adjustments: A calorie-controlled diet emphasizing whole grains, lean proteins, and healthy fats can effectively reduce body weight and visceral fat.

2. Medical Interventions:

• Medications: Metformin, commonly used for diabetes management, has shown modest benefits in reducing weight and insulin resistance in overweight individuals at risk of diabetes.
• Bariatric Surgery: For individuals with severe obesity, bariatric surgery can provide substantial and lasting weight loss.

3. Complementary Approaches:

• Yoga and Acupuncture: Studies suggest that yoga and acupuncture can improve metabolic health, reduce waist circumference, and enhance overall quality of life.

Weight and Menopausal Symptoms

Obesity can exacerbate menopausal symptoms such as hot flashes, depression, and joint pain. Conversely, weight loss through lifestyle changes has been shown to alleviate these symptoms and improve health-related quality of life.

Conclusion

While weight gain during midlife is largely due to aging, the hormonal shifts of menopause play a critical role in increasing central abdominal fat. Addressing this issue requires a combination of lifestyle changes, medical interventions, and, where appropriate, hormonal therapy. Weight management during menopause is not only vital for reducing health risks but also for enhancing quality of life and overall well-being.

Source:

Davis, S. R., Castelo-Branco, C., Chedraui, P., Lumsden, M. A., Nappi, R. E., Shah, D., & Villaseca, P. (2012). Understanding weight gain at menopause. Climacteric, 15(5), 419–429.