The Association of Perimenopause and Menopause With Weight GainJanuary 31, 2022
Perimenopause and Menopause With Weight Gain: Menopause is a state characterized by the absence of menstruation for 12 months. With menopause comes a cascade of changes in the body, but one of the most obvious external changes in many females is weight gain.
Most women notice some weight gain as they enter this period in their lives, and it is important to understand the process in order to offset this gain and learn when to seek help once this weight gain leads to obesity. While the reason for obesity after menopause is not entirely clear and still warrants further research, a key player in this process is Estrogen.
The Estrogen Hormone
The major female sex hormone in the body is Estrogen (also known as Estradiol). Estrogen is a hormone secreted by the ovaries that plays a role in a variety of functions in the body, and the focus here is its role in weight gain and interactions with the hypothalamus, a key portion of the brain that regulates food consumption and energy expenditure.
Estrogens modulate the activity of molecules involved in orexigenic (food seeking) action, which in turn causes an increase in food intake. Estradiol also modulates the activity of an enzyme lipoprotein lipase which is a key enzyme regulating fat metabolism.
Estrogens and estrogen receptors are responsible for many aspects of glucose and lipid metabolism. When estrogens decrease in our body, there is in turn a risk of developing metabolic syndrome and thus cardiovascular diseases as heart attack and stroke. It causes an imbalance of lipids in our body and predominant abdominal fat accumulation. An estrogen deficiency with menopause can predispose women to Type II Diabetes and Cardiovascular disease.
It is important to understand the aforementioned roles of estrogen because menopausal women experience a steep decline in estrogen levels beginning in the perimenopausal state. In the normal menstrual cycle, both estrogen and progesterone levels function to keep the body healthy and avoid weight gain.
As estrogen levels increase, there is associated early satiety during the follicular and periovulatory phases of the menstrual cycle. Progesterone levels can also be linked to eating during the luteal phase of the cycle. Progestins may increase binge eating, which can be exacerbated by negative emotional states. Preclinical research indicates that the decrease in eating during the preovulatory phase is a way for estrogen to increase the satiating potency of the gastrointestinal hormone cholecystokinin.
There can also be a decrease in the preference for sweet foods during the follicular phase of the menstrual cycle, which protects against weight gain. However, none of these mechanisms occur once menopause ensues, which is the start of the weight gain women tend to experience at menopause with surgical removal of ovaries or with natural age-related menopause.
Women tend to eat more after menopause as satiety does not set in easily and they may be more likely to seek sweet foods. Menopausal women are three times more likely to develop obesity and metabolic syndrome than premenopausal women.
Menopause in Obese Females
There are interesting observations in regard to menopause in obese females. Menopause can also be accompanied by a variety of symptoms, which are often more severe in obese women. These symptoms can include hot flashes, night sweats, sleep difficulties, mood swings, vaginal dryness, hair loss, difficulty concentrating, general aches and pains, etc. These symptoms can even last up to ten years. So, while obesity tends to worsen menopausal symptoms, menopause can in turn induce obesity.
With the growing evidence that estrogen does have an effect on obesity following menopause, the natural conclusion would be to find a way to replace that estrogen, but it’s not that simple and requires ongoing research. Estrogens have evidently been found to reduce cardiovascular risk and total cholesterol and LDL levels. Estrogen therapy may thus have a positive impact on women after menopause experiencing weight gain. However, there are both risks and benefits to such therapy. When symptoms of estrogen deficiency are severe, the benefits often outweigh the risks.
Such treatment needs to be determined on an individual basis, considering the potential risks of breast cancer, stroke, DVT, and coronary heart disease in some patients with estrogen therapy. Thus, the lowest effective dose for the shortest duration is usually prescribed by physicians.
Moreover, there are solutions to weight gain during menopause that are risk-free. These include lifestyle changes with responsible eating. Reducing food intake at each meal is a great first step because the number of calories required by the body decreases with age.
Pairing smaller portion sizes with a reduced carbohydrate intake in each meal is the key. A fiber-rich diet that includes sources such as flax seeds, peas, beans, vegetables, and lentils will also satiate the body’s hunger.
With the diet changes, regular exercise is important for at least an hour each day. It has been found that stress and tiredness can induce hunger, creating a tendency to binge. Therefore, taking part in relaxation activities can help relieve stress. Avoiding sleep deprivation is important as well.
