Weight gain at the time of menopause

George Panotopoulos

Author: Dr George Panotopoulos, MD, PhD
Athens, Greece
Specialist in Internal Medicine, Obesity & Nutrition
SCOPE OBESITY European Fellow

The facts

In developed countries, women live 1/3 of their lives (or about 30 years) after menopause. In these countries, 2/3 of women after the age of 40 are already overweight or obese. 

Many women report that they gain weight at or near the time of their menopause. In a survey in Europe, post-menopausal women were asked about the influence of various hormonal events on their weight: 50% of these women claimed an increase of weight of at least 4.5 kg at the time of menopause and only 4% mentioned a decrease of the same order. The amplitude and even the reality of the menopause-related weight gain remain controversial.

Body weight increases with age both in women and in men. This is observed in lean, normal weight and in overweight subjects.  Whether the rate of weight gain is influenced by the occurrence of the menopause is not clear.

Is it a real problem?

In a 3 year prospective study on weight changes in women between the ages of 42-50 years, most women gained weight. The average weight gain was 2.2 + 4.1 kg during this period; 20% of women gained more than 4.5 kg, and only 3% lost more than 4.5 kg. Weight gain was associated with changes in the risk factors for coronary heart disease (blood glucose, lipids and arterial pressure). It must be stressed that the variability in weight changes was considerable (from a 14.8 kg loss to a 32.4 kg gain). Other smaller studies showed no significant effect of menopause on weight gain.

Apples vs pears

Body composition also changes with age: fat and abdominal mass increase, bone mass, lean body mass (muscles) and body protein decrease and there is a relative increase in extracellular fluid. 

Menopause influences most of the effects of aging on body composition. It is well known that there is an accelerated loss of bone mineral content and a microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture at menopause and that collagen synthesis decreases.

Independently of weight gain, many menopausal women complain of modifications of their morphology (i.e. an increase in abdominal fat deposition), so “pears” become “apples” … Studies on body composition have demonstrated that the menopausal transition is associated with significant changes in body composition. Abdominal (visceral) adiposity is recognized as an independent predictor of coronary heart disease. It has been suggested that the menopause may induce a more android distribution of body fat, and thus contribute to the increase in cardiovascular disease after menopause. 

Gluttony or sloth?

The post menopausal decline in lean tissue mass has been confirmed by various studies using accurate methods of body composition (DXA). In a cross-sectional study, in healthy women aged 49-60 years, changes in lean (fat-free) mass, including a post-menopausal decline in lean tissue (muscles) and bone mass, were mainly menopause-related. Other studies led to similar conclusions, with a dramatic decline of lean mass after the age of 50 years. The decline in lean mass quantity and quality (more intramuscular fat) is the major characteristic of menopause-related changes in body composition. This effect has serious consequences on metabolic rate. Metabolic rate and energy expenditure depend on age and lean mass. So the decline in lean mass provokes a decrease of basal metabolic rate (about 200 - 250 calories per day) at menopause. 

At the same time, changes in food intake (perhaps less calorie intake but more saturated fat and less protein and fibre intake), less fat oxidation and less free-living activity are observed. These changes are present from the perimenopausal period, 2-4 years before menopause. The menopause also marks a time of dramatic social change for women and has often been regarded as negative: changes in roles, responsibilities and relationships, less ability to exercise and socialize, changes in household composition, marital harmony, pattern of work and retirement. 

Any hope?

Whether hormone replacement therapy (HRT) prevents or provokes additional weight gain in the early menopausal years must be examined critically since scant data are available on the effects of HRT on body composition and fat distribution. Preliminary data suggest that hormone replacement therapy prevents weight gain due to the effect on metabolic rate and lean mass. It seems also that HRT prevents body fat redistribution (towards an upper body fat distribution) after menopause.

Lifestyle changes around the time of menopause have the potential to impact on morbidity, mortality, quality of life and cost of care. Menopause can be a favorable time of life for many of women; they have more time to follow their own interests, more time for leisure pursuits and exercise, more time to review their lifestyles. Cardiovascular events, risk factors (hypertension, diabetes, lipid disorders), breast cancer risk, dementia risk, osteoarthritis, urinary incontinence depend on body weight, nutrition, physical activity and lifestyle decisions.

The interventions targeting weight loss in postmenopausal women have shown efficacy of various intensities of exercise when combined with appropriate nutrition in producing lower body weight, lower fat mass, improved insulin sensitivity and cardio respiratory fitness. Weight loss did not have any adverse effect on lean mass and did not necessarily prevent bone loss but often attenuated bone loss.

In conclusion

Menopause onset is associated with increased total fat and abdominal (visceral) fat and decreased energy expenditure and fat oxidation. These modifications can predispose to or aggravate obesity if lifestyle decisions and changes are not made. Menopause changes may modify general health status and subsequent quality of life, so they are priority in health service delivery. It is important to focus on the early perimenopausal years.