Weight Loss and Menopause: What You Need To Know
It’s never too late to begin your weight loss journey. Cathleen McKnight, DNP, a certified menopause provider, explains the science behind losing weight as you age.
It is possible for women to lose weight as they age and before, during, and after menopause. You’ll see this repeated a few times as you read on. It’s not just a mantra, it’s the truth.
As a certified menopause provider with advanced training in obesity medicine, I frequently remind patients that they can meet their goals to lose weight and become healthier. It’s never too late.
Menopause is an incredible milestone and the perfect time to gear up and revive your wellness journey.
- Weight loss goals for women over 40 are reachable.
- Weight loss before, during, and after menopause is doable.
- Losing weight as you age can reduce your risk of common midlife health conditions.
- Optimizing diet, exercise, sleep, and brain health is your path to the healthiest version of you.
What Is Menopause?
Natural menopause is marked by the final menstrual period due to loss of ovarian and hormonal function. Natural menopause is diagnosed in hindsight after an individual is without a period for 12 uninterrupted months. The average age of natural menopause is 50 to 52<sup>1</sup>.
Induced menopause is the absence of a period that follows a procedural intervention, such as removal of both ovaries, chemotherapy, radiation, or other form of ovarian toxicity. For purposes of this discussion, “menopause” refers to “natural menopause”.
<p class="pro-tip"><strong>Still getting your period? Learn more about </strong><a href="/blog/period-blood-sugar-levels">how your period can affect blood sugar levels</a></p>
What Is Perimenopause?
The prefix, “peri-” translates to “surrounding”, like “perimeter” or “periscope”.
Perimenopause begins with the onset of menstrual irregularities and continues through the first 12 months after the final menstrual period. In other words, perimenopause covers the menopause transition to the final menstrual period and through the first year of postmenopause.
As perimenopause sets in, hormones begin fluctuating. As hormones change, it’s common to experience menopause symptoms that can last for years before and after the final menstrual period, such as<sup>1</sup>:
- Hot flashes
- Night sweats
- Sleep issues
- Vaginal dryness
- Urinary frequency or urgency.
During perimenopause, it’s not uncommon for women to gain weight. This does not mean that menopause is necessarily the guilty party.
That’s right! Menopause might not be the metabolism buster we thought.
<p class="pro-tip"><strong>Learn more about </strong><a href="/blog/hormones-and-weight-loss">hormones and weight loss</a></p>
Midlife Body Changes
Additional changes to the body often occur around menopause and postmenopause. While there may some connections, it is not all of menopause’s fault. Many changes are attributed to the aging process, behavioral factors, or a combination of the two<sup>1</sup>.
<p class="pro-tip">Related: Aging, Blood Sugar, and Metabolic Health</p>
Common midlife changes in women:
- Increased body weight
- Decreased sexual function and desire
- Altered pelvic floor function
- Decline of mental abilities
- Difficulty sleeping
- Changes to skin and hair
- Challenging headaches
- Loss of bone and joint issues
- Shifts in mood.
Shifts in hormones play a role in the midlife changing process. For example, decreased estrogen can contribute to vaginal dryness, which can interfere with sexual function and desire and cause more frequent urinary tract infections. Similarly, hot flashes and night sweats (collectively called “vasomotor symptoms” in the medical world) may negatively impact sleep, headaches, and shifts in mood.
While hormone changes in menopause are a known contributing factor to many of these midlife body changes, it’s not necessarily the sole cause. We see some of these same changes in aging males.
What does this mean? Menopause and aging changes often happen together, and there is overlap. But the bad rap for body changes doesn’t completely fall on menopause.
<p class="pro-tip">Most women struggle with symptoms-related menopause and midlife body changes. Yet only a very small portion of the population seeks treatment for their bothersome symptoms<sup>2, 3</sup>. You don’t have to suffer! Consult your healthcare practitioner or a menopause specialist.</p>
How a Women’s Weight Can Change With Age
With age, lean muscle mass decreases and fat increases. This does not necessarily mean that weight increases. As muscle decreases in the body, so does the metabolic rate. A reduction in metabolism means less energy is expended. In turn, nutritional needs for energy also dwindle.
The knowledge base in science is ever growing. Until recently, many signs indicated that physiologic changes to metabolism in women started in midlife and in relation to menopause. But that might not be the case.
