Weight and Menopause

Weight-loss patients are often filled with this self-loathing. Their internal narrative is commonly extremely negative, using phrases such as “I hate myself”, “I am disgusting”, and “ I will not look at myself”. This is further complicated by the fact that they dually reward and punish themselves by overeating and eating ‘comfort foods.’ They seek out high-fat, high-sugar, high-carbohydrate ultra-processed food that they know has the potential to increase weight and contribute to poor health. This is because the high they get from the sugar within these foods and the Dopamine release has the power to lift their mood briefly. They are not usually aware that this high becomes shorter- and shorter-lived over time, so just as with any other drug, they increase their intake to get the same effect. This leads to sugar addiction, which is hard to manage because most people are unaware of it initially.

The addiction is complex to break as we all need to eat, and our brains are wired to encourage us to seek out fuel. This part of the brain is prehistoric and is known by all food manufacturers who develop food and packaging specifically to trigger this craving and satisfy it but only for a short amount of time. Unfortunately, the prehistoric brain could not adjust the craving purely to healthy carbohydrates, fats, and sugars. This is a habit that must be developed.

So, what does this have to do with menopause?

As with all weight loss, untangling menopause weight gain and implementing manageable and sustainable weight loss is not simple.

In menopause, women often develop a sweet tooth or a craving for high-fat, high-sugar, ultra-processed food. This is thought to be connected to the hormone fluctuation creating fatigue, alongside disruption of the serotonin levels affecting mood. Add to this the fact that Serum Serotonin re-uptake inhibitors (SSRI’S), a form of anti-depressants and certain forms of HRT cause weight gain, and it is no wonder women at this stage in life struggle and can feel as if they face an impossible task.

Simultaneously in the peri-menopausal period, women tend to become less active because of changes to lifestyle-children growing up, changing demands on them in terms of family and work. Combine this with constant yoyo dieting, going for extended periods of the day without eating, having a poor diet, not exercising, or only focusing on cardio, and women’s metabolism slows down. At this point, they are at an increased risk of insulin resistance, and they lose muscle mass. The lack of muscle mass itself is a crucial factor towards their metabolism is slowed. These additional factors are widely accepted as important influences on weight gain and, more worryingly, the increase of visceral fat at this stage in life. The good news is these factors, long thought unchangeable, can be addressed, and weight loss, reduction of visceral fat and increased muscle mass can be achieved.

This is not to say that the hormone dysregulation that happens in the peri-menopausal and menopausal phases is without significance when it comes to women’s weight. The complex hormone interaction, continual production and regulation of levels are key in maintaining the homeostatic function of every function in the body. It is not just sex hormones. It is all hormones, including insulin and cortisol.

In menopause, weight gain and weight loss are both influenced not just by the effect of the reduction of oestrogen, in particular Oestradiol, but also by the residual higher level of androgens and testosterone as a result. A closer examination of the drop in Oestradiol and the continued production of estrone demonstrates a link to weight gain in menopause due to their role in regulating metabolism. Peripheral aromatisation is responsible for the continued production of estrone at a much lower level, and sex hormone-binding globulin production is simultaneously reduced. This reduction is linked to an increased risk of type 2 diabetes.

Cortisol levels become raised due in part to hormone fluctuation and the impact on emotional function. Commonly the menopause and peri-menopause phase in life is incredibly stressful for women. This heightened stress, exacerbated potentially by extrinsic factors such as work and relationships, leaves the woman in a perpetual state of adrenal stress, continually releasing cortisol. This is in opposition to the usual rise in cortisol in the early hours triggering individuals to wake up and then levels dropping off as the day progresses, allowing them to sleep in the evening. Elevated cortisol levels are also thought to be related to fat storage in the abdominal region. The continued prominent levels of cortisol also interfere with sleep patterns and disrupted sleep also influences the storage of abdominal fat.

This is one of the most dangerous areas of the body to accumulate fat. The accumulation of fat in specific locations, such as thighs and hips pre-menopause, is designed to be used by the body in pregnancy and breastfeeding. In menopause, this is no longer required, so the body shifts the storage of fat to the abdomen and a higher percentage of excess fat to around the organs- visceral fat. High abdominal circumference is linked to an increased risk of various adverse health conditions, including diabetes and cardiovascular disease. This hormone dysregulation has a pivotal impact on female metabolism. Understanding and knowing how to manage this is key to helping these patients.

Where to start?

As discussed, several key elements are involved in weight loss in the menopausal woman, including food cravings, location of fat deposits, speed of metabolism, muscle mass, sleep, and hormone regulation. A weight-loss plan for these women should contain the following elements

1. A thorough consultation establishing patients’ lifestyle and diet habits to implement habit-building strategies to increase exercise and the intake of high fibre, higher fat and reducing the amount of processed food high in sugar. This reduces inflammation in the patient, which reduces a substantial number of issues for women in the peri-menopausal and menopausal phases.

2. Assess and refer to specialists if necessary to commence HRT where appropriate, and the patient wishes to do so. It is not always necessary to commence HRT as sometimes commencing a weight-loss plan with all of these steps can be enough for women to relieve symptoms and manage them more easily.

3. Educating patients to understand the nutritional value of their food choices and the effect it can have on their hormone function, mood, sleep, energy levels and metabolism.

4. Gut health optimisation to improve the function of the body, skin, and vaginal health and improve mood. Consider supplements, C, B and Omega oils.

5. The focus on resistance training in one of the many forms (not just weightlifting) to build muscle mass to speed the metabolism, support the immune system and strengthen bones-key in reducing the risk and effect of osteoporosis. This also provides an alternative source of dopamine release essential for improving mood and reviving a sense of achievement and wellbeing.

6. The realignment of circadian rhythms implementing good sleep practices to build good sleep back into their lifestyle.

I have patients who have had remarkable success and noticed changes within two weeks. Not just with their weight but with their mood and sense of wellbeing. This, for me as a practitioner, is the best result because once they can be in a positive space, they can see and feel the value of the changes they are making, which is key to sustaining new habits.

It is, however, essential to understand it is not a one size fits all. A standard package and approach will not work, and good weight loss must be a bespoke treatment tailored to the individual’s needs.

My clinic offers bespoke weight-loss plans with and without pharmacological intervention. My Sese Slim programme is a medical weight-loss program designed around the individual and their needs and lifestyle. This is to ensure it is sustainable for them. It uses Saxenda, where appropriate, as a tool to assist them with replacing old habits with new ones.

When offering weight loss, it is essential to be qualified in the management of weight and obesity. Understanding the psychology of weight loss, the hormonal challenges of menopause, the pathophysiology of related weight gain and its specific challenges to weight loss.

This article was written for the Consulting Room Magazine.

Fancy grabbing a FREE subscription to the Consulting Room quarterly aesthetic trade magazine?

Immerse yourself in the world of aesthetic medicine with our captivating Consulting Room Magazines. Each edition is carefully curated with CPD-certified content, delving into various sectors or topics within the field. Our unique quarterly themed editions take a deep dive into different sectors or topics associated with the world of aesthetic medicine with articles written by leading practitioners in their fields of expertise.

Get your free subscription now at: https://www.consultingroom.com/magazine/

Unlock a treasure trove of aesthetic knowledge!

To access a digital archive of all previous magazines and articles, including this one, simply provide your details here and enjoy lifetime access to our digital magazine archive. Explore past issues and delve into a wealth of valuable content.

Weight and Menopause

Keep In Touch