- Co-authors: Martin Kueh, Nicole Fong

Let’s talk about menopause. It is a natural process that often takes place between the ages of 45 and 55, signifying the next chapter of a woman’s life. Among various biological adjustments, weight fluctuation is an important concern, which many perceive as an imminent process. Statistics showed women in menopause gain an average of 1 pound per year, and 20% of women gain 10 pounds during the menopausal transition. The good news is weight gain is not an inevitable fate.

What drives menopausal weight gain?

Starting through the lens of science. One major hormone, oestrogen, is responsible for regulating and distributing fat. As oestrogen levels decline naturally, fat storage tends to increase, leading to changes in our body frame as more fat cells are situated in the abdomen and cause weight gain. However, menopause weight gain is not entirely based on hormonal changes; it is also the reduction in muscle mass associated with menopause. Less muscle mass leads to a slower metabolic rate, making weight gain easier.

Menopause transition interferes with daily life. Hormonal changes result in symptoms including muscle weakness, hot flush, fatigue, and mood swings, which can be daunting to live with physically and mentally. Considering the collective interfering factors, engaging in physical activity can be arduous. Additionally, menopause affects the quality of sleep, leading to sleep deprivation and craving for sugary foods. The interplay of hormonal changes and the body trying to adapt to these changes create an unsettled environment that culminates in weight gain.

How to take control of menopausal weight gain?

1. Nutrition

This is the key pillar of weight management in menopause, albeit no universal dietary recommendation exists. Healthy weight maintenance requires a reduction in energy intake by opting for smaller portions with more nutrient-dense filling food. It is recommended to consume more vegetables, fruits, and whole grains. Increased intakes of calcium-rich food (e.g., cheese, milk, yoghurt), iron-rich food (e.g., spinach, beans, lentils), omega-3 fatty acid-rich food (e.g., fatty fish, flaxseeds, chia seeds) and vitamin D-rich food (e.g., salmon, egg yolks, mushrooms) can improve menopausal symptoms and overall cardiometabolic health.

Limiting the consumption of alcohol, caffeine, high-sugars, processed carbohydrates, high-sodium, and spicy foods can attenuate menopausal symptoms and provide cardiometabolic beneficial effects. New approaches for menopausal weight management include tailored meal plans, gut microbiome-based approaches, and dietary supplements like probiotics, prebiotics, and vitamins, which are being explored. The emerging innovation may hold promise for a more personalised dietary plan during menopause.  

2. Physical activity

While a balanced diet is crucial, it is equally important to incorporate exercise into your weight loss plan for long-term success. Overall, regular physical activity spanning 8 to 10 weeks improves metabolic health across different exercise modalities and intensities.4 This economic intervention also exerts positive effects on both physical and psychological quality of life.5 You can start with at least 30 minutes of walking every day to build momentum.6 Cycling is another beneficial alternative. Once you are on a roll, you can implement high-intensity interval training, involving alternate intervals of intense exercise with brief rest. You can also combine with resistance training (e.g., resistance band workout, squats and leg raise) twice a week for added well-being benefits.6 Incorporating activities like yoga and tai chi, helps improve flexibility and promote relaxation. By embracing variety in your workout, you can achieve your fitness goals while engaging in a more enjoyable and sustainable workout experience.

3. Menopausal hormone therapy (MHT)

MHT has been suggested to tone down menopausal weight gain by correcting hormonal imbalance. It is a common misconception that MHT causes weight gain. In fact, it helps weight distribution by increasing lean body mass and decreasing belly fat. Benefits are more likely to outweigh the risks if the treatment is initiated for symptomatic women before the age of 60 years or within 10 years after menopause. Irrespective of the timeframe for action, MHT has been proven to reduce menopausal symptoms, which directly translates to improved quality of life and renewed energy. However, these benefits must be weighed against the potential risks of blood clots among females living with obesity. When considering MHT, it is important to personalise the treatment by determining the appropriate dose and start date tailored to the individual's specific needs and health status.

4. Cognitive behavioural therapy and support groups

Psychological distress in menopausal individuals can lead to unhealthy behaviours and hinder the ability to follow weight loss advice and maintain self-control during the menopausal transition. Cognitive behavioural therapy has been found to effectively reduce menopausal symptoms and improve the overall quality of life by challenging negative beliefs and replacing them with positive coping strategies.8 Participating in support group therapy sessions can create a safe space for individuals to openly discuss certain topics of interest and taboo topics. Additionally, it offers an opportunity to connect with people who have had comparable experiences, fostering a sense of community and empowerment.

Key Takeaway

While weight management is challenging to navigate during the menopause transition, it is important not to let it define you. The journey to break free from obesity can be achieved through prioritising physical and emotional health and seeking healthcare professionals to help make informed choices.