In mid-life, women tend to gain weight in their midsection, also known as “belly fat”(1).
While an inconvenient nuisance for many, belly fat can have serious effects on our mental and physical health…. The two most important things we need to protect and strengthen within ourselves.
Many of us suffer from feelings of inadequacy and unattractiveness in a world that values youth and beauty.
Belly fat compounds poor confidence and can worsen mental health struggles for many women in midlife.
Well, ladies…
“Fuck that! you look great, and you should rock it anyway!”
“You, too, can play a role in re-shaping [pun intended] the image of beauty by being YOURSELF, a strong woman that feels comfortable in her own skin!”
— Erica Klag, wicked witch
Poor confidence is only one negative aspect of belly fat. The other, perhaps more important, factor is the health risks associated with belly fat.
Because of these risk factors, it is critical to do what we can to prevent, slow, halt, or reverse this weight gain.
Read on to learn more about how and why we gain belly fat and learn what you can do to slow, stop or reverse midlife weight gain.
Why and How We Gain Belly Fat in Midlife
Hormonal Changes During Menopausal Transition
Estrogen
is a hormone that, more or less, controls the menstrual cycle. It is made in the follicles of the ovaries, which also house our eggs. The production of estrogen occurs when the cells of the follicles are stimulated by follicle-stimulating hormone. This part of our cycle is known as the Follicular Phase. Once circulating estrogen levels are high enough, the pituitary gland releases a surge of luteinizing hormone which stimulates the maturation and release of an egg. Also known as Ovulation. The remaining follicle then produces progesterone which promotes increased vasculature of the uterus in preparation of a fertilized egg. This phase is called the Luteal Phase. If pregnancy does not occur, progesterone levels drop, menstruation occurs, and the cycle repeats.
Reproductive life span
Our reproductive life, from first menses to menopause, also has stages.
In peak years, our estrogen levels rise and fall with regularity as all body systems and hormone production is at their peak.
In late reproductive years, as we approach perimenopause, the number of viable follicles reduces and therefore follicle-stimulating hormone becomes varied because it basically has no place to go.. These circulating hormone levels fluctuate subtly which will have little to no effect on our period’s duration and frequency.
Early menopausal transition, which is generally thought of as perimenopause, is when we see an even greater decline in follicle numbers resulting in an increase in follicle-stimulating hormone and lowering of estrogen. Larger fluctuations and an overall decline in circulating estrogen lead to disruption in menstruation. You may notice you start skipping periods or the duration is shorter or longer. The levels of hormones affect other parts of our bodies as well including our bones and brain.
Late menopausal transition is a time when we see significant interruptions and irregularities with our menses. Follicle counts decrease further worsening the imbalance of estrogen and follicle-stimulating hormone and resulting in interruptions in menstrual cycles until full menopause.
Menopause has been reached when menses have been absent for a year.
Postmenopause, follicle-stimulating hormone levels fluctuate as our follicular count continues to drop. Around 3-4 years after menopause, our follicle-stimulating hormones finally stabilize and follicle count remains very low.
Menopausal Transition
Age vs other factors
The age at which each stage is entered and the duration of each stage varies among women. However, research has shown the average age of menopause is 50 years(1, 2). However, there are several factors believed to influence the process(1, 2) such as
- Race/Ethnicity
- Reproductive history
- Weight and body mass
- Premenopausal cardiovascular health
- Physical activity, diet, and alcohol use
- Smoking
- Genetics
Symptoms
Each stage not only introduces interruptions in our menstrual cycles but can also elicit several other signs and symptoms. Many women can make simple lifestyle adjustments like carrying a fan, while others require no modifications. Some, however, experience symptoms that can negatively affect their quality of life.
Signs you are starting/are in/have finished menopausal transition include(5)
- Changing periods (i.e. heavy menses, duration of menses, missed menses)
- Hot flashes
- Loss of bladder control
- Difficulty sleeping
- Vaginal dryness or pain during sex
- Mood changes and depression
- Memory problems
- Thinning skin
- Aches and pains
- Weight changes
Belly Fat and Menopausal Transition
Belly fat isn’t just a vanity issue, it’s a serious health issue as well.
That weight you’ve been putting on, especially around your midsection, is something called visceral fat which has been linked to increased risk of cardiovascular disease, insulin resistance, type 2 diabetes, and breathing problems(4).
