While there are numerous symptoms that are disruptive in perimenopause, weight gain is one of the top concerns women want addressed. Even if they’re sleeping four hours a night, or having hourly hot flashes, or bleeding heavily for ten days at a time, weight gain somehow makes it to the top of the list of concerns.
It is estimated that about 80% of women in perimenopause gain some weight, but why does this occur?
One prevailing theory for weight changes is fluctuations in estrogen, which can lead to a redistribution of fat into the abdominal area. Since adipose (fat) cells increase the production of estrogen, it’s been theorized that due to the declining function of the ovaries, the body increases the production of adipose cells to make up for the lack of estrogen.
However other research suggests that weight gain occurs in women as they age, independent of perimenopause. So if weight gain is not directly related to perimenopause, what else could be going on?
One of the keys to understanding the reason for weight gain is knowing that there can be different types of weight gain. While I subscribe to the health at every size mindset, if weight gain is a concern, I view it more as a symptom than an issue in and of itself. We can have body-wide weight gain versus abdominal weight gain. The most common type of weight gain I see in perimenopausal women is abdominal weight gain.
So let’s talk about some frequent causes of weight gain in perimenopause and beyond.
One of the most common issues at this time of life is thyroid imbalance. In fact, it’s so common that there’s a term for it, “thyropause”.
As we’ve discussed before, the list of thyroid symptoms and perimenopause overlap quite a bit. Since your thyroid controls metabolism, it is responsible for setting your basal metabolic rate. In other words, your thyroid controls how much energy (calories) is needed from food to keep your body alive.
If your thyroid is under-functioning, that metabolic rate decreases, so even if you’re eating the same amount and types of foods, the demand for energy is less and your body will store the extra calories.
To find out if your thyroid is under-functioning, it is critical to get properly tested.
Another common reason for weight gain, particularly abdominal weight, is stress. When cortisol (a stress hormone) is elevated over time due to chronic stress, it creates more abdominal fat. Stress is tied to many symptoms of perimenopause so I plan to write an entire article just on that.
Related to stress is insulin and blood sugar balance. Chronic stress can reduce our bodies’ sensitivity to insulin. Insulin is the hormone responsible for getting glucose from your blood into the cells where it can be used. Think of it as a key that unlocks the door to let glucose into the cell.
If you develop insulin resistance where your body is not as sensitive to insulin, the only way your body knows how to correct it is to produce more insulin. All the body recognizes is the extra glucose hanging out so therefore, we must need more insulin. The problem is that insulin is not a harmless hormone. Insulin is very pro-inflammatory and promotes fat storage (ie abdominal fat).
While there can be a few factors that can influence insulin sensitivity, nutrition is usually a big piece of the puzzle. Besides stress, eating excess sugar and carbohydrates will cause your body to lose its sensitivity to insulin and create insulin resistance. There are almost 80 different names for added sugars so sugar is ubiquitous in an American diet unless you take active steps to reduce it.
I always encourage patients to start by reading ingredients labels. Educate yourself on where hidden sources of sugar are coming from so you know what foods need to be swapped out for a low sugar or low carbohydrate option.
Other considerations around weight gain include sleep and food sensitivities. Research has shown that inadequate sleep can increase weight. We need at least 7 hours a night to help maintain a healthy weight. I’ve also commonly seen food sensitivities add some weight, mostly because of extra inflammation that’s created in the body. Once the food sensitivities are identified and removed, I’ve had many patients lose an extra 5-10 pounds in a few short weeks due to the reduction in inflammation.
Exercise tends to be the main focus when women want to lose weight. While it is important, if there is underlying thyroid, blood sugar imbalance, or chronic stress, exercise can only do so much. If anything, solely focusing on exercise as a form of weight loss can add to your stress if you’re not seeing results despite exercising diligently.
That all being said, there are some important considerations around weight. First, body mass index (BMI) is our current standard for determining whether someone is of a healthy weight or overweight. There’s been a lot of controversy around BMI over the years. To start, BMI has a racist origin. In addition, BMI is not accurate in determining whether someone is healthy or not since muscle weighs more than fat and BMI is based solely on a height to weight ratio.
Whenever a woman comes in my office and wants to lose weight, I always encourage them to identify the deeper motivation behind the desire to lose weight. Weight is just a number and is not a good indicator of health so what is their real reason for wanting to lose the weight. Do they want to feel more confident, have more energy, or reduce joint pain? Or is it because we live in a fat-phobic society?
The last thought I’d like to share about weight gain relates to aging. As discussed earlier, weight gain seems to possibly be tied to getting older, whether that’s due to perimenopause or other factors. That being said, we cannot expect to make it through life with the exact same body shape.
The only constant in life is change so we should have the expectation that our body will change over time. Just as we do not expect a 20 year old to “regain” the body of a pre-teen, don’t put the pressure on yourself to fit into the same clothes you did 20 years ago. While it may sometimes be a hard pill to swallow, we are lucky to age as some people don’t get the opportunity.
Focusing on the positive health outcomes you’re looking to attain rather than becoming obsessed with a trivial number will not only move you towards the health goals you want but is also freeing in the process.