A compelling study published in 2021 showed that metabolism differs for all people across four stages in life regardless of gender<sup>4</sup>. There was no change in metabolism during menopause and midlife when body weight and muscle mass were taken into consideration.* The study suggests:
- Infants to age 1 reach their highest metabolism over a lifetime
- Toddlers to young adults (ages 1 to 20) show a slow in calorie burn by approximately 3% per year
- Adults through midlife (ages 20–60) level off with a consistent metabolism*
- Older adults (60+) observe a year-over-year reduction in caloric spend by about 0.7%.
The results of the study infer that the weight gain seen over perimenopause and menopause may be more likely attributed to lifestyle factors, such as decreased movement, increased food or alcohol intake, developed health condition that affects weight, or other person-specific factor.
While the study is not 100% conclusive, it is making a big splash in the world of science and obesity medicine. The jury is still out but the finding may be the start to busting the menopause metabolism myth.
<p class="pro-tip">Despite the controversy, there are two facts that are consistent: Weight loss can occur, and weight gain can be prevented around menopause with diet and exercise.</p>
Postmenopause Health & Other Common Midlife Conditions in Women
What does weight have to do with it? Weight has A LOT to do with it.
There are many conditions to be on the lookout for starting in midlife and extending through older age that are associated with body weight. A few of the common midlife conditions include:
- Pre-diabetes and diabetes
- High blood pressure
- High cholesterol
- Thyroid disease
- Gallbladder disease.
Prediabetes is a yellow light. It is a caution state of hyperglycemia where blood glucose averages above normal but below the threshold for diabetes. Individuals with prediabetes are at risk for diabetes.
Lifestyle interventions, like diet modifications and exercises, prevent conversion to diabetes and can reduce risk 40–70% in adults with prediabetes<sup>5</sup>.
Diabetes is a long-lasting health condition that affects the way your body processes sugar in your bloodstream. Insulin, a hormone produced by the pancreas, helps regulate blood sugar. In a person with diabetes, the pancreas, a vital organ, cannot make enough insulin or the body cannot use the insulin efficiently to bring blood sugar down<sup>6</sup>.
Like prediabetes, lifestyle changes and weight loss can help control diabetes and prevent negative consequences of chronic elevations in blood sugar, such as vision changes, nerve pain, and challenges to healing when sick or wounded<sup>7, 8</sup>.
High blood pressure
High blood pressure is when the blood flow running through the arteries exerts higher than normal burden on the arterial walls. When pressure remains consistently elevated, the arteries become less flexible, which can lead to impaired blood flow.
High cholesterol increases risk for buildup of fats and cholesterol on your artery walls. The buildup, called plaque, can cause narrowing of the arteries, impair blood flow, and burst, creating a blood clot.
When there is inadequate blood flow related to elevations in blood pressure or cholesterol, it can lead to serious issues, including heart attack, stroke, or another medical emergency.
Weight loss can help improve these conditions and decrease the likelihood of poor health outcomes and medical emergencies. In overweight and obese women, a small reduction in weight (3%) has demonstrated health benefits, such as correction in cholesterol levels, and decreasing the risk for diabetes<sup>1</sup>.
Moderate weight loss of 5–10% shows even greater health benefit and risk reduction, spanning additional cholesterol benefits, control in blood sugar, better blood pressure, improved liver function, increased function in day-to-day activities, and reduction in chronic pain<sup>9</sup>.
<p class="pro-tip"><strong>Learn more about </strong> <a href="/blog/hormones-metabolic-syndrome">how hormones can affect metabolic health</a>.</p>
Osteoporosis is a condition defined by low bone mass. Some bone loss comes with the territory of aging. However, excess bone loss with osteoporosis creates high risk for fractures and healing. The loss of bone can occur from deterioration of bone tissue or disruption of the ability to adapt its size and shape in response to physical stress. Lower weight, or “thinness,” is a risk factor for osteoporosis<sup>1</sup>.
The risk for osteoporosis with lower weight is not an excuse to seek weight loss. One expert review clarifies that moderate weight loss does not necessarily impact bone health<sup>10</sup>.
Practice combined, or multicomponent training, to support bone health in midlife when bone deterioration is inevitable and during times of weight loss. Multicomponent training includes a variety of exercises, including weight-bearing drills, resistance activities, muscle strengthening, and aerobic exercises<sup>11, 12</sup>.
Cancer affects an estimated one in three women during their lifetimes according to the American Cancer Society<sup>13</sup>. Thirteen cancers have been identified to have an association with overweight and obesity. An estimated 13.1% of cancers are linked to obesity<sup>14</sup>.
