Weight gain and body fat redistribution as women enter perimenopause and menopause is a very real and universal phenomenon that virtually all women will experience. In fact, there’s even a colloquial term for it: middle age spread. Decreasing levels of activity do play a part in weight gain, as we tend to become more sedentary as we age. But the biggest known culprit for weight changes during menopause has to do with how women’s hormones change as the years go by.

Estrogen and progesterone are the celebrity hormones of women’s health, critical to sexual and reproductive health and development, including puberty, ovulation, menstruation, and menopause. They are produced mostly by the ovaries, and are therefore sometimes referred to as ovarian hormones. (The adrenal glands on top of each kidney produce some estrogen and progesterone, and fat tissue can also make estrogen, but the vast majority is produced by the ovaries.)

Estrogen drops and weight gain

A woman’s ovaries will first start producing a significant amount of estrogen and progesterone during puberty, and will continue to release these hormones at high rates throughout her fertile years, in this way regulating ovulation and the menstrual cycle. Gradually during perimenopause, which usually occurs in a woman’s 40s, her levels of estrogen and progesterone will begin to decline. This is caused by a depletion in the number of estrogen-producing follicles in her ovaries. When she hits menopause and stops releasing eggs some 4-10 years later, her estrogen and progesterone levels drop even further.

In other words, perimenopause and menopause are transitions that happen as our bodies gradually produce less and less estrogen and progesterone. The fluctuations and drop in these hormones, especially estrogen, are responsible for many of the more challenging symptoms of menopause like hot flashes, night sweats, mood swings, thinning skin and hair, libido changes, vaginal dryness, and sleep disturbances. Also, weight gain. As ovarian hormones drop, several things happen that frequently result in the weight gain and redistribution that are one of the hallmarks of menopause:

  1. Lower metabolism. As ovarian hormone production drops, so does a woman’s resting metabolic rate, or the number of calories that she burns at rest. This may be due to the fact that lower levels of estrogen reduce activation of brown fat, the metabolically-active body fat that burns energy (unlike the other type of fat, white fat). The metabolic decrease isn’t massive; one study found that the average drop is equivalent to 50-70 calories per day. This doesn’t sound like much, but over time, this reduction can contribute to creeping weight gain.
  2. Lower muscle mass. Lean mass, or muscle mass, also decreases when estrogen production drops. Lean mass is more metabolically active than fat, and therefore burns more calories at rest. The more muscles you have, the more calories you burn! Lean mass is also denser and heavier, which means that more of it can lead to a leaner appearance at the same weight.
  3. More visceral fat. Lower estrogen leads to a shift in fat distribution, with more fat around the middle, under the muscles and the surrounding the organs. This is known as visceral fat. Visceral fat is particularly unhealthy as it is correlated to higher risk of inflammation and chronic diseases like heart disease, hypertension, and diabetes.
  4. Increased appetite and reduced satiety. Estradiol, the primary form of estrogen produced in women’s ovaries, may suppress appetite and increase feelings of satiety after a meal via several different mechanisms, including the regulation of certain gut peptides like cholecystokinin.

How hormone therapy factors in

Several studies in both animals and humans over the past several years have shown that hormone replacement therapy can slow the creep of menopausal weight gain and redistribution in many women, via the mechanisms above. Specifically, estrogen treatment can slow the loss of muscle mass, the accumulation of visceral fat, and the drop in metabolism by keeping the body’s estrogen levels from dropping to the levels at which these changes typically occur.

However, there have also been studies performed on postmenopausal women where those on hormone replacement therapy (HRT) and those on a placebo did not show significant differences in overall weight change, only in weight distribution. So while the jury is still out on whether hormone replacement therapy definitively helps manage overall weight, the evidence is strong that it does slow weight redistribution to the middle, and also slow the other specific changes listed above that can lead to weight gain.

While the precise interplay of ovarian hormones with every complex metabolic process involved in weight regulation is not fully understood, we do know that these things are deeply intertwined. To cite just a couple examples, estrogens and estrogen receptors regulate various aspects of glucose and lipid metabolism throughout the body. And estrogens contribute to the regulation of liver lipid metabolism and serum lipoprotein levels.

What Evernow can do to help

At Evernow, we believe strongly in self-love and acceptance at all stages of life. But we also believe in using science and modern medicine to help us live our best, most vibrant lives through our middle years and beyond. We should also be clear that at Evernow we do not prescribe hormone replacement therapy specifically as any kind of stand-alone treatment for weight loss.

So while studies are increasingly illuminating the various biological mechanisms through which depletion of ovarian hormones at menopause can lead to weight gain, hormone replacement therapy is not a diet pill. You’ll still have to move more and eat healthful foods in order to lose the weight you’ve gained thus far.

However, anecdotally our members say that the sense of being “stuck” at a weight and unable to move the scale does go away, and weight loss starts to work more like it did before menopause. If weight changes are one of the menopause symptoms that are causing you to feel less confident and less like your old self, in concert with other menopause symptoms like sleep disturbances, hot flashes, night sweats, and decreased libido, you may want to consider giving hormonal treatment a try to see if it helps you feel like yourself again.

If you're interested in learning whether Evernow and hormone therapy might be right for you, click here.