Peri-menopausal weight gain

Many patients tell me: ‘I just can’t lose weight as easily as I used to!’ and ‘I never carried weight around my middle, now I have a spare tyre’. Does this sound like you?

Women’s bodies and hormones undergo major changes as we move into our forties and into peri-menopause (the period leading up to menopause). The number of egg follicles in our ovaries steadily declines as we age, resulting in peri-menopause in months when we don’t ovulate. This means that we don’t make as much progesterone as we used to. At the same time, our estrogen levels, while generally trending downwards, fluctuate wildly.

The result of these hormonal shifts is that we experience mood swings, sleeplessness, heavy periods, irregular periods, night sweats, hot flashes and very often, stubborn weight gain, especially around the middle.

Many women find that while they could easily lose those extra kilo’s when they were younger by increasing their exercise levels, this is no longer a solution. The standard advice of ‘Eat less, exercise more’ simply doesn’t work anymore. The harder they push, the more stubbornly the fat rolls stay.

It is a simple fact that you cannot fight biology. Nature always wins. While there are many changes in our bodies as we age contributing to weight gain, the two hormones with the greatest effect here are cortisol and insulin.

Insulin resistance

Insulin levels naturally increase with age. Additionally, years of eating diets too high in sugar and carbohydrates finally catches up with us as a condition called Insulin Resistance. When we eat carbs, our blood sugar levels rise steeply. High blood sugar levels are damaging to the blood vessels and organs such as the eyes and kidneys. Normally, the body has a system to bring those blood sugar levels down quickly through the action of insulin. Insulin acts like a messenger, binding to a receptor on the surface of cells and opening up a channel through which cells take up the glucose in the blood. It can then be used as fuel by the cell. However, if blood glucose levels remain elevated because we are constantly snacking and eating sugar-laden meals, insulin levels likewise remain high. Eventually, the cells of the body become resistant to the signaling by insulin. It is like some-one constantly ringing your doorbell – eventually you will stop opening the front door and probably disconnect the doorbell.

However, to protect the blood vessels, blood glucose levels cannot be allowed to remain high. The body does the next best thing: the insulin stimulates adipose cells to take up the glucose and store it as fat. This happens especially around the abdomen. To compound the problem, abdominal fat is metabolically active, and releases compounds which increase inflammation. And chronic inflammation leads to more insulin resistance, creating a vicious loop.


Many women in their forties and fifties carry a large burden – work stress, financial responsibilities, caring for aging parents, relationship difficulties. The body interprets stress in a literal fashion, and prepares for leaner times ahead. Cortisol is an anabolic hormone, meaning it causes the breakdown of tissue. Unfortunately, the breakdown is not of fat, but of muscle. In fact, it causes the storage of fat, to serve as reserve fuel to tide you over.

The preservation of lean muscle mass as we age is extremely important, and not only to ensure strength and flexibility to prevent falls. The greatest uptake of glucose from the blood is into the large muscles of the legs and buttocks. Loss of muscle mass due to increased cortisol therefore contributes to greater insulin resistance.

Excessive exercise, as well as drastically cutting calories, are both perceived as a stress by the body, leading to more cortisol secretion. In stead of solving the problem, they contribute to further abdominal fat deposition.

The solution

It is therefore necessary to address the factors driving the process by lowering insulin and cortisol levels.

A whole-food nourishing diet, with adequate, quality protein, moderate to low carbohydrates and healthy fat, as well as plenty of vegetables will ensure stable blood sugar levels and supply the nourishment your body needs.

Moderately intense exercise may be more beneficial. Adding in strength training will help to preserve muscle mass. Be careful with excessive endurance training that increases cortisol secretion. Build in recovery days with activities such as yoga, tai chi and leisurely walks in nature to counteract stress. Meditation and other stress-reduction techniques are also very valuable in lowering stress and cortisol levels.

Love photo created by jcomp –