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Women and Menopause

Women and Menopause: The Menopause Metabolism

Women and Menopause: The Menopause Metabolism

As a female physician who specializes in weight management, weight gain during menopause and peri-menopause are the most common condition I deal with.

So many women share the history of never having had to worry about weight until all of a sudden with perimenopause or menopause it is like a switch has turned off, and somehow their metabolism has changed. Studies show that during the years after menopause, the average woman will gain thirty pounds.

Women who take HRT may experience less initial weight gain, but several years later; women on hormones have gained a similar amount of weight compared to women who have never used hormones.

Is Weight Gain with Menopause Inevitable?

When trying to come up with a solution to the challenge of avoiding the seemingly inevitable weight gain, I thought, “Will I, like most of my patients, be bewildered and gaining weight in several years despite doing all that I can to prevent it?”  This was the question I often asked myself during the day-to-day clinical practice of medicine in weight management.  It has been one of the driving questions that I seek answers for when I go to conferences or read the scientific literature.  I have found some very encouraging answers to the dilemma and my patients are very grateful.

The Role of Carbohydrates

The answer I have found and implemented successfully in treating my patients for weight gain comes down to carbohydrate tolerance.

A young male athlete has a high tolerance to carbohydrate.  He has a larger muscle mass due to his young age, his male gender and his high level of physical activity.  The young male athlete is able to utilize his carbohydrates or glucose right at the level of his muscles. The young male athlete would be able to run and perform well with a diet high in carbohydrate so much so that athletes have practiced carbohydrate loading before events of peak performance. This gives cells the fuel needed to supply the large demand for energy.

This high carbohydrate, low protein diet, which is also the backbone of the food guide pyramid, provides optimal nutrition for the athletic male. In fact, the food guide pyramid was developed from information gathered from active men in the military. But what about the postmenopausal woman who is obviously more sedentary, what does she need?

Most women become less active with age and experience a decline in muscle mass.  Even women who still continue to exercise experience a decline in muscle mass due to age, but the decline is much less than that seen with sedentary women.   A high carbohydrate diet requires one of two things:

1)  Utilization of energy by the skeletal muscle

-Or-

2) Storage of excess calories into body fat.

As a woman’s muscle tissue declines, fat tissue is becomes the site where her extra dietary carbohydrates will be delivered and stored. More is going into storage than is being utilized by muscle tissue.  She gains body fat, usually in the central or abdominal area of her body.  The rise in abdominal fat is what triggers the cascade of an important metabolic hormonal imbalance called insulin resistance, which directly affects the risks for heart disease.  Insulin resistance makes it very, very difficult for excess carbohydrates to be used by skeletal muscle tissue. In my practice, I find a high correlation with menopause and the onset of insulin resistance in women who have been previously insulin sensitive.

Women who carry weight in their abdomen will usually have higher insulin levels and eventually higher blood glucose levels consistent with pre-diabetes.  The abdominal weight causes her bad cholesterol to increase while lowering her good cholesterol, which is the pattern that contributes to heart disease.  Abdominal fat also increases the level of inflammatory hormones, which also contribute to heart disease.  In my opinion, it is the deposition of abdominal fat and not lack of estrogen that is the main reason women experience more heart disease after menopause.

The metabolism that arises with the onset of menopause can be very frustrating, but is very treatable.  I have had success helping so many patients lose weight despite the changes their body has undergone.  My goal is to correct body chemistry so that the body relearns how to lose weight and create a stable metabolism long-term.


To learn more about the menopause metabolism, please call our office at 239-593-0663.


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