Seeking help from a dietician can be of paramount importance as a subtle increase in calories will make us gain weight. For every 9.3 Calories of excess energy that enters the body, approximately 1 gram of fat is stored.
Also, consulting with a bariatric surgeon when diet and exercise fail is a dependable way to lose weight. Using a bariatric program that provides experienced dieticians, exercise specialists, and bariatric surgeons would be a firm foundation for a successful weight loss journey.
After Bariatric Surgery: Issues and Symptoms to Contact a Bariatric Surgeon for
Short term issues to contact your surgeon for:
- Shortness of breath: This is a symptom of a wide range of problems including Pulmonary embolism, drug reaction, unrelated heart attack, or asthma attack, among others. Seeking immediate help is necessary.
- Chest pain: This can be related to hiatal hernia repair or bariatric surgery. Your surgeon may order tests like CT of the chest to rule out serious pathology. Some patients have mild lower chest pain and it improves with time. This can be postoperative pain which will improve pain medications prescribed for surgery.
- Abdominal pain: It is common to have upper abdomen pain after surgery at the site of incisions, and it improves with walking and pain medications. Any pain not improving with pain medications should be reported to your surgeon. Sometimes a CT scan is necessary to rule out complications from surgery as deemed necessary by your surgeon.
- Fever more than 102 degrees Fahrenheit: There are several reasons to have a fever after bariatric surgery including decreased expansion of the lungs (which can be helped by walking and using your inspiratory spirometer), Pneumonia, or a serious complication like a Leak or Missed bowel injury. Any fever more than 102 degrees Fahrenheit should be reported to your surgeon. Your surgeon may ask you to come for a checkup or report to an ER to rule out a serious complication of surgery.
- Signs of Stroke: One-sided weakness or transient blindness can be a sign of a stroke and requires ER visit.
- Dizziness, blackout, syncope, or fall: This can be a sign of Dehydration. Sometimes it is hard to keep up with drinking after surgery as there can be transient pain on swallowing. This is very common after bariatric surgery as sometimes a patient needs IV fluids especially if there is superadded nausea with pain.
This can also be a manifestation of post-operative bleeding and may need you to report to the ER immediately.
- Vision changes: This can be related to many things including blood sugar level changes, dehydration, and electrolyte imbalance.
- Hoarseness of voice: This can be related to the tube used in your trachea for breathing during surgery.
- Soreness in calf muscles: This can be a manifestation of dehydration, electrolyte imbalance, or a clot in your leg veins (DVT). Continue electrolyte repletion and contact your surgeon if it doesn’t improve.
- Bleeding per rectum: Contact your surgeon immediately if you’re having fresh blood in your stool or black tarry stool.
- Blood in vomiting: A small amount of blood in vomiting is not uncommon after bariatric surgery and may not be a sign of any serious complication. However, it should be reported to the surgeon to rule out a serious complication.
Long term issues:
Plateau of weight loss before you reach your goal body weight: This could be related to lack of physical activity. A very subtle imbalance of food intake and energy expenditure can cause weight gain.
Increased portion size: This can be treated with increasing protein intake, counseling, and ‘pouch reset’ when we place our patients on a sugar-free liquid diet for a short period of time.
Generalized Weakness or fatigue: May be related to a vitamin deficiency, deficient protein intake, or decreased total calories. Your dietician can help. Your surgeon will do routine blood tests periodically to do surveillance on vitamin and nutrient deficiency.
Acid reflux or upper belly pain: This could be related to bariatric surgery or hiatal hernia which may need medications or a day operation to repair the hernia.
Upper abdomen pain or right-sided pain with or without radiation to the back: Your surgeon will likely order an abdomen ultrasound to evaluate your gall bladder. Gall bladder stones, sludge, or dysfunction of the gall bladder may require a day operation to remove the gall bladder.
Weight regain: Contact your physician as there are further options like ‘pouch reset’ and management with diet and exercise plans.
ABOUT THE AUTHORArsalla Islam, MD, FACS, FASMBS is a board-certified surgeon practicing at My Bariatric Solutions in Decatur, Texas. Dr. Islam is a fellow of the American College of Surgeons (FACS) and a fellow of the American Society for Metabolic and Bariatric Surgery (FASMBS). She is a member of the Parkland Surgical Society and the Society of Vascular Surgery (SVS). She is known as one of the top vascular, endovascular, and bariatric surgeons in the Dallas, Fort Worth region and beyond.