Fat accumulation around our waist is common for women in menopause and it’s related to a few factors
- Hormone changes (as explained above)
- Loss of lean body mass
- Genetics
- Lifestyle
Hormonal changes during the menopausal transition are linked to weight gain though the mechanism is not well understood.(3)
- It is thought that lower circulating estrogen levels result in increased androgen levels.(4)
- Androgens, like testosterone, may direct where fat accumulation occurs, at least to some degree.
- To compound the issue, visceral fat can alter the way our bodies use fat for energy causing further weight gain.(4)
How to Combat Belly Fat
3 ways
I want to recognize that you’ve already taken your first step by opening this blog post and reading as far as you have! Congratulations, you’re off to a great start! Take this success and feel good about it. Use it to motivate yourself to take the next step.
If you didn’t read the information above, that’s actually fine. The following information is what you came here for anyway.
There are a few things you can do to slow fat accumulation, halt weight gain, or even lose those extra pounds.
- Eat a well-balanced diet
- Exercise
- Hormone Replacement Therapy
1. A Healthy Diet
Eating a well-balanced diet is a must! Here are some key dietary interventions to keep in mind as you make decisions around food.
Low-energy diet
a low-energy diet (just a fancy way of saying a low-calorie) is recommended for women in menopausal transition. A low-energy diet can prevent metabolic alterations thereby reducing our risk of cardiovascular or metabolic disease and weight gain. Incorporating more fresh fruits, vegetables and lean proteins (i.e. fish and chicken) is a simple strategy to reduce calories.
High protein
protein needs increase as we age and this is related to the loss of lean body mass (aka loss of muscle). Be sure to make your diet rich in proteins by including lean proteins such as chicken, fish, eggs, low-fat dairy, soy, and/or nuts at each meal (especially breakfast) and snack.
Omega-3 Fatty Acids
increasing omega 3 fatty acids can help improve our lipid profile by increasing HDL (the good fat). Good sources of Omega 3’s are flaxseed, fatty fish such as salmon, fortified products, or fish oil.
Probiotics
probiotics are bacteria that aid in digestion, produce some vitamins, or protect against intestinal infections. Probiotics are found in yogurt and fermented foods.
Vitamin D
vitamin D is essential for bone health and is involved in metabolic processes and disorders such as high cholesterol. Our skin synthesizes Vitamin D from precursors found in certain foods making sunlight the best way to get Vitamin D, however, it can also be consumed. Good sources of Vitamin D include cod liver oil, salmon, tuna, and products fortified with vitamin D like milk. Supplementation is also an option but doses may vary depending on personal medical history. Daily requirements of Vitamin D are 5 μg/day (19–50 years), 10 μg/day (51–70 years), 15 μg/day (>70 years).
Antioxidants
antioxidants are a classification of compounds found within foods that benefit us by reducing inflammation and fighting cancer-causing free radicals. Fresh fruits and vegetables contain high concentrations of these compounds particularly almonds, artichokes, blackberries, blueberries, cherries (sour), chokeberry, chocolate (dark, unsweetened), cloves, ground cranberry juice, coffee, cranberries, grape juice, cranberry juice, pomegranate juice, pecans, raspberries, spinach, strawberries, walnuts, coffee, tea, and red wine.
2. Exercise
Lean body mass
Lean body mass is our healthy muscle tissue. During and after the menopausal transition, muscle mass decreases at a faster rate.(3) The proposed mechanism relates to hormonal shifts causing an acceleration of normal muscle loss as we age.(4) The bottom line here is that lean muscle mass dictates our metabolism. The more muscle we have, the more calories we need to fuel those muscles. Lower muscle mass results in lower calorie needs and if we continue to eat the same amount of food we did when we were younger, the excess calories will be stored as fat.
Genetics definitely play into fat accumulation as well. Unless you’re into genetic codes, the science behind this is painfully boring. The takeaway is that if other women in your family tend to gain weight in their midsection, then you are prone to it as well.
Lifestyle factors can also contribute to weight gain. Low activity levels and poor dietary choices as well as a history of disordered eating can all contribute to weight gain. To compound the issue, sleep disturbances leave us feeling tired and our natural response to combat the tiredness may be to eat more calories.
Routine
Incorporating exercise is important at any age, yet is particularly important for women in peri- and post- menopause(1). Regular exercise during and after menopausal transition can
- burn calories(1)
- condition and build muscle resulting in increased metabolism (aka calorie utilization)(6)
- strengthen bones(6)
- improve hot flashes(6)
Recent research looking at the type of exercise (weight training vs cardiovascular) determined that both are essential though weight-bearing and resistance exercises have been undervalued in the past.(6) Other studies looking at light to moderate activity produced mixed results.(8)
A good exercise routine includes a mix of weight-bearing, strength training and aerobic/cardiovascular(9).
