Menopause, 'Freshman 20' Again

The HWN Team with guest journalist Diana Rodriguez | Insider

While putting periods, cramps and PMS behind you may be a bonus, new challenges take their place. Beyond the hot flashes, insomnia, and irritability, you have another issue to consider – a thickening middle

In her book The Menopause Diet, Larrian Gillespie, MD, points out almost 50 percent of women age 45 and older are overweight. And the usual tactics to try to lose a few extra pounds doesn't seem to work anymore. It's 'The Freshman 20' all over again. 1-3

There are a number of reasons why women gain weight during menopause, but the root of the problem is changes in hormone levels that accompany aging and menopause. First, the body makes more fat. "As we age, we have changes in estrogen that affect both metabolism and insulin, and those are two key factors that affect how the body then makes adaptations," says Dr. Gillespie. "One of the adaptations is to add fat to substitute for missing estrogen."

The other problem is that women feel hungrier and tend to eat more. "When estrogen drops, we change our gastric-emptying rate. We don't secrete as much of the hormone that makes us feel full, so we start to eat more. We can eat longer before we get the 'full' sensation," says Gillespie.

It all goes back to biology and the cavewoman days, when holding onto fat was a very useful trait. "Women are made to reproduce in the face of starvation. We are very efficient at packing on fat because we need to procreate," says Gillespie. And when you start eating more and your body turns more of your food into fat, the pounds start adding up. These changes also affect your body's insulin response, which makes it more difficult for the body to efficiently use carbohydrates. "Then we start storing it as fat, because that's what the body does – what it doesn't use, it puts away for the winter," adds Gillespie.

Genetics and slow metabolism don't help the problem either. If your family members tend to be thicker around the middle and put on extra pounds in their abdominal area, you're likely to store extra fat there as well. Plus, your metabolism slows as you age and just isn't as speedy as it was when you were younger. Aging also triggers the loss of muscle mass, which helps keep metabolism up. If you don't work hard to keep those muscles toned, your metabolism will slow and allow the fat to build up. 4

Limiting carbohydrates and increasing fruits and vegetables is the way to ward off weight gain, according to Gillespie. "It's learning what you can eat and cannot eat, which is why you then start to realize how you have to shift the ratio of what you eat," says Gillespie. Eating several mini-meals -- of about 250-300 calories each -- throughout the day can also help keep the pounds at bay.

Research is also giving women clues about how to beat the menopausal pounds

In a 2012 study, researchers from the University of Pittsburgh Medical Center looked at women's weight-loss efforts during their post-menopausal years. "The purpose of the study was to show that weight loss is possible. That was the main overall study," says Bethany Barone Gibbs, PhD, assistant professor at the University of Pittsburgh Department of Health and Physical Activity and lead investigator of the study. Her team then analyzed the data collected during that study to determine how the women lost weight. 5, 6

"The study that we just published was trying to look at the women who had success losing weight and the women who didn't do so well, and then see if we could distinguish the behaviors of the women who didn't. It was an experimental design to see [which of] these behaviors would cause them to lose weight," in the short and long term, explains Dr. Gibbs. 

The study results found what worked in the short-term, and what worked in the long-term. "For the long-term weight loss, important changes included decreasing sugar-sweetened beverages and desserts, decreasing meats and cheeses, and increasing fruits and vegetables," says Gibbs. "What is really exciting for me about these results is that if you just looked at short-term weight loss, increasing fruits and vegetables was not a predictor; the women who had better weight loss didn't necessarily increase fruits and veies. But, at four years, that was a distinguishing factor." 

So instead of focusing on a quick-fix weight loss, it's most important to look beyond a few months out and concentrate on long-term strategies to keep you healthy in all of your post-menopausal years. "Maybe certain behaviors aren't going to give you a short-term fix -- it may take a longer time to help you maintain your weight and keep it off. Decreasing the desserts and sugar-sweetened beverages mattered in the short and long term – it's a very important strategy," says Gibbs. 

Cachet - Although menopause related weight gain is more or less universal, there is a paucity of research studies that look at how to combat this health issue. Hopefully the Pittsburg study sets the precedent.

So, what's a women supposed to do in the meantime?

It's important to focus on health rather than a number on the scale, and to examine a lifestyle versus a diet, stresses Gillespie. "It's not about numbers – it's about understanding that it's the BMI, the waistline under 29 inches, all these things that relate to where fat is positioned," she explains. "You can be skinny and still be unhealthy; if all your fat is intra-abdominal, you're in bad shape."

Of course, don't forget the importance of exercise. "You can lose weight without exercising. But if you want to maintain weight loss, you need to increase muscle mass," says Gillespie. "It doesn't have to be blood-sweat-and-tears exercise – it's doing exercise consistently, in 15-20 minutes spans -- an hour every other day is great." 

Making long-term, permanent changes makes weight loss easier and more effective. "Once you make a lifestyle change then you're not going into starvation, and weight becomes a gradual issue," says Gillespie. 

The Bottom Line

"Nothing is going to be the same as in your 20s. You're different – just be observant and catch all the problems early when you can do something about them," says Gillespie. Until that next medical breakthrough changing your lifestyle and the foods you eat – and how and when you eat them – seems to be the best way to combat menopause-related weight gain. Plus you may feel and even look like your 20 again!


  1. Larrian Gillespie, MD
  2. The Menopause Diet
  3. The Freshman 20
  4. Menopause weight gain: Stop the middle age spread,
  5. Pitt Researchers Identify Behaviors That May Lead to Successful Weight Control in Older Women, University of Pittsburg, August 28, 2012
  6. Barone Gibbs B et al, Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study, J Acad Nutr Diet. 2012 Sep;112(9):1347-1355, 1355.e1-2. doi: 10.1016/j.jand.2012.06.012

Diana K. Rodriguez is a freelance writer who has written numerous health-related news and feature stories. Mrs. Rodriguez has written extensively for HealthDay as well as a number of private clients, and her work has appeared on many popular websites, including Everyday Health, Real Age, MSN and Yahoo! Prior to becoming a freelancer, she worked in the health insurance industry in member communications. She lives in Louisville, Ky. and holds a B.A. in journalism and French from Miami University and has been freelancing since 2006.

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