Overweight and obesity, according to the definition of the World Health Organization (WHO) are considered as an abnormal or excessive fat accumulation that may impair health (WHO, 2016). For those of us who have ‘been there’ with our increased fat distribution during our menopause transition, some of these health issues include:
- higher blood pressure
- changing cholesterol levels
- erratic blood sugar levels which can lead to Insulin Resistance and Type 2 Diabetes
- aching ankles and muscles
- fluid retention
- and the issue that got me the most, an inability to tolerate exercise.
‘Menopause is usually a cause of many concerns’, mentions the 2017 report on obesity in menopause (Kozakowski et al, 2017), ‘and one of the most important, is the fear of weight gain’.
My own weight gain arrived almost out of the blue. I was still exercising, eating healthily, but still I felt bloated and ‘heavy’, especially in my breasts. In comparison to hot flushes and insomnia, this was one of the most difficult changes in my body to comprehend.
If your weight around your abdomen keeps increasing now that you are in menopause or you’ve moved into post-menopause, your fat cells are storing excess oestrogen. Despite the rapid fall in oestrogen levels, the contribution of environmental and other lifestyle factors (such as not sleeping and the build-up of inflammation in the body) are also important.
Oestrogens in women are responsible for the accumulation of fat in subcutanous tissue, particularly in the gluteal and thigh regions and around the abdomen. Prior to menopause, oestrogen receptors connect with circulating oestrogens to maintain our menstrual cycle and to keep us healthy for reproduction purposes. During menopause (when our periods are altered as we progress towards the cessation of them with age), these oestrogen receptors also attract other steroid hormones – mainly androgens (testosterone and androstenedione). Whilst these are typically known as male hormones, don’t let that full you – if you still have your ovaries, you are also producing these androgens and they are also produced in the adrenal pathway, when we are feeling stressed and can’t sleep. This occurs when cortisol is high.
But here’s the other issue – if you are overweight or obese going into your menopause transition, this has an impact on the conversion of these androgens to oestrogens. It’s a confusing time for your fat cells. Because your fat cells love storing excess oestrogens in your body.
Fat is metabolically active and oestrogen has a role to play in this. Our fat cells love to store oestrogen and because women have enzymes that make them store fat around their abdominal region – which is part of our ancient ‘survival’ physiology – mid-life is a time of our lives, when we become more vulnerable to a condition called oestrogen dominance.
Fat-storage is not the only part of the menopause weight-gain story. Our liver health matters too. If the liver is fatty or inflamed, it can’t clear excess oestrogens. For women on higher doses of oestrogen in their HRT, this includes excess oestrogen provided from this source.
When our liver can’t metabolise excess oestrogens effectively, our fat cells store these additional oestrogenic compounds as we move through menopause. Hence, oestrogen becomes the ‘dominant’ hormone in relation to it’s opposing hormone, progesterone. This makes us ‘oestrogen dominant’ and as a consequence of this, progesterone levels can become low. Your hot flushes, bloating, water retention, sleep, sore joints and aches and pains may become worse.
What happens then, is what happens to millions of women around the world in menopause – including myself. Progesterone becomes too low in contrast to oestrogen, so we feel bloated, heavy, sore and uncomfortable. It’s exhausting carrying all that excess weight around too. Breast tissue has numerous oestrogen receptors, so they can become swollen, heavy and uncomfortable. For those of us who enjoy exercise, heavy breasts and increasing belly-fat, make exercise that much harder to tolerate. Don’t even mention the expense with having to purchase new bras!
As well, abdominal obesity is a key factor in the development of Insulin Resistance (my article on this is HERE) and a condition called Metabolic Syndrome. This is a cocktail of health issues (high blood pressure, high cholesterol, high blood sugar and high triglycerides and for many of you, fatty liver) that arises from being overweight or obese in menopause.
When we store excess oestrogens in our fat cells (including liver and breast tissue) then we can develop a conditioncalled oestrogen dominance. What this means is that oestrogen becomes the ‘dominant’ hormone to the detriment of progesterone as we move through menopause and into post-menopause.
But there’s more to the oestrogen dominance story and this is my greatest concern for women moving through menopause into post-menopause. It’s not just the fat cells in the abdominal area expanding with excess oestrogen – fat cells are expanding around the heart muscle as well. This is known as para-cardial fat and this type of fat increases our risk for heart disease as we age. Furthermore, the layer of para-cardial fat increasess the stress on our heart, especially if we aren’t sleeping. It’s a double-whammy of health chaos as we get older and it’s important to turn this around.
As I slowly pieced together the menopause-misery jigsaw, I pulled together cardio-vascular research, diabetes and heart-health research as well as physical activity and longevity studies and of course nutrition research that was focused on mid-life women’s health and weight management.
