“It’s the belly-fat that disturbs me. I can’t get into my jeans that I could get into a year ago” was her cry for help. “For years I was playing competitive sport but I’ve stopped that now but still try to run. I also have 2-3 wines at night, but I don’t think this affects my belly fat.” [Lynne, Australia]
The liver is a curious organ – especially as we transition menopause. Not only does it have to remove toxins overnight, but for women who have had decades of stress, including the physical stress of training and competing in sports, the liver accumulates and holds onto inflammation. When it is inflamed, it also contributes to a leaky gut.
During menopause, all of this past inflammation can catch-up on you – to be frank, everything just goes ‘belly-up’.
I’ve written about our ageing liver in numerous blogs but when relatively new research arrives in my inbox, confirming how our changing liver is affected by stress, both present and past, it’s time to remind you about how your past life influences your current and future health as you transition menopause.
For a generation of women having participated in vigorous exercise and sports (myself included), when the belly fat arrives in our 50s, it’s not only confusing but also frustrating.
Little did I realise how much work our liver has had to do over the years and nor do many other women who have carved their way in competitive sports, high-intensity exercise or for those of you, who have had a lot of emotional stress in your life. Just one episode of stress messes up liver biochemistry.
So, if you have experienced a lot of stress this year or you are really busy at work, or jeans no longer fit because your belly-fat is increasing, then this article is for you.
I want you to understand how stress impacts your liver (and your gut) and subsequently, your weight and menopause symptoms.
Stress and your Liver Health in Menopause
Inflammation in our liver can sit around for years. Especially if those years leading up to menopause, have been well, … ‘stressful’. Follow this up with the changes to our fat cells and liver during our menopause transition (Brady, 2015), this can also impact belly-fat storage around your abdomen – at the site where you want to button up your jeans.
I so remember that despair and wish that at the time, I had understood the powerful connection between our ageing liver and stress (both physical and emotional).
‘Psychological stress is associated with a variety of pathological conditions resulting in liver injury through multiple systems, including the sympathetic nervous and adreno-cortical system.’ [Joung, Cho et al, 2019, p. 1].
Stress (both physical and psychological) leads to the reduction in hepatic (liver) blood flow. This is important to understand. Because every time your hepatic blood flow is reduced, then you are also messing up your gut health and of course, increasing the build-up of inflammation in your body.
Your lovely liver is part of your sympathetic nervous system axis which also includes your adrenal glands. As such, when we are feeling stressed or under-the-pump or worried, or, for those of you who do a lot of exercise and have done for years, the resulting reduction in oxygen uptake in the liver, due to reduced liver blood flow, causes inflammation – mainly in the beautiful mitochondria, which are the cells that help to burn fats to turn into energy. This inflammation places a lot of strain on ageing liver cells, (Chandel et al, 2000).
It’s something for all of us to consider if we’ve had a life well-lived and are struggling with anxiety, stress and increasing belly fat during or after menopause.
Some of you may well be arriving in peri-menopause and menopause, with a tired, inflamed liver which can become worse if you aren’t sleeping well.
If your blood work has shown that your liver enzymes are high (whether you drink alcohol or not) you might just relate to what I’m telling you. For those of you who are also doing lots of vigorous exercise (e.g. CrossFit and Boot Camps) and your weight isn’t shifting, or you feel that you are experiencing more puffiness, bloating and hot flushes, then understanding that you need to focus on your liver health and your sleep first before doing lots of energetic exercise, is crucial.
Peta was the same – as a competitive triathlete and coach, she was frustrated with not being able to lose weight and have the energy she needed to train and compete. As she mentioned,
“I’d lost all my mojo and drive to train. Getting out of bed was hard enough. All the reading I had done had told me that my oestrogen levels were dropping in peri-menopause, so I was stuffing myself with oestrogen products but Wendy’s programme told me I was feeding myself stuff that was making it worse – and the stress and lack of sleep and everything plus feeding myself high protein (eggs etc) sports nutrition foods, had turned my body into a cocktail of hormones.”
She kindly shares her story HERE.
Female exercisers and women who work in physically demanding jobs must remember that before, during and after exercise or when workloads are high, the liver has a lot of work to do.
When muscles are demanding more glucose (sugar) to function, e.g. as in exercise, the liver is busy turning over glucose and lactic acid from its storage cells. The muscles only store enough glycogen (stored glucose) to produce small amounts (up to 20 seconds) of ATP (your energy molecule) when you start to exercise – ATP is needed for muscle contraction.
The harder you train or exercise or the more stress that you experience daily, the more work your liver has to do to keep supplying your muscles and brain with energy. To achieve this, your liver is working harder than it should to help produce your chronic stress hormone called cortisol.
