Weight gain in perimenopause
I see a lot of women in clinic who are in their 40s and 50s and who struggle with weight loss. They all have a similar story: they are putting on weight, mostly around the abdomen, and no matter what they do, they can’t lose the weight. They try all the strategies that have worked well for them in the past, namely eating less and exercising more, and still, the scales are not moving and if they do, they go up but most certainly not down! This is of course very frustrating and having gone through perimenopause myself, I know first hand what they are talking about.
So why do we put on weight during these years?
Perimenopause is a time of change, including metabolic change. Estrogen fluctuates a lot during those years, which leads to an increase in body fat, particularly around your tummy. The estrogen rollercoaster also contributes to hot flushes and night sweats, which means we don’t sleep well. When we don’t sleep well, our hunger hormones can get confused, which influences our appetite, i.e. we eat/snack more. Lack of sleep also means we don’t want to exercise or we simply don’t have the energy to be active. It doesn’t help that our joints are also impacted by the loss of estrogen. As estrogen levels drop, cartilage becomes more vulnerable to wear and tear, increasing the risk of joint degeneration. This is why we experience joint pain (hello frozen shoulder!) and osteoarthritis in those years, and that of course makes us even less keen to exercise!
The issues don’t stop here though. Lower levels of estrogen, progesterone and testosterone contribute to reduced insulin sensitivity, which can cause insulin resistance and that can contribute to weight gain. This is particularly annoying given that this time of our lives often comes with increased stress (teenage children, work, aging parents etc), which increases our cortisol levels. Chronically elevated cortisol levels can drive cravings for snacks and refined carbs, and as our insulin has gone to sleep, the sugar is not moved into our cells and the cells stay ‘hungry’ for more sugar (because they haven’t been ‘fed’), which leads to more high sugar snacking!! And the viscous cycle goes on….
As you can tell, there is a lot going on and we are not finished yet. As we age, we lose muscle. The gradual loss of estrogen increases that muscle loss further. And why is that important? Muscle tissue is the largest site of glucose uptake, so when we have less muscle, the body’s ability to regulate blood sugar, i.e. take up the sugar from the blood stream, decreases. The result is weight gain, particularly around the tummy.
And finally, perimenopause also affects gut health, which then can lead to inflammation and weight retention. Why is the gut affected by perimenopause, you might ask. Well, that’s because estrogen helps maintain diversity and balance in the gut microbiome, and it can also affect the gut lining, and contribute to what’s commonly called ‘leaky gut’. Intestinal permeability (aka ‘leaky gut’) means that toxins and bacteria can pass into the bloodstream, which can then trigger inflammation anywhere in the body. Estrogen and progesterone also both influence the movement of food through the intestine, which can lead to constipation and bloating.
If you now think it sucks to be female, I won’t blame you! This post will have hopefully shown you that weight gain in perimenopause isn’t just about willpower, or the lack of it. It’s a complex process, but the good news is that there are lots of things we can do to avoid this weight gain or reverse it. Go to my blog on weight loss in perimenopause to see what it is, or if you want to understand what’s going on for you personally– and remember, we are all different – book in for a 1:1 consult with me here.
