Dealing With Weight Gain During Menopause: Let's Unravel the Mystery!

So, you've hit that magical yet perplexing stage in life – menopause. If you're nodding your head in agreement, you're not alone. Weight gain during perimenopause and menopause is a common gripe among women. But here's the good news – it's not all your fault! In this blog, we will delve into why this happens and take a closer look at the fascinating changes your body undergoes during this transformative phase.

First off, menopause and perimenopause typically kick in for women between the ages of 45 and 55. It's that time when you start noticing changes in your body before you bid farewell to your monthly cycles. You might be familiar with hot flashes, night sweats, shifts in your periods' frequency and intensity, and even mood swings. But what often takes center stage for many women is the frustrating shift in weight and body mass distribution. Suddenly, your clothes fit differently, your body feels like it's on a rollercoaster, and your efforts at the gym seem to yield fewer results. And to top it off, this usually happens with little to no change in your usual diet or exercise routine. Frustrating, right?

Menopause is sometimes called our "second puberty," and for a good reason. There's a hormonal revolution happening within your body. Progesterone and estrogen, the dynamic duo that played a crucial role in your reproductive years, are now doing a different dance. As you transition into perimenopause and menopause, the choreography changes. Initially, you experience a surge in progesterone, while estrogen continues to be produced in pre-menopause. But as menopause looms, progesterone levels take a nosedive, followed by a drop in estrogen levels. It's a hormonal shift!

Now, let's get to the heart of the matter – why does your body seemingly betray you with weight gain during this time?

Weight Gain and Menopause: Finding the Culprit

Please take a deep breath; it's not all your doing! Research has shown that menopausal women are three times more likely to develop obesity and metabolic syndrome abnormalities than their pre-menopausal counterparts. Multiple studies have pointed the finger at one major suspect: the loss of estrogen. To put this into perspective, estradiol levels, a form of estrogen, typically range from 100 to 250 pg/mL in cycling females and plummet to 10 pg/mL in post-menopause. This means that you end up spending a significant portion of your life grappling with estrogen deficiency.

As you approach menopause, certain health issues and diseases tend to rear their heads, hinting at changes in sex hormones as the culprits. Women also tend to accumulate more visceral fat (the fat around your abdomen and organs) during the menopause transition, even as their subcutaneous fat (the fat on your arms and legs) remains stable or decreases. Visceral fat is the troublesome type of fat, as it raises your risk of cardiovascular disease, weakens your immune system, and serves as a precursor to metabolic syndrome. This condition paves the way for diabetes and other health issues.

To truly grasp the connection between menopause, obesity, and metabolic syndrome, we need to dig a bit deeper into the intricate relationship between estrogen and your metabolism. Part of this story revolves around cholesterol, the building block for all sex hormones. Cholesterol is transported in your bloodstream by lipoproteins, including LDL (low-density lipoproteins), HDL (high-density lipoproteins), and triglycerides (fatty acids).

Estradiol is pivotal in your liver's ability to manage and eliminate cholesterol. But when estradiol levels decline during menopause, less cholesterol gets converted into sex hormones, and your liver becomes less efficient at detoxing cholesterol. This leads to elevated cholesterol levels, which can promote inflammation and increase your risk of cardiovascular disease.

Estradiol also promotes insulin sensitivity, helping your liver and body efficiently manage blood sugar. But when estradiol takes a nosedive, insulin resistance can rear its head, putting you at a higher risk of diabetes and fatty liver disease. This shift also correlates with increased central obesity, insulin resistance, dyslipidemia, hypertension, and cardiovascular disease, primarily because of rising LDL cholesterol levels.

But here's an intriguing twist: bone density loss also plays a role in the accumulation of fat cells. Your bone marrow is usually hard at work, producing more bone than fat cells. However, as estrogen levels drop, your bone marrow shifts gears, favoring the production of fat cells over bone cells. These fat cells are then released into your bloodstream, reaching specific types of fat tissue and contributing to an increase in overall body fat.

Different Types of Fat in Your Body

Your body doesn't just have one type of fat; it's a bit more complex than that:

  1. White Adipose Tissue (WAT):
    • These are the typical fat cells we think of.
    • They can be found beneath your skin (subcutaneously) and around your organs (viscerally).
    • WAT cells are your energy reservoirs.
    • Subcutaneous fats break into free fatty acids, providing a steady energy source.
    • Visceral fats, however, are less predictable, breaking down in response to signals rather than energy demand.
    • In lean individuals, WAT makes up about 10-20% of body weight and can expand in both cell size and quantity when there's an excess of it.
    • Interestingly, visceral fat is more closely tied to menopause, while subcutaneous fat is influenced more by your nutrition and activity levels. And here's a tidbit: some WAT cells originate from your bone marrow, as we mentioned earlier!
  1. Brown Adipose Tissue (BAT):
    • Think of BAT as your body's thermogenic engine.
    • We have the highest amount of BAT when we're babies, but much dwindles as we grow into adulthood.
    • BAT is crucial in regulating insulin resistance, shielding you from obesity and diabetes.
    • It's inversely correlated with body mass index (BMI).
  1. Bone Marrow Adipose Tissue (BMAT):
    • This type of fat ends up competing with bone growth in your marrow.
    • When your bones experience mechanical stress (like running or strength training) or receive hormonal signals, your marrow leans towards producing bone-building cells called osteoblasts.
    • But when your marrow encounters oxidative stress, glucocorticoid signals, or prolonged immobility, it begins churning out adipocytes (fat cells) instead.

