“I’ve gained 10 pounds in the last 2 years! Something must be wrong! Please check my hormones!” I hear this often from patients in their 40s. Each time, I brace myself as I tell them some answers that they are probably not going to like.
When you get more mature (a much better term than “aging”), your metabolism begins to decrease. So if your diet and exercise look the same in your 30s as they did in your 20s, you will likely begin to gain weight. This happens a little more drastically as you enter perimenopause, usually around your mid-40s. With the decreasing levels of estrogen in perimenopause, you begin to lose muscle mass, and muscle has a much higher metabolism than fat. When menopause officially arrives (diagnosed as no period for a year), weight gain begins to happen disproportionally in the belly.
If the weight gain is associated with changing hormone levels, then why not prescribe some hormones to prevent it? Sadly, it’s not quite that easy or I would be wearing seven estrogen patches right now. While postmenopausal hormone replacement has been associated with less abdominal fat distribution, it doesn’t prevent weight gain and has many other risks, so it is not used for weight control. Perimenopausal hormone therapy has not been shown to reduce weight gain.
But it’s not all bad news. With healthy diet choices and tweaking your exercise regimen, you can maintain a healthy weight through perimenopause and menopause. Here’s what I tell my patients:
Get a Physical
The first step would be to get a full physical. In your 40s, you need to have a checkup every 2-3 years with your primary care doctor to check for conditions like high cholesterol and heart disease. Weight gain could be related to metabolic issues such as thyroid issues or diabetes, which your doctor will usually check for with routine blood work.
Move Your Body AND Pump Some Iron
We should all be moving our body at least body 30 minutes a day. Walking, Zumba, biking, spin, aerobics, running, or whatever works for you. Exercise helps your heart, mood, sex drive, and prevents osteoporosis.
However, if you are only doing cardio, you will likely begin to lose muscle as you approach menopause, so you need to add some type of weight training to your routine to build muscle and improve your metabolism. If the thought of lifting traditional weights seems boring, intimidating, or not feasible in your schedule, there are many other options. I personally recommend a high-intensity interval training (HIIT) workout that uses weights because it combines your cardio and weight training. While it might seem intimidating at first, it can be scalable to all ages and fitness levels. Or yoga may be more your style. Types of yoga that really engage your muscles and core (like power yoga or vinyasa) can also help with your strength and metabolism. Yoga has also been shown to reduce other menopausal symptoms like brain fog, hot flashes, and insomnia.
Other options would be body-weight exercises than can be found in a plethora of YouTube videos, Pilates, or barre workouts. The key is finding a workout that you like (or at least don’t hate) and staying consistent.
Check Your Refrigerator
While exercise can help improve your metabolism and maintain your weight, you cannot exercise your way out of a bad diet. I often will gain 3-5 pounds when I am marathon training (running 40-50 miles a week) because I am so hungry, I eat all the time. When I was in my 20s, I could mostly eat what I wanted as long as I exercised daily, but when I hit my mid-30s, I had to start watching my diet too. And by 40 I had to be purposeful about both to maintain a healthy weight. Many of us have let some healthy habits lax over the last year of 2020, and it’s time to get our health back on track.
The first step is to cut out or significantly cut back on added sugar and alcohol. Your body doesn’t need these empty calories, and they provide no nutritional value. I love cookies and wine as much as anyone, but my metabolism does not. You will also enjoy them more if they are a special-occasion treat and not an everyday habit. Next is trying to make sure you are eating five to seven servings of fruits and vegetables a day. Limiting fried foods, processed foods, and red meat is also important. I do not recommend any specific “diet,” but rather finding a healthy way to eat that you can incorporate into your life for the long term.
Some resources I recommend to my patients are the book The Obesity Code. I find this type of eating plan is especially helpful for patients who tend to carry their weight in their abdomen, have PCOS, or have prediabetes or metabolic syndrome. For patients who struggle with forging new healthy habits, I like the book Better Than Before or One Small Step Can Change Your Life.
“It’s not fair. I used to be able to cut back for a week or two and drop 10 pounds and now that doesn’t really work.” I hear this from my frustrated 40-somethings on a weekly basis. There are no quick fixes in perimenopause. This isn’t a time for fad diets, popping pills, or taking supplements to drop a few pounds for a special event. This is a time to really focus on your health.
Some patients are truly in an unhealthy place. If your BMI is greater than 30 or you have medical conditions affected by your weight, you need to find a way to embrace healthy lifestyle changes. The health choices you make today will greatly affect your quality of life in the coming decades.
For other patients, the extra 10 pounds of perimenopause may be more of a vanity issue. If you have a healthy BMI and no medical concerns, then you have to decide: Are you are willing to go to the workout and diet extremes it takes to maintain your perceived goal weight, or can you accept your new normal? Most of us in our 40s don’t have the time or energy to exercise 2 hours a day and count every calorie that passes through our lips. A healthier approach in this situation is to focus on your health and not the number on the scale.
Perimenopause is an awesome opportunity to set a healthy tone for the second half of your life. It’s not a time for yo-yo diets and self-loathing, but a time to objectively look at your health and make the best choices you can. Increase your veggies, put down that second glass of wine, add in some weight training, and see your doctor for a checkup. Because you only live once, and you want that once to be an awesome, healthy, fulfilling life.