There are many factors that suggest how and why the relationship between higher weight and cancer exists. Specific to women, fat tissue is the primary source of circulating estrogen in postmenopausal women<sup>15</sup>. The extra estrogen in overweight and obese individuals likely relates to an increased risk for breast, endometrial, ovarian, and other select cancers<sup>16</sup>.
Individuals carrying excess weight are more likely to have increased levels of insulin and insulin growth factor, a condition called hyperinsulinemia or insulin resistance. The increased insulin levels are associated with colon, kidney, prostate, and endometrial cancers, in addition to the development of type 2 diabetes<sup>16, 17</sup>.
Thyroid disease is a medical condition where the thyroid cannot produce the correct amount of hormones to maintain balance. Thyroid disease can occur in response to underlying conditions or independent of any known cause. In one study looking at women across the nation, one in 10 women aged 42–52 displayed indications of thyroid dysfunction<sup>20</sup>.
Thyroid hormones regulate metabolism, body temperature, and contribute to food breakdown and processing. Thyroid disease may impact weight loss and weight gain depending on how the thyroid hormones are affected<sup>21, 22</sup>.
Gallbladder disease, or gallstones, occur two times more frequently in women when compared to men. Gallstones become a problem when they cause symptoms due to movement or blocking with the bile duct, which releases digestive juices into the small intestine.
Being overweight or obese, a female, and having concentrated central adiposity (excess fat tissue around the waist versus the hips and thighs) are all individual risk factors for developing gallstones. As if that isn’t enough, rapid weight loss can also contribute to the formation of gallstones. But don’t be intimidated by the double-edged sword, weight loss at a gradual, slow pace lessens the risk<sup>23</sup>.
Weight Loss & Disease Prevention: Postmenopause & Midlife Health
It is possible to lose weight around the time of menopause and after.
Weight loss and disease prevention in midlife may be promoted in a single, unified goal: Live a healthy lifestyle. A healthy lifestyle includes behaviors that support total wellness of body and mind.
To promote a healthy lifestyle, focus on the following:
- Optimize your diet
- Strive for high-quality sleep
- Engage in stress-relieving self-care activities
- Lose 5–10% of your body weight if you are overweight or obese
- Stay up to date on routine health maintenance (for example, annual physical, blood work, immunizations, and preventive screenings as recommended by your dedicated healthcare provider).
How to Live a Healthy Lifestyle: Perimenopause and Postmenopause
Ready to act? Here are some specifics on how to lose weight and live an overall healthy lifestyle peri and postmenopause.
Optimize your diet
Incorporate Mediterranean-style eating patterns
The Mediterranean diet supports weight loss and many studies<sup>[24, 25]</sup> show that the dietary pattern improves risk for heart disease, stroke, obesity, type 2 diabetes, cancer, degenerative brain disease (like Alzheimer’s, Huntington’s, and Parkinson’s disease), and may also increase quality of living.
<p class="pro-tip">Learn more about the Mediterranean diet</p>
The Mediterranean-style diet centers the base of nutritional intake around vegetables, fruits, nuts, seeds, legumes, whole grains, herbs and spices, fish and seafood, and extra virgin olive oil. Poultry, eggs, cheese, and yogurt are eaten in smaller, moderated amounts.
<p class="pro-tip">Principles of the Mediterranean diet include avoiding or rarely consuming: red meat, added sugars, sweetened beverages, processed meats, refined grains and oils, and highly processed foods.</p>
The Mediterranean diet also appears to have a role in blood sugar control<sup>26</sup>.
Monitor your blood sugar to help lose unwanted weight
Hunger recognition is a method that teaches you to connect physical symptoms of hunger with blood glucose level so you eat when your body really needs the nutrients. In one study, the hunger recognition methodology produced greater weight loss over five months, when compared to increasing vegetable intake and physical movement.
Another study supports monitoring of glucose to train recognition of hunger queues, although participant adherence to the protocol of only eating when blood glucose was 85 mg/dL or 4.7 mmol/L or lower was difficult for some to follow<sup>27</sup>.
While hunger training is promising, it appears that additional research is needed to refine protocols for recommendations. However, that doesn’t mean you shouldn’t start monitoring your blood glucose for weight loss now.
Continuous glucose monitors (CGM) show encouraging results for targeting positive behavior modification<sup>28</sup>. Why? Well, everybody and every body is different. My blood sugar response to consuming a meal may be drastically different from your blood sugar response to the same meal<sup>29</sup>. A team of experts published a study where personalized dietary interventions lowered post-meal blood sugar levels<sup>30</sup>.
