For many women, the journey through menopause is a roller coaster of symptoms including hot flushes, night sweats, sleep disturbance, dry and itchy skin, mood changes, anxiety, depression and weight gain. For some, it can be relatively uneventful.
Menopause is medically defined as not having any menstrual bleeding for 12 months. Most women reach this milestone between the ages of 45 to 55.
Even though weight gain is common, you can beat it by using menopause as an opportunity to reset your eating and exercise habits.
Read more: Thinking of menopausal hormone therapy? Here's what you can expect from your GP
Do women gain weight at menopause?
Australian women tend to gain weight as they age.
During menopause, women also experience a shift in how fat stores are distributed around the body. Fat tends to move from the thigh region up to the waist and abdomen.
A review of studies that quantified changes in body fat stores before and after menopause found total body fat mass also increased significantly.
While the average weight increase was only about one kilogram, the increase in percentage total body fat was almost 3%, with fat on the trunk increasing by 5.5% and total leg fat decreasing around 3%.
Average waist circumference increased by about 4.6 centimetres and hips by 2.0 centimetres.
Other bad news is that once postmenopausal, women have lower total daily energy needs. This is partly because body fat requires less energy to maintain it compared to muscle. So even if your weight doesn’t change, the increase in body fat means your body needs fewer kilojoules each day.
In addition to this, the menstrual cycle had a small energy cost to maintain ovarian function. This amounted to about 200 kilojoules a day, which is now “saved”.
The bottom line is that unless your transition to menopause is accompanied by a reduction in your total energy intake or an increase in your physical activity, you’re at high risk of weight gain.
But there is some good news
Around 60% of women manage to avoid weight gain at menopause.
They manage this by either decreasing the total amount of food they eat, cutting down on fat and sugar, using commercial weight loss programs, doing more exercise, or a combination of all these.
They key thing is that they change some aspects of their lifestyle.
So what works best?
Until recently, only three major studies had tested interventions.
The Women’s Healthy Lifestyle Project compared the impact of receiving support to improve diet and exercise habits over four years covering menopause, to making no changes at all.
Women who changed their lifestyle had lower body weights, less abdominal fat and better blood sugar levels compared to those in the control group.
The second study, of 168 women, enrolled them into a 90 minute Nordic walking program, three times a week.
This was associated with a reduction in weight, body fat and waist circumference, as well as blood levels of bad cholesterol and fats, highlighting the benefits of endurance walking.
The third study divided 175 Nigerian women into two groups: one group undertook a 12-week circuit training exercise program, the other was a control group.
Women in the exercise group reduced their waist circumference relative to their hips, indicating a reduction in abdominal fat, even though their total body weight did not change.
Read more: Health Check: what's the best diet for weight loss?
The 40-something trial
More recently, we studied 54 women aged 45-50 years in the “40-Something” trial.
We randomly assigned half the participants to receive healthy eating and physical activity support from health professionals, using motivational interviewing to encourage behaviour change. The other half received information only and were asked to self-direct their lifestyle changes.
Our aim was to prevent weight gain in women who were in either the overweight or healthy weight range as they entered early menopause.
We encouraged women who were overweight to reduce their body weight to achieve a body mass index (BMI) in the healthy weight range (BMI 18 to 25). We encouraged women already in the healthy weight range to maintain their weight within one kilogram.
We gave all women the same healthy lifestyle advice, including to eat:
- 2 serves of fruit and at least 5 serves of vegetables every day
- 1-1.5 serves of meat or meat alternatives
- 2-3 serves of dairy
- wholegrain breads and cereals.
- limit foods high in fat and sugar
- cut down on meals eaten outside the home
- engage in moderate to vigorous physical activity for 150-250 minutes per week
- sit for less than three hours per day
- take at least 10,000 steps per day.
Women in the intervention group had five consultations with a dietitian and exercise physiologist over one year to provide support and motivation to change their eating habits and physical activity.
After two years, women in the intervention group had lower body weights, less body fat and smaller waist circumferences compared to the control group who received information pamphlets only.
When we evaluated changes based on their starting BMI, the intervention was more effective for preventing weight gain in women initially of a healthy weight.
Of all the health advice, eating five serves of vegetables and taking 10,000 steps per day were the most effective strategies for long-term weight control during menopause.
Read more: What is a balanced diet anyway?
Although weight gain, and especially body fat gain, is usual during the menopausal transition, you can beat it.
Rather than menopause being a time to put your feet up, it’s a time to step up your physical activity and boost your efforts to eat a healthy, balanced diet, especially when it comes to the frequency and variety of vegetables you eat.