As a resident physician training in OB/GYN, my education on menopause was a lot like my education on nutrition – missing. Surprising, since half our lives as women, if we are lucky, is spent in this period of our reproductive cycle. Fortunately for me and my patients, I had some great mentors out in private practice like Dr. Cathy Schmitt and Dr. Jack Blackstone who were willing to share their hard earned wisdom. I feel comfortable treating most symptoms of menopause except for the one that is currently plaguing me and maybe some of you as well. Yep, weight gain especially right around the middle.
I’ve been doing some research on this topic and I’m going to share the information I’ve learned but I do have to warn you that what we do know is a drop in the bucket. First, menopause is typically associated with weight gain. This is true in population studies, my patient anecdotes and in my own personal experience. That weight also tends to be central or around the waistline. If you are in menopause you know this is true. And, if that isn’t bad enough, the authors that are writing papers are menopause like to hypothesize that our weight is because we are less active. While over time we might slow down to some degree, most of us perimenopausal women don’t just plop down on our asses and give up just because we’ve stopped having periods. So, I am calling BS to all those study authors who keep regurgitating this crap. Something else is going on and just because we don’t know exactly what it is, doesn’t mean we can just decide that perimenopausal women are lazy.
What can I tell you then? For those of you not yet in this stage, menopause is defined as cessation of menses for greater than 12 months, that is associated with the loss of hormone production from the ovaries. Any time before and during that 12 months is defined as the perimenopausal period and can last for up to 10 years. As I’ve mentioned before, menopause can be associated with weight gain and it can be to the tune of 1 pound a year for 10-15 years. OUCH. Some of this may be due to a decrease in activity but we know it also has to do with the loss of hormone production. Over 50 hormone receptors exist in the brain in the weight control areas. Clearly these are affected but the how is still a BIG mystery.
You might be wondering why, if the loss of estrogen and progesterone is associated with menopause and menopause is associated with weight gain, we can’t we just replace the estrogen and progesterone and stop the weight gain. This is a great thought but the actual answer is more complicated than simply adding back the two hormones we miss the most. Our reproductive system is complex and we know giving hormone replacement therapy doesn’t necessarily stop weight gain but it also doesn’t cause the weight gain either. So what do the individual hormones do? Stay tuned for Part II of the mysteries of menopause.