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Midlife Weight Changes

Many women are concerned about weight gain that seems to come with menopause. While the average woman gains two to five pounds during menopause, some women are at risk for greater weight gain. In addition to weight gain, there is a shift in body fat distribution to the midsection.

Women’s weight gain and increase in midsection fat in mid-life are thought to occur in a number of ways. While most long term studies of the perimenopausal transition show that natural menopause does not affect body mass index (BMI) or cause weight gain, many women do report weight gain. What impact does estradiol (the primary estrogen responsible for menopausal symptoms) replacement have on the process and how exactly does it regulate fat distribution?

Factors controlling human fat tissue accumulation/metabolism are largely unknown. What is known is that low estrogen levels that occur with menopause are associated with loss of subcutaneous fat and gain of visceral fat. Subcutaneous fat is more equally distributed throughout the body, while visceral fat is located around organs inside the abdomen and deeper in the body. The fat cells around the abdomen are regulated by estradiol, whereas the fat cells in subcutaneous tissue are not. As women approach menopause, estradiol levels decrease, removing protection from abdominal weight gain. Since the two different types of fat cells are now on equal metabolism levels, fat is then allowed to accumulate in the abdomen.

So do higher levels of estrogens cause obesity, or does obesity cause higher levels of estrogens? Since higher levels of estrogens are seen in heavier postmenopausal women, many believe that these higher estrogen levels have caused the obesity, which is not the case.

Midsection weight gain, which occurs with decreasing levels of estradiol, causes insulin resistance and subsequent increases in plasma insulin and insulin growth factor. This leads to increasing levels of estrogens and bioavailable androgens, testosterone and androstenedione. This excess weight results in increased estrogen concentrations from conversion of androgens, mainly androstenedione, to estrogens, mainly estrone.

So the middle-age spread can often be resolved with estradiol replacement. It has been shown to manage mid-section fat accumulation and prevent subsequent progressive insulin resistance consistent with metabolic syndrome and reduce the risk of developing diabetes.

Weight gain is generally always happening as people age. Weight gain does happen in menopause, but that’s not to say that it happens because of menopause. In reality, the woman may weigh the same as a few years ago, but the pants may not fit comfortably anymore.