For more and more cortisol to be produced, the liver is producing cholesterol to help the adrenal glands make cortisol. The increased production of cortisol uses up your calming progesterone in the production pathway. When progesterone levels are low in comparison to oestrogen, menopause symptoms may become worse. Check out the symptoms of low progesterone below.
This is why, whether must be aware that over many years, the liver is an organ that may have had considerable changes to its load and ‘stress’. This may affect the inflammation that builds up during our menopause transition – a time when our liver is shrinking and losing volume as we move into post-menopause. (Brady, 2015).
I talk to you about all of this in my Masterclass on Menopause – have you listened to it yet? It’s 2 hours of ‘aha’ moments for you I hope – and yes, because I’ve pre-recorded it, you can ‘pause’ me anytime. In this webinar, I teach you how our liver changes with age – and don’t forget, menopause is the gateway to your biological ageing. You might feel young, but inside your body, your organs and tissues are changing and ageing.
As such, there are some mid-life lifestyle changes that you can make to accommodate your hormonal changes and if stress is an issue for you, then I encourage you to focus on not only reducing stress, but also on your liver health.
That’s what the two different MyMT™ programmes teach you – Circuit Breaker is for you thinner women, whilst Transform Me is for those of you who want to lose your belly-fat and weight (see the video at the end of this article below).
Then of course, in a life ‘well-lived’ for many women arriving in their 50s and beyond, there is alcohol and its impact on the liver. And don’t worry, I‘m not entirely a tea-totaller myself, but when I better understood the physiology of bringing together ALL of the factors that contributed to stress and inflammation on my ageing liver, it made sense that all the evening alcohol wasn’t being metabolised in an inflamed liver and was also contributing to more hot flushes and night sweats.
Inflammation in the liver, reduces ALDH enzymes, which affects alcohol metabolism. But there’s also the fact that alcohol increases fat storage of oestrogens in women who are already overweight or have fatty liver.
Alcohol aromatises into oestradiol, a form of oestrogen. In humans, oestradiol (E2) is the predominant circulating oestrogen. If you have breast cancer, then you might know all about this type of oestrogen already.
Oestrogens have effects in many organ systems that contribute to cardiovascular risk vs. protection, including regulation of liver lipid (fat) metabolism, (Palmisano et al, 2017).
Too much oestrogen from various sources, is sometimes not a good thing – especially, for those women (like me) who may already produce a lot of oestrogen naturally and store it in fat cells. For those of you who are overweight or obese, then your fat cells also make their own supply of oestrogens – yes! This increase in the size of fat cells can be problematic with menopause weight gain and this in itself can be problematic for our post-menopause cardiac and metabolic health.
As women, the levels of the enzymes that stores fats into cells (lipo-protein lipases) is highest in the fat-storage cells around our abdomen and under our diaphragm. It makes sense that when the liver can’t do its job of metabolising and clearing excess oestrogens and cholesterol, then fat might accumulate around these areas.
Our fat cells are full of oestrogen receptors, so fat cells attract circulating oestrogen and oestradiol (another form of oestrogen) as well as make their own oestradiol. I’ve written about the research behind this discovery HERE for you.
Hence, when excess oestrogen is stored in fat cells, this hormone may become higher in comparison to progesterone, making oestrogen the ‘dominant’ hormone. This is what is meant by the term, ‘oestrogen dominance’ – and you can read about this condition in another blog HERE.
As we move into post-menopause, the result of liver inflammation and the accumulation of belly-fat can be devastating for our heart and can lead to Type 2 diabetes. Women’s health studies are replete with these concerns in post-menopausal women. And this is what I’m passionate about you turning around.
To do so, you must have a focus on liver, gut and heart health and this is what I’ve evidenced from emerging lifestyle science.
So, if this sounds like you, then no matter where you are in the world, please come join me online when you can. I want you to turn back the clock on your liver health during and after menopause. My annual January Transform Me sale is now open and as I’m limiting numbers this time, I don’t want you to miss out, so the information is HERE for you. I hope you can join me. The programme opens on January 1st, 2023.
Dr Wendy Sweet, PhD/ Member: Australasian Society of Lifestyle Medicine
Brady C.W. (2015). Liver disease in menopause. World J Gastroenterol. 7;21(25):7613-20.
Chandel, N. S. , McClintock, D. S. , Feliciano, C. E. , Wood, T. M. , Melendez, J. A. , Rodriguez, A. M. , & Schumacker, P. T. (2000). Reactive oxygen species generated at mitochondrial complex III stabilize hypoxia‐inducible factor‐1α during hypoxia a mechanism of O2 sensing. Journal of Biological Chemistry, 275(33), 25130–25138.
Joung JY, Cho JH, Kim YH, Choi SH, Son CG. (2019). A literature review for the mechanisms of stress-induced liver injury. Brain Behav. 9(3):e01235. doi: 10.1002/brb3.1235. Epub 2019 Feb 13. PMID: 30761781; PMCID: PMC6422711.