From the Guidelines
Sex hormones, particularly estrogen, play a crucial role in weight management during menopause, and their decline can lead to weight gain and metabolic changes. During menopause, the decrease in estrogen levels affects metabolism, reducing the rate at which the body burns calories, and alters fat distribution from a gynoid (hips and thighs) to an android (abdominal) pattern, as noted in studies such as 1. Estrogen also influences appetite regulation and energy expenditure, so its decline can increase hunger and decrease physical activity, further contributing to weight gain. Additionally, lower estrogen levels can reduce muscle mass, further slowing metabolism. Some women find that hormone replacement therapy (HRT), which typically includes estrogen (such as estradiol 0.5-1mg daily) and sometimes progesterone (such as 100mg daily for women with an intact uterus), helps manage weight during this transition, as discussed in 1. However, HRT should be prescribed at the lowest effective dose for the shortest duration necessary, as it carries risks including blood clots and certain cancers. Beyond hormonal interventions, menopausal women should focus on:
- Increasing physical activity (particularly strength training to preserve muscle mass)
- Consuming a nutrient-dense diet with adequate protein
- Managing stress
- Ensuring sufficient sleep to counteract the metabolic changes associated with declining sex hormones. It's essential to weigh the benefits and risks of HRT and consider individual factors, such as the risk of osteoporosis and fractures, which can be reduced with HRT, as shown in studies like 1. Ultimately, a comprehensive approach that includes lifestyle modifications and, when necessary, hormonal therapy, can help menopausal women manage weight and mitigate the risks associated with declining estrogen levels.
From the Research
Role of Sex Hormones in Weight Management During Menopause
- Sex hormones, such as estrogen, play a significant role in weight management during menopause 2.
- The decline in estrogen levels during menopause can lead to changes in body composition, including increased fat mass and decreased lean mass 3.
- Weight gain during menopause is predominantly due to a reduction in spontaneous activity, and advice on controlling energy intake and increasing physical activity may be necessary to prevent weight gain 2.
Impact of Physical Activity on Menopause Symptoms
- Physical activity, such as yoga and aerobic exercise, may be beneficial for managing menopause symptoms, including physical, urogenital, and total symptoms 4.
- However, the evidence for the impact of physical activity on vasomotor and psychological symptoms is inconclusive 4.
- Regular aerobic exercise during early postmenopause may slow vascular decline by improving nitric oxide bioavailability, promoting positive vascular remodelling, and lowering systemic inflammation 3.
Effect of Hormone Replacement Therapy on Cardiovascular Disease Risk Factors
- Hormone replacement therapy (HRT) has been shown to decrease the risk of developing cardiovascular disease (CVD) and to have a significant impact on many CVD risk factors, including blood lipid and fibrinogen levels 5.
- However, the addition of progestogen to estrogen may negate some of the beneficial changes of estrogen, and there are contradictory effects of HRT on CVD risk factors in women 5.
- The combination of physical exercise and HRT may have a positive effect on cardiovascular and metabolic health in postmenopausal women, including decreasing systolic blood pressure and improving peak oxygen consumption 6.
Importance of Exercise and Lifestyle Modifications
- Regular aerobic exercise and resulting improvements in cardiorespiratory fitness have consistently been shown to be preventive of CVD, and may be beneficial for managing menopause symptoms 4, 5.
- Lifestyle modifications, such as controlling energy intake and increasing physical activity, may be necessary to prevent weight gain and manage menopause symptoms 2.
- The combination of physical exercise and HRT may be more effective than either intervention alone in improving cardiovascular and metabolic health in postmenopausal women 6.