To give you an idea of where this post is going to go, and if you would like a one-sentence summary, I’ll quote a 2012 paper by Davis et al. titled Understanding Weight Gain at Menopause(1):

“In summary, weight gain does not appear to be affected by the hormonal changes of the menopause.”

If that’s not enough for you, read on…

In the years after the release of SPEED, we were often asked why we did not include a section on sex hormones and their ability to affect weight loss. Many times, this was accompanied by a story about how the sharer tried and tried for years to lose weight but never got results until they balanced their sex hormones, or started hormone replacement therapy (HRT), or began taking a supplement which helped a suspected sex hormone problem. The reason we didn’t spend much, if any, time discussing sex hormones and their effect on weight loss is that the evidence doesn’t support much of an effect at all. Adhering to the brevity principle in SPEED prohibited discussion of a non-issue. But, alas, a discussion is now warranted due to our wish that this project be as comprehensive as possible based on the available evidence, brevity be damned.

Menopause: what happens?

During menopause, even though the pituitary is still producing follicle-stimulating hormone and luteinizing hormone, the dying off of ovarian follicles results in less production of estrogen and progesterone. A comprehensive discussion of the symptoms of the peri-menopausal period are not warranted, and instead only those which may affect weight management will be brought into question where appropriate.

Why Might Menopausal Changes Induce Weight Gain?
There are a few plausible mechanisms by which the disruption of hormone processes may affect a woman’s ability to manage weight:

  1. Changes in hormones may affect water retention. Water retention due to hormonal shifts is obvious to any woman who gains a few pounds in a matter of days during her menstrual cycle. (11) The pounds of fat gain commonly blamed on menopause, however, would not be explained by this transient water retention.
  2. Changes in hormones may affect resting metabolic rate (RMR) and/or total daily energy expenditure (TDEE). Whether or not resting metabolic rate decreases through menopause is unclear. Lovejoy et al observed a decrease in total daily energy expenditure (TDEE) and sleeping EE in women over a four-year period. Changes occurred regardless of menopausal status and were NONsignificantly more pronounced in postmenopausal than in premenopausal women.(5) Duval observed maintenance of resting energy expenditure in postmenopausal women over time, but an increase in women who were in the change during their follow-up period.(2) Importantly, both papers observed a decrease in activity through the observation period and an increase in time spent in the sedentary state.
  3. Changes in hormones may increase appetite, resulting in greater caloric intake. Nope. Lovejoy observed a decrease in energy intake over the perimenopausal period and a change in composition of the diet away from protein and toward carbohydrate.

How do Postmenopausal Women Lose Weight?

Question: So, it remains, can a postmenopausal woman lose weight and, if so, how does she do it? Answer: Reduce calories. Or exercise. Or both. Shocking, I know…

Quick Evidence Review:

Kim and Kim studied the effects of 16 weeks of line dancing exercise (3x/week for 60min) on postmenopausal women and found a 2kg weight loss vs 2 kg weight gain for the experimental and control groups, respectively. Interestingly, subjects were considered obese by body fat being greater than 32% while baseline BMI was around 25 kg/m2 in both groups. (3)

Pettee et al studied the effects of a lifestyle intervention (LI) in women who were using hormone replacement therapy (HRT) and either continued or discontinued use over 18 months. The recommendations of the lifestyle intervention were 150 minutes per week of moderate exercise and 1300-1500 calories/day food intake. Both groups (HRT continued and HRT discontinued) experience similar results over 18 months (mean 17.3 vs 16.0 lbs lost) compared to HRT-C and HRT-D participants of the Health Education group. (7)

Kuller et al investigated a lifestyle intervention in women aged 44 to 50 at baseline. The women in the LI group were asked to eat 1300 calories and increase physical activity so as to burn 1000-1500 calories per week. At 6 months, the time where the intensive group program ended, weight loss was mean 10.7 lbs, then slowly regressed to a very modes .18lbs at 54 months. The assessment group gained mean 5.2 lbs by 54 months. At 54 months the difference in weight between pre and postmenopausal women was non-significant. Interestingly, at 54 months, there was a wide range of variability in weight change in both the assessment and LI groups, ranging from greater than 20 lbs lost and greater than 20 lbs gained. There are two main lessons here: 1. Adherence to LIs wanes after intensive interventions cease and since adherence to general dietary guidance varies, metabolic ward studies are fun to have. I couldn’t find any for this topic.(4)

