Saturday, April 16, 2011

Perimenopause and Weight Gain in Women

I have an acquaintance – I’ll call her Erika – who was, frankly, a trophy wife. Now she is nearing 50, but you would never know it. Erika used to dance professionally, so she is used to long workouts and little food. If you offer her a cracker, she’ll say, “I’m watching my figure so others will.” She does Pilates as well as running and cycling, and she added kickboxing to her schedule because she thinks the instructors are cute.


Money is not an issue, so Erika has the best in skin care, hair care, Botox injections, spa vacations, and of course, fabulous clothes. She has very little body fat, so – as many celebrities do – she gets injections in her cheeks to keep her face from looking too gaunt.


Erika is enviably toned all over and still wears bikinis, but she is obsessed with the fact that she no longer fits perfectly into her wedding gown. She has one “problem area” she cannot defeat. Even though her weight has hardly changed, she has developed a little bit of a belly. She started doing sit-ups and crunches, but it stubbornly will not move.


At this point, Erika is fighting with Mother Nature. Although she is eating the same, and exercising as much or even more than ever, her body is now different. Because of our changing internal landscape, it is completely normal for women to gain from three to six pounds on our bellies during perimenopause (the years before women reach menopause, which is the complete cessation of menstrual periods).


Dr. Pamela Peeke researched the phenomenon of female middle-aged spread and nicknamed it “menopot.”  Erika’s little meno-belly is there for a reason. As we age, our estrogen levels decline. As the ovaries start to fail and produce less and less estrogen, our bodies work harder to convert calories into fat cells, because fat cells can release estrogen. In order to help maintain estrogen levels, our bodies naturally maintain a small amount of fat on our bellies. This extra weight may help reduce the symptoms we can experience as we cruise toward menopause, including hot flashes and bone loss.


If you have gained a few pounds through your perimenopausal years, it’s not your fault! There are many factors that could be at work:


Most women experience a drop in metabolic rate beginning at around age 40. This age-related decline is in part due to genetic, hormonal and neurological changes beyond our control.


A decline in metabolic rate also can be linked to a decline in muscle mass. We lose muscle tissue as we get older, partly because of a drop in testosterone levels. Muscle tissue burns more calories than fat, even at rest. So when muscle is lost, there is a corresponding drop in metabolic rate. This is a factor over which we have some control. Build up your muscle mass, and your metabolism will rise.


Some medical disorders pack on pounds. Your body may change the way it responds to insulin, making it difficult for you to maintain your weight. Sometimes a thyroid condition will throw off the delicate balance of the hormones in your body. Working closely with your doctor to monitor your health can help you minimize menopudge due to disorders that can be treated.


Some medications cause weight gain. This can be very discouraging, but if you need to take the medicine, try to be philosophical about it. Ask your doctor if another medication might be just as effective without the same side effects.


And finally: our old friend, stress. When we are under chronic stress, our bodies release the stress hormone cortisol. The list of bad things cortisol does to the body is long and scary. For the purpose of this article, keep in mind that increased levels of cortisol make it hard to lose or even maintain weight.


There is a lot of bad advice out there about handling menopudge. “Spot reduction” exercises will not work. Harshly limiting your calorie intake will not work, either. (It will put your body in fat storage mode, also called the “famine effect”).  Beware the strident articles online and the Draconian measures they suggest. If your weight is within an acceptable range, don’t get sucked into the drama.


The people who love you won’t care if you put on five pounds. If you aren’t exercising very much, try to do better. Add some weight-bearing exercises to keep up your bone strength and to build muscle. Adding intense intervals to your exercise regimen will allow you to exercise for shorter periods of time, to greater effect. If your eating habits aren’t great, you know what to do. If you have gained an excessive amount of weight and the number on the scale is just too high, talk to your doctor about getting it under control, because too much fat stored around your middle is a risk factor for high blood pressure and heart disease. We don’t want to lose you.


But the truth is it’s time for Erika to stop trying to fit into the body-skimming gown she wore years ago. Her husband still thinks she is a miracle, so what’s the problem? Sometimes resistance is important, but sometimes it is just another way of hating your body. A little menopot is natural and even beneficial, and learning to love your body is a lot better for your health than stressing over those extra pounds.

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