<p class="pro-tip">Also Read: The Scientific Evidence for Using CGMs for Weight Loss</p>
Learning how your body responds to foods gives powerful insight into what dietary modifications may set you up for weight loss success. If you learn that a particular food or meal skyrockets your blood glucose, you can try to avoid foods that raise blood sugar or combine these foods with protein and fiber to blunt the glycemic response.
While a little bit of sugar is unlikely to cause weight gain, high spikes cause responsive levels of insulin to be released. The labile, or “up-and-down” effects of this hormone negatively impacts hunger regulation in the hypothalamus through a feedback system. It can cause decreased feeling of fullness, increased likelihood of overeating, and creates an inconsistent output in energy throughout the day, which can be very taxing on the mind and body.
“Sugar crashes” are named after the body’s response to drop or bring down a high level of sugar. You may feel pretty crummy and drained from energy when you crash. This feeling causes your body to seek more energy through food, often causing you to eat more calories than you actually need.
Over time, consuming foods that significantly raise blood sugar creates even more problems than possible weight gain, like insulin resistance. Insulin helps move glucose into the cells, where energy is produced. When insulin resistance sets in, your body responds differently to increased glucose, leading to even more elevations in blood sugar and insulin, and decreases in hormones like leptin (which controls hunger).
Thus, weight loss and weight maintenance can be positively influenced when blood sugar is monitored and contemplated in food choices.
Calories In, Calories Out
Targeting a personalized diet that keeps your blood sugar from jumping can assist in losing weight irrespective of calorie-counting because it can help you change your mindset<sup>28, 29, 30</sup> about your lifestyle habits.
<p class="pro-tip">Learn more about CGM for weight loss here.</p>
Increase protein to increase feeling full and satisfied after eating
When protein increases satiety hormones and is the main contributor to feeling full that translates to greater weight loss and lower calorie intake. Unlike sugar, protein does not effect energy intake on the next meal or snack. Protein also helps preservation of lean muscle mass.<sup>32</sup>.
Focusing on multicomponent exercise not only promotes bone health but also prevents deterioration of (and can possibly add) lean muscle mass that comes with aging<sup>10</sup>. During weight loss, fat-free mass also helps boost metabolism, which typically falls as the pounds on the scale drop.
Practice Good Sleep Hygiene
Sleep is important in tuning many processes in the body that control weight. When sleep quality or quantity is compromised for a prolonged period of time, metabolism and hormone function takes a hit, and altered hormone function is correlated with obesity<sup>33, 34, 35</sup>.
Here’s what happens in your body when your sleep hygiene is suboptimal:
- Ability to process sugar circulating in the blood decreases (glucose tolerance)
- Response to insulin to help regulate blood sugar decreases (insulin sensitivity)
- Rise in appetite is possible and related to additional release of cortisol (a hormone)
- Ghrelin (or “Grrrr-elin,” as I like to call it) elevates, promoting stomach grrrr-owling and triggers physical hunger cues
- Leptin decreases, the hormone that communicates “enough” so you pump the breaks on eating.
5 Tips for Better Sleep Hygiene
- Keep a routine bedtime and morning rise time throughout the week and weekends
- Create a conducive sleep environment (quiet, dark, and comfortable)
- Avoid screen time for several hours leading up to bedtime (TV, computers, phones, and other devices)
- Steer clear of large meals, caffeine, and alcohol before you try to count sheep
- Exercise early in the day.
The consequences of stress can trigger cortisol release in the body, which can make certain persons more susceptible to weight gain and obesity<sup>37</sup>. Try some of these stress-reducing activities throughout the week<sup>38</sup>:
- Rehearse mindfulness by purposefully paying attention to the present moment with an attitude of acceptance<sup>39</sup>
- Listen to guided imagery or meditation
- Regulate with diaphragmatic breathing
- Practice self-care
- Do things that make you happy.
<p class="pro-tip">Read more about optimizing your brain health, including stress management.</p>
Beginning a New Chapter
Menopause is not the end. It is a new beginning to the next chapter. Embrace your midlife journey.
View this stretch as a freeing time. Free from periods and all the problems that follow. Free from pregnancy scares. Freedom to focus on yourself and what you need and want. Free to paint your picture of wellness. And free to rid yourself from unwanted weight and health risks.