If you’re in your 40s or 50s and your clothes are fitting differently, even though you’re eating the same and moving the same, you’re not imagining it. It’s one of the most common things women tell me in clinic. And it’s usually followed by, “What am I doing wrong?”

Most of the time, the answer is: not much. Your body is changing, and what worked in your 30s may not work in the same way now.

What is actually changing?

A large US study that followed women through the menopause transition (the SWAN study) found something really interesting. The number on the scales kept creeping up slowly through midlife, at about the same rate before and during the transition. But underneath that number, things were shifting. From the start of the transition, the rate of fat gain doubled and muscle (lean mass) started to go down, and this carried on until around two years after the final period (1).

So your body is made up differently. More fat, less muscle. And the fat tends to move to the middle. An international review on menopause and weight found that while ageing and lifestyle drive most of the weight change, the hormone changes of menopause are linked to more body fat, especially around the tummy (2).

Why does it happen?

It’s usually the shift in hormones, but there are usually other things going on as well. The ones I look at most:

• Oestrogen and progesterone. As they change, the body tends to store more fat around the middle.
• Prolactin. Prolactin can rise with ongoing stress and with an underactive thyroid. Higher prolactin has been linked with weight gain, so it’s one of the hormones we check in your blood tests.
• Blood sugar and insulin. Many women become less sensitive to insulin in midlife. A glucose test on its own only tells you you’re not diabetic yet. Insulin and HbA1c show what’s happening before that.
• Muscle. We lose muscle every year after 30, so we need to be replacing it. Muscle uses glucose: the more muscle you have, the less sugar stays in your blood.
• Thyroid. A slow thyroid can make weight harder to shift. This needs more than just measuring your thyroid stimulating hormone (TSH): a fuller thyroid panel, including antibodies and thyroid cofactors.
• Sleep. Night sweats and broken sleep add up. In one study, just two short nights of sleep lowered leptin (the hormone that tells you you’re full), raised ghrelin (the hormone that makes you hungry), and increased cravings for sweet and starchy foods (3).
• Moving less. Midlife often means more hours sitting: at a desk, in the car, on the couch at night.
• Stress. Midlife is busy. Ongoing stress affects sleep, cravings and where we store fat. Stress management techniques are priceless at this stage of our lives. We aren’t going to avoid stress, we need to manage it!

And these are just some of the things we check!

What helps

This isn’t a willpower issue, and it isn’t about eating less and less. It’s about getting strategic and knowing where to put your efforts. A few things can make a real difference for most women:

• Protein at every meal. It helps keep you full and supports your muscle.
• Strength training. Start small, even 20 minutes a week, and build up when you’re ready. I only started weight training at 50, and you feel strong. It changes things.
• Keep moving through the day. Get up every 30 to 60 minutes, walk after meals and take the stairs. Moving your muscles also keeps your lymphatic circulation flowing, which can help with fluid retention and that puffy feeling.
• Proper savoury meals. If you don’t eat proper meals, you’ll go on the hunt for snack foods and never really feel satisfied.
• Look after your sleep. Keep the bedroom cool and finish eating two hours before bed.
• A stress tool you actually use. Something small, every day.

These are just some ideas. What makes the difference is how they’re put into place for you: drilling down into your unique biochemistry, your likes and dislikes, your lifestyle, and knowing where you’re starting from. That’s the difference between easing into changes and it feeling like a hard slog. General advice can’t understand your particular situation.

Why I start with pathology

Most women are focusing on the wrong things to change. Every woman is different. For one woman it’s mainly her insulin, for another it’s her thyroid, her iron or her sleep. Sometimes it is just the hormones. A full set of blood tests shows what’s going on under the bonnet, so you can put your energy into the changes that will have the biggest impact for you.

This is the time to relook at your health. Not just to feel slimmer and stronger, but to feel good in your mood and energy, and to look after your future self. The years ahead matter, and what you do now helps you be ready for them.

Cheers,
Maria xx

The best money you’ll ever spend is on your health, and now is the time! Our 6-month How to Do Menopause program starts with your pathology and builds a plan around you, with the flexibility you need to fit it into your unique lifestyle. It’s run by naturopath and clinical nutritionist Maria Harpas, who has a Bachelor of Health Science (Complementary Medicine) and 17 years of clinical experience, and research nutritionist Christa Nicola, who has a Master’s in Human Nutrition specialising in peri/menopause and over 20 years of experience working with women.

Find out about the program →

References

1. Greendale GA, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. insight.jci.org/articles/view/124865
2. Davis SR, et al. Understanding weight gain at menopause. Climacteric. 2012;15(5):419-429. pubmed.ncbi.nlm.nih.gov/22978257
3. Spiegel K, et al. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141(11):846-850. Summary: University of Chicago Medicine