Swift et al observed that in postmenopausal women participating in a structured exercise program designed to burn either 4,8,or 12 kcal/kg/week, higher habitual activity (steps/day) was associated with greater decreases in waist circumference and weight. (9)

Nuri et al investigated the effects of 2x/week walking combined with 2x/week resistance training in postmenopausal women with breast cancer. Significant differences from controls (who gained weight) were found over 15 weeks for weight, BMI and waist/hip ratio.(8)

Mason et al investigated whether or not a history of weight cycling impeded weight loss in postmenopausal women assigned to 1 of 4 conditions for 12 months: control, diet, exercise, or diet+exercise. History of weight cycling had no effect on ability to lose weight. Good news if you’ve lost and re-gained weight, even multiple times. Don’t let it hold you back from trying again.(6)

Van Pelt et al observed that women who perform endurance exercise regularly do not experience the reduction in resting metabolic rate (RMR) that sedentary women do. Importantly, HRT use was matched between groups of exercisers and non-exercisers. (10)

Visceral adiposity and body composition:

Although weight gain cannot be directly attributed to menopause, an increase in central adiposity can. (1) Exercise has been shown to counter this increase, including during the menopausal period. (3,4,6,7,8,9,10)

Conclusion

As I did in the introduction, let me quote Davis et al to conclude:

“In summary, weight gain with age is a global socio-demographic issue that is not a consequence of the menopause. In contrast, increased central abdominal fat appears to be a direct consequence of the menopause.”

Want to counter-act either of these? Reduce calories, increase activity (see how I re-packaged “eat less, move more”?) and use all the techniques found in the book section here to boost adherence and motivation. Good luck!

References:

  1. Davis SR, et al. (2012) Understanding Weight Gain at Menopause. Climacteric. 15, 419-429.
  2. Duval et al. (2013) Effects of the menopausal transition on energy expenditure: a MONET Group Study. Eur J Clin Nutr. 67(4), 407-11.
  3. Kim J, Kim D. (2012) Effects of Aerobic Exercise Training on Serum Sex Hormone Binding Globulin, Body Fat Index, and Metabolic Syndrome Factors in Obese Postmenopausal Women. Met Syn Rel Dis. 10(6), 452-457.
  4. Kuller LH, et al. (2001) Women’s Healthy Lifestyle Project: A ronadomized clinical trial: Results at 54 months. Circulation, 103(32), 32-37.
  5. Lovejoy JC, et al. (2008) Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes. 32(6) 949-958.
  6. Mason C, et al. (2013) History of Weight Cycling Does Not Impede Future Weight Loss or Metabolic Improvements in Postmenopausal Women. Metabolism, 62, 127-136.
  7. Pettee KK, et al. (2007) Discontinuing Hormone Replacement Teherapy: Attenuating the effect on CVD rish with lifestyle changes. Am J PRev Med, 32(6), 483-489.
  8. Reza Nuri MRK, et al (2012) Effect of Combination Exercise Training on Metabolic Syndrome Parameteres in Postmenopausal Women with Breast Cancer. J Cancer Res Ther, 8(2), 238-242.
  9. Swift DL, et al. (2012) Exercise Training and Habitual Physical Activity: A randomized controlled trial. Am J Prev Med. 43(6), 629-635.
  10. Van Pelt RE, et al. (1997) Regular Exercise and the age-related Decline in Resting Metabolic Rate in Women. J Clin Endo Met. 82(10), 3208-3212.
  11. White CP. (2011) Fluid Retention over the Menstrual Cycle: 1-year data from the prospective ovulation cohort. Obs Gyn Int,1-7

*Duval et al have a new paper out in 2014 regarding eating behavior during the menopausal transition, also a part of the MONET study. I do not have full access to this paper but a quick perusal of the abstract leads me to beleive it won’t change much.

**The review by Davis et al referenced an article by Poehlman et al that was retracted due to fraud. None of the reasons for citing Davis here, or the quotes used, change due to the retraction of the Poehlman paper.

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