One study discovered that mice without ovaries had more visceral and subcutaneous fat due to increased production of bone marrow fat cells from estrogen loss. On average, women gain around 12 pounds within eight years of entering menopause. This same study also found that increased body fat correlated with high blood pressure and that post-menopausal women had gained 36% more trunk fat, 49% greater intra-abdominal fat, and 22% more subcutaneous abdominal fat. That's quite a significant change.

Now, let's delve into the metabolic puzzle that menopause throws at us. As we age, we often witness a decline in muscle mass, known as lean body mass, and an increase in visceral and subcutaneous fat. This isn't just a coincidence. Estradiol, a form of estrogen, is vital in stimulating our cellular energy factories, the mitochondria. When estradiol levels plummet, our ability to efficiently signal mitochondria for energy production takes a hit.

Think of it this way: skeletal muscle mass and strength peak occur during our mid-20s and 30s. After that, it's a downward slide, with degenerative muscle loss ranging from 3-8% every ten years after hitting 30, and it accelerates as we age!

When we lose muscle strength, we're talking about sarcopenia. Osteopenia, on the other hand, refers to bone density loss. These two often show up together, earning the tag "osteosarcopenia." This combination raises your risk of weakness, hospitalization, and even death. 

Surprisingly, when we evaluate osteoporosis alone (loss of bone density), the risk of frailty is much lower than when sarcopenia (loss of muscle mass and strength) is part of the equation. In other words, losing muscle mass and strength is a more significant threat to your health than bone density loss. Of course, we can't ignore that bone density loss still poses substantial risks, including fractures and bone pain, when estrogen levels drop.

Here's another compelling tidbit: skeletal muscle burns up to three times more energy than fat cells. Muscle mass supports your metabolism, helping you maintain a healthy energy balance. So, without sufficient estradiol, you're dealing with a metabolic double whammy:

  1. You have less capacity to burn energy due to lower lean body mass and reduced skeletal muscle.
  2. Your energy is less efficient due to reduced mitochondrial function and diminished skeletal muscle.

Additionally, estrogen is essential for signaling critical enzymes in the Krebs cycle, the powerhouse process that generates ATP (adenosine triphosphate) for your cells. ATP is like fuel for your body, helping you burn fat and energy. When you lose estrogen, you lose the ability to signal your cellular powerhouses (mitochondria) to kickstart the fatty acid breakdown and lipid breakdown processes. Both processes rely on fatty acids derived from LDL cholesterol for energy.

But wait, there's more to the story! Studies suggest that follicle-stimulating hormone (FSH), often used as a diagnostic marker for menopause, also plays a crucial role in metabolic management during menopause. The higher your FSH levels, the more weight gain and bone loss you'll likely experience. Although more research is needed to grasp this effect fully, it's a noteworthy aspect of the menopause discussion.

And there's yet another group of hormones to consider: androgens, particularly testosterone. 

As estrogen takes a backseat during menopause, we start to see a shift in the balance between estrogen and androgens in our bodies. Androgens, including testosterone, become more dominant. But don't jump to conclusions – this doesn't mean testosterone is the enemy. We must assess and monitor hormone levels to determine the best approach. When androgens gain the upper hand, it can lead to additional shifts toward central adiposity (fat around your abdomen) and insulin dysregulation.

So, what can you do to navigate this intricate web of hormones and changes during menopause?

Embracing Estrogen Replacement Therapy (ERT) as a Path to a Better Metabolism and Quality of Life

Here's a ray of hope: research involving mice whose ovaries were removed – a situation mimicking the hormonal changes during menopause – showed that they experienced trunkal obesity and metabolic changes, much like humans. However, when these mice received estradiol (E2) replacement therapy, they returned to their normal weight and muscle mass.

Another study unveiled that estrogen replacement therapy can lead to lower LDL cholesterol levels, reducing LDL in your abdomen's visceral fat and improving insulin signaling. Estradiol is a crucial cog in the metabolism wheel, working diligently to maintain a healthy quality of life during post-menopause.

But estrogen supplementation isn't the sole solution. It's just one piece of the puzzle. Consider incorporating sufficient protein, vitamin D, calcium, creatine, and strength training into your routine to complement any hormone support you might consider. This holistic approach can contribute significantly to your overall well-being.

In conclusion, the key to understanding your hormone levels – especially their interplay – is through testing. When you undergo testing, it's essential to distinguish between sufficient and deficient estrogen levels. There should be a clear differentiation between the pre-menopausal and post-menopausal estrogen ranges. This can be accurately assessed through either LC/MS-MS serum (blood) testing.

So, there you have it, a comprehensive look at the intricate dance of hormones during menopause and how it relates to weight gain. Understanding these changes is the first step in embracing this transformative phase of life with confidence and vitality. Remember, menopause may bring challenges but also ushers in new opportunities for health and well-being. 

If you think that this type of treatment might be right for you, then consider signing up for a free discovery call so we can answer any questions you may have.

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