The more I read, the more I began to understand that the greatest concern for women as they age, in terms of their expanding waistline and belly-fat, wasn’t necessarily to do with hormonal changes but a cluster of changes that relate to our changing physiology in menopause and the accumulation of inflammation that has been building up for decades.
When we aren’t sleeping, when our joints feel sore and we are losing precious muscle and becoming oestrogen dominant, then our metabolism changes too. It’s why I loved this insight from research out of the Australian National University, recently published in the American Journal of Obstetrics and Gynecology. If I had this research a few years ago, it would have saved a lot of lonely research of my own. In a review of studies that included more than 1 million pre- and post-menopausal women, the researchers learnt what I and many other women, have discovered in real life – that our waist circumference increases during and after menopause and as such, there is a shift in our metabolism, which can send us into worsening health with age.
“It’s important to understand how women’s bodies change as they age because women have higher rates of some diseases than men”, said Ananthan Ambikairajah, a PhD candidate at the Australian National University, who led the study. “The implications are important, because central fat has been linked with dementia risk, and central fat is linked with cardiovascular disease risk. As such, more attention needs to be paid to central fat accumulation, because that’s the bad stuff,” mentioned Ambikairajah.
Every extra kilo of weight is an added burden on your joints, heart, liver, cholesterol, muscle function and insulin levels as you age. That’s what concerns numerous women on my 12 week Transform Me programme as well.
It’s also the reason that I know that many of you can’t do the exercise necessary to ward off changing heart-health and Type 2 diabetes. Whilst there is an emphasis on more vigorous cardio and strength training as we age, in order to battle the bulge, I know myself that we are often too exhausted from not sleeping to tolerate this type of exercise. That’s how I felt myself.
As I often say, menopause itself isn’t the issue. This is a natural life stage that we all go through. The issue is that we are ageing. And because we are ageing, we are losing our precious muscle and when this happens, we gain fat, especially the fat that is centralised around the abdomen. This abdominal weight gain increases oestrogen dominance, which then changes our heart and metabolic health. That’s why, in post-menopause women, the risk for cardio-vascular disease (heart attacks and strokes) is higher for women than men.
Incredibly, because of our oestrogen dominance, sleep problems and muscle loss as we move into post-menopause, we can add 1-2 kg a week during menopause.
The women who join me on their online weight loss course over 12 weeks (or you can take longer) MyMT Transform Me programme, discover that turning around post-menopause belly-fat has nothing to do with hours spent exercising, or low carb, high protein, high fat, hard-to-adhere to, popular diets. It’s all to do with sleeping all night and taming our oestrogen dominance through changing our choices and routines that have been set for years. One of these factors is to change our diet and get off foods that are high in oestrogen and reduce our exposure to oestrogen-mimicking chemicals and pesticides. I talk about this in my Liver-Lover module.
When we know what to do, this allows us, first and foremost, to stop gaining fat. We can’t lose weight until we stop gaining. Following that, we need to discover how to re-balance our blood-sugar levels and reduce the impact of insulin, our blood sugar regulation hormone. When insulin is out of balance, then this very quickly sends us into more fatigue and weight gain. This means that we also need to focus on giving ourselves a liver rescue so that excess oestrogens are metabolised.
All of these factors combined –
- not sleeping,
- increased insulin,
- high stress levels,
- testosterone changes and
- loss of muscle tissue –
have the greatest impact on our changing health and weight gain as we move into post-menopause.
If this is you, then will you let me help you? The 12 week online programme is everything I needed to know when my health and weight began to change as I moved through menopause. It would be my privilege to help you too. To learn more, my video is below. I would love you to listen to it sometime.
Egger, G. & Dixon, J. (2009). Inflammatory effects of nutritional stimuli: Further support for the need for a big picture approach to tackling obesity and chronic disease. Obesity reviews : an official journal of the International Association for the Study of Obesity. 11, 137-49.
Kozakowski, J., Gietka-Czernel, M., Leszczyńska, D., & Majos, A. (2017). Obesity in menopause – our negligence or an unfortunate inevitability?. Przeglad menopauzalny = Menopause review, 16(2), 61–65.
Manco, M. ,Nolfe, G. , Calvani, M., Natali, A., Nolan, J., Ferrannini, E., Mingrone, G. (2006). Menopause, insulin resistance and risk factors for cardiovascular disease. Menopause, 13 (5), 809-817
Patni, R., & Mahajan, A. (2018). The metabolic syndrome and menopause. Journal of Mid-life Health, 9(3), 111–112.
Weickert M. O. (2012). Nutritional modulation of insulin resistance. Scientifica, 2012, 424780.
World Health Organisation (WHO). Obesity and Overweight Fact Sheets (2020). https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight