Menopause, a natural biological transition marking the end of menstrual cycles, often brings unexpected changes to a woman's body, including weight gain. This article explores medical and lifestyle approaches for managing weight during menopause, offering evidence-based strategies to help women navigate this transition with confidence.
Understanding Menopause and Weight Gain
Menopause is clinically confirmed after 12 consecutive months without periods, typically occurring between ages 45 and 55, with the UK average at 51. The preceding phase, perimenopause, can begin 4-8 years earlier, characterized by fluctuating hormone levels that trigger physical and emotional adjustments. Common symptoms include hot flashes, night sweats, and mood swings.
During perimenopause and menopause, women may experience weight gain, often around the midsection, even without changes in eating habits or exercise routines. This is due to hormonal fluctuations, particularly declining estrogen levels, which influence fat distribution. Metabolic rates can also drop by 5-10% during this life stage, making previous weight management strategies less effective.
"When my patients say, ‘I went to sleep and I woke up and I felt like I was 20 pounds heavier,’ I believe them," says Monica Christmas, MD.
Factors Influencing Midlife Weight Gain
Several factors contribute to weight gain during menopause:
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- Aging Metabolism: Muscle mass decreases with age, especially after menopause. Women, in particular, lose 3-5% of their muscle mass per decade starting in their 30s, with that loss only accelerating after menopause. Muscle is metabolically active, requiring more energy to sustain, so its loss slows metabolism. The loss of muscle mass and increase in fat mass translates to more than weight gain. The muscle tone lost from reduced hormone production is often replaced by fatty tissue deposits.
- Hormonal Changes: Estrogen helps maintain muscle strength by preserving muscle mass and keeping the proteins responsible for muscle contractions healthy. As estrogen levels decline, muscle mass maintenance becomes more challenging. Estrogen also helps regulate appetite by modulating ghrelin (which increases food intake) and leptin (the satiety hormone). When estrogen levels dip, ghrelin levels rise, increasing appetite and cravings.
- Lack of Sleep: Insomnia and night sweats can lead to exhaustion, reduced exercise, and increased carbohydrate consumption for quick energy. Poor quality sleep can also increase ghrelin.
- Stress: Midlife demands can trigger the release of cortisol, the stress hormone, which promotes emotional eating and interferes with blood sugar regulation, potentially leading to insulin resistance.
The Role of Medication
While lifestyle modifications are crucial, medication can also play a significant role in managing weight during menopause. Weight loss drugs may be appropriate if body mass index (BMI) is greater than 30kg/m2 or 27KG/m2 with other medical comorbidities like diabetes or hypertension.
GLP-1 Receptor Agonists
Semaglutide, a GLP-1 receptor agonist, has become a popular option for weight loss, including for those dealing with menopause-related weight gain. GLP-1 is a naturally occurring hormone that lowers blood sugar levels and slows digestion, promoting a feeling of fullness. It also works in the brain to silence food noise, further promoting a feeling of satiety.
Semaglutide is the star ingredient in FDA-approved prescription weight loss medications like Ozempic, Wegovy, and Zepbound. Doctors have used GLP-1 receptor agonists to treat T2D for almost 20 years. In 2017, the Food and Drug Administration approved a new iteration, Ozempic (semaglutide), as a T2D treatment; in 2021, a larger amount of semaglutide, rebranded as Wegovy, was FDA-approved for people with obesity or who are overweight and have health problems related to that excess weight.
In a March 2021 New England Journal of Medicine study, adults receiving a weekly 2.4 mg injection of semaglutide for about 15 months lost 15% of their body weight-35 pounds, on average-compared to just 2.4% body weight loss in the placebo group.
Possible side effects of GLP-1 medications are nausea, constipation, or other gastrointestinal discomfort.
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Examples of GLP-1 medications include:
- Wegovy (semaglutide): A weekly injection that regulates appetite and slows digestion.
- Zepbound (tirzepatide): A weekly injection that regulates appetite and slows digestion.
- Ozempic (semaglutide): A diabetes medication sometimes prescribed off-label for weight loss.
- Saxenda (liraglutide): A GLP-1 medication that is FDA-approved specifically for the treatment of obesity.
Other Weight-Loss Medications
- Generic bupropion-naltrexone: Cost of medication included with membership.
- Metformin: When appropriate, your clinician may prescribe other weight-loss drugs with which other members have found success such as Metformin and combination Naltrexone and Bupropion.
Hormone Replacement Therapy (HRT)
While not typically prescribed solely for weight loss, Hormone Replacement Therapy (HRT) is linked with decreases in total fat mass and abdominal fat and improvements in insulin resistance and cholesterol levels. Hormone therapy may also help perimenopausal and menopausal women lose weight by easing vasomotor symptoms that affect sleep, such as insomnia and night sweats.
Hormone therapy may also help perimenopausal and menopausal women lose weight by easing vasomotor symptoms that affect sleep, such as insomnia and night sweats. Better sleep yields more energy for exercising and helps regulate appetite hormones.
Combining Semaglutide with Hormone Therapy
Combining hormone replacement therapy (HRT) with semaglutide may improve weight reduction while also helping manage menopause symptoms. In a recent Mayo Clinic study, postmenopausal women who were overweight or had obesity and combined semaglutide and HRT experienced about 30% more significant weight loss than those using semaglutide alone.
Lifestyle Modifications
Effective weight management during menopause requires strategic adjustments to diet and lifestyle:
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- Nutrition: Prioritize lean proteins, high-fiber carbohydrates, and healthy fats. The Mediterranean diet, rich in anti-inflammatory foods, limits sugar, sodium, processed carbohydrates, trans and saturated fats, and processed foods. It includes whole foods rich in nutrients, fiber and antioxidants that work together to optimize health and maintenance of a healthy weight.
- Exercise: Aim for 150 minutes of moderate-intensity physical activity and two days of muscle strengthening per week. Weight-bearing exercises like Pilates are particularly effective for targeting core strength, where menopausal weight often deposits.
- Sleep: Prioritize good sleep hygiene to regulate appetite hormones and improve energy levels.
- Stress Management: Find healthy ways to manage stress, such as yoga, meditation, or spending time in nature.
WeightWatchers (WW) Clinic
WeightWatchers (WW) offers a clinic program that combines weight-loss medications with their Points® program. This approach aims to help individuals lose weight and keep it off. The program includes:
- 1:1 check-ins with doctors or clinicians
- Insurance support to maximize coverage
- The Points® program
- Access to effective meds like Wegovy® and Zepbound,® if you qualify
- Dedicated Care Team handles insurance, refills, and your questions through 24/7 chat
- Expert-led nutrition Workshops and fitness classes
- Tailored app to help you maximize results and feel your best.
Members on prescription weight-loss medications lose up to 54% more weight when pairing meds with the Points® program.
Addressing Common Concerns
- Side Effects: Mild side effects, such as nausea, constipation, and diarrhea, are common with weight-loss medications. These may lessen over time.
- Cost: Weight-loss drugs can be expensive and aren't always paid for by insurance.
- Weight Regain: Many people gain back some of the weight they lost when they stop taking weight-loss drugs.