Weight Gain in Menopause
By Paul Hueseman, PharmD
brought to you by Bellevue Pharmacy, a ProjectAWARE
Many women are concerned about weight gain that is typically associated
with menopause. Although the average woman gains two to five pounds
during the menopausal transition, some women are at risk for greater
weight gains. There is also a hormonally driven shift in body fat
distribution to midsection fat stores in menopause.
Women's weight gain and increase in adiposity (fat) in mid-life
are thought to occur through a number of mechanisms. Almost all
the available long-term studies of the perimenopausal transition
show that natural menopause does not affect body mass index (BMI)
or cause weight gain. So are women gaining weight or not? And what
impact does estrogen replacement have on the process?
Few reported studies have had a sufficiently long period of observation
to show that weight gain actually does occur as a result of menopause.
For this reason the issue of what happens to body weight at the
menopausal transition itself has remained unclear. The longest available
study evaluated women over a 20-year period and found on average
women gain total body weight from age 35 to 65 and that neither
the loss of ovarian hormones nor their subsequent replacement reduces
a detectable change in this trend.
While estrogen replacement has not been found to impact weight
gain, other studies have found that it helps manage abdominal fat
stores better than women not taking estrogen replacement. This points
to estradiol, which decreases in menopause being responsible for
fat redistribution to the abdomen.
How exactly does estradiol regulate the fat distribution? Factors
controlling human adipose 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. Visceral fat is located around organs inside the
abdomen and deeper in the body than subcutaneous fat. The fat cells
around the abdomen are regulated by estradiol, whereas the fat cells
in subcutaneous tissue are not. As women approach menopause, their
estradiol levels decrease. They then no longer have 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.
The most difficult concept to grasp is the clinical question Do
higher levels of estrogens cause obesity, or does obesity cause
higher levels of estrogens? Since higher levels of estrogens are
seen in the heavier postmenopoausal women, clinicans have been led
to believe that these higher estrogen levels have caused the obesity,
which is not the case.
First, weight gain, especially in the abdominal region, causes
insulin resistance and subsequent increases in plasma insulin and
insulin growth factor (IGF-1), which 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. After menopause, when ovarian production of estrogens
stops, this conversion becomes the primary source of estradiol.
In addition to prevention of abdominal obesity, estrogen replacement
therapy has been shown to prevent subsequent progressive insulin
resistance consistent with metabolic syndrome and reduce the risk
of developing diabetes.
Weight gain does happen in menopause, but that's not to say that
it happens because of menopause. Weight gain is generally always
happening as people age. All too often the weight gain is blamed
on menopause. This may be easy to do, however, because the central
obesity fat mass transition is noticeable. In reality, the woman
may weigh the same as a few years ago, but the pants may not fit
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