MENOPAUSE IS USUALLY A CAUSE OF MANY CONCERNS AMONG WOMEN. ONE OF THE MOST IMPORTANT IS THE FEAR OF WEIGHT GAIN. IN FACT, IT IS WELL KNOWN THAT OBESITY AND METABOLIC SYNDROME ARE FOUND IN WOMEN IN THIS PERIOD OF THEIR LIFE THREE TIMES MORE OFTEN THAN BEFORE MENOPAUSE.

A close up of a woman with obesity that is caused by unhealthy food. Woman with hand on stomach to represent indigestion sitting on a sofa and copy space

There are a lot of myths – women are not sure whether obesity is associated with menopause per se, or perhaps with “hormonal therapy”? Is weight gain inevitable, something to which one should be reconciled, or is it the result of negligence in the areas of diet and physical activity?

A lot of distressing symptoms in a woman’s life appear during menopause, such as hot flashes, mood disorders, sleep disturbances, and recurring infections of the urogenital tract. Moreover, a lot of metabolic problems emerge at this time – increase in body weight, insulin resistance, and glucose and lipid metabolism disturbances. In consequence, the risk of development of Type-2 diabetes, osteoporosis, cardiovascular and oncological diseases increases.

Obesity should be seen as one of the most important disturbances associated with the menopause, being not only a medical but also a social and economic problem. The incidence of obesity in the United States among women prior to menopause is 65 percent, and among women following menopause is almost 74 percent.
Oestrogens in pre-menopausal women are responsible for the accumulation of fat in the subcutaneous tissue, particularly in the gluteal and femoral regions. At menopause there is a rapid fall in oestrogen levels, leading to an increase in body weight, unfortunately usually in the form of central obesity (fat inside the abdominal cavity). It is estimated that postmenopausal women had an almost five-fold higher risk of developing abdominal obesity and associated diabetes compared to premenopausal subjects.
Central obesity has a much higher association with medical problems related to obesity, particularly diabetes, dyslipidaemia, hypertension and cardiovascular disease. In addition, weight gain in midlife contributes to other health risks including cancer, arthritis, mood disorders, and sexual dysfunction.

Do oestrogens affect appetite?

It is well known that fat tissue, particularly in obese subjects, is the source of many hormones, one of the most important of them is leptin. Its levels reflect the volume of fat mass.
Leptin inhibits appetite, acting centrally in the brain. It has been demonstrated that oestrogens increase the activity of leptin action, therefore helping with appetite suppression. At menopause when there is a rapid decrease in oestrogen, subsequently there is much less appetite restriction.

Moreover, activity of ghrelin – the strongest hunger producing hormones produced in the stomach, (but also produced locally in the hypothalamus) – is partially blocked by oestrogens.
Pre-menopause, oestrogen therefore aids to reduce appetite. It can be assumed that the rapid decline in levels of oestrogen would contribute significantly to an increase in appetite.
Undoubtedly, weight gain during menopause is common. It is largely due to hormonal changes that take place at this time. However, also other factors should be taken into account. These include
genetic as well as environmental factors, among which lifestyle changes (unhealthy diet, lack of physical activity), illness, certain medications, and other factors should be mentioned.

Ageing itself is associated with decrease in lean body (muscle) mass, which decreases the metabolic rate, potentially increasing the body’s ability to accumulate fat tissue. Ageing is also associated with decrease in physical activity, which may be subtle and therefore not easily perceived by the individual.

Because we lose muscle mass with age, we burn fewer calories at rest and also when we exercise. Couple these changes with moving less, and you have a recipe for weight gain. This explains why you may gain weight with the same diet and exercise routine that previously worked for you. When indicated, menopausal hormone therapy can be considered to manage bothersome menopausal symptoms, however there is no evidence that hormone therapy works as a treatment for obesity in post-menopausal women. Hormonal therapy is not recommended for prevention of chronic disease or prevention or management of weight gain.

Fear of obesity associated with menopause widely expressed among women seems to be justified. Observations confirm a high prevalence of weight gain and higher risk of many diseases related to obesity, especially cardiovascular events and cancers, in this period of women’s life. For more information about how we can assist you with your weight-loss goals, please contact us at Surgery
Gold Coast clinic.

DR JASON FREE BVSC (HONS)
MBBS (QLD) FRACS SPECIALIST
BARIATRIC SURGEON
Suite 2,
Pindara Professional Centre
8-10 Carrara Street,
Benowa
Tel: 07 5564 6501
surgerygoldcoast.com.au