Weight-bearing exercises are generally low impact and include activities such as walking and yoga.
Strength training exercises are higher impact and include activities such as
- free weights and/or weight machines
- bands
- squats
- planks
Aerobic exercise includes running or jogging, dancing, stair climbing, or playing sports such as tennis, basketball, soccer, etc. Swimming and cycling are excellent aerobic exercises but because they are not weight-bearing they will not aid in maintaining bone health.
Exercising a minimum of 30 minutes a day, 3 times a week is a good place to start but incorporating higher impact, strength training exercises to these routines may further assist you in the battle against belly fat.
3. Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) is an interesting option but while it can be used to moderate symptoms of menopause, it may come at a price. Hormone therapy has proven to reduce many of the signs and symptoms of menopausal transition including belly fat accumulation but may increase your risk for heart attack, stroke, blood clots, breast cancer, gallbladder disease, and dementia. It’s best to talk to your primary care physician or gynecologist to decide if HRT is right for you.
Putting it all together
This post contains a lot of information and some of it may have been a little dry or scientific in nature. Sorry about that! To make up for it, let me take a minute to pull it all together for you.
- Hormonal changes that occur during the menopausal transition, particularly the imbalance of estrogen and androgens, cause us to be more prone to belly fat.
- Belly fat, also called visceral fat, may lead to impaired metabolism and an increased risk of cardiovascular disease or metabolic syndrome.
- Hormone replacement therapy is one strategy used to combat weight gain in menopause but it is not for everyone and comes at a risk.
- Lifestyle factors are another strategy for weight gain and can benefit other areas of our lives as well. Diet and exercise modifications can have a tremendous effect on our overall health.
- Eating a diet composed mostly of fresh fruits and vegetables, lean proteins such as fish and chicken, nuts, and yogurts/fermented foods may naturally reduce calories, increase protein, and provide much needed antioxidants, omega 3’s, and probiotics.
- A good exercise routine that includes a mix of weight-bearing, strength training, and aerobic exercises is an essential part of weight loss, particularly during the menopausal transition. Weight-bearing exercises will help maintain bone health. Strength training will build muscle thereby increasing our metabolism and calorie utilization. Cardiovascular, or aerobic, exercises can create calorie deficits.
Your Turn
Set a Goal
Remember when I congratulated you on reading that far into the blog post and told you to use that success as motivation to make the next step. That was a really, really small step, wasn’t it? One you didn’t even notice you did. That’s what I want you to do when you think about incorporating one of the lifestyle components mentioned in the article into your current daily routine. Make it so small you are not inconvenienced by the change.
See How to Keep your New Year’s Resolution post about S.M.A.R.T goal setting for more information on how to be successful in meeting your goals. Small changes lead to BIG results.
After reading this post, what stands out to you? Did you find any of this surprising? What is one lifestyle modification you are willing to (and can) incorporate in your daily routine? I’d love to hear what you will incorporate in the future. Tell me in the comments below.
Happy goal setting, ladies!
References
- US Department of Health and Human Services, National Institute on Aging. Menopause. Accessed 12th of December 2021
- https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000912
- Warren, Michelle P. Visceral fat accumulation, Menopause: October 2015 – Volume 22 – Issue 10 – p 1030-1031 doi: 10.1097/GME.0000000000000538
- Ko SH, Kim HS. Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients. 2020;12(1):202. Published 2020 Jan 13. doi:10.3390/nu12010202
- US Department of Health and Human Services, National Institute on Aging. Hormone Replacement Therapy. Accessed 12th of December 2021
- Daly, R. M., Dalla Via, J., Duckham, R. L., Fraser, S. F., & Helge, E. W. (2019). Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription. Brazilian journal of physical therapy, 23(2), 170–180. Accessed 01 January 2022
- E. Berin, M. Hammar, H. Lindblom, L. Lindh-Åstrand & A.-C. Spetz Holm (2021) Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms, Climacteric
- Daley A, Stokes‐Lampard H, Thomas A, MacArthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD006108. DOI: 10.1002/14651858.CD006108.pub4. Accessed 01 January 2022
- Mishra, N., Mishra, V. N., & Devanshi (2011). Exercise beyond menopause: Dos and Don’ts. Journal of mid-life health, 2(2), 51–56. Accessed 01 January 2022
