Does my weight and metabolism change during the menopause transition?
During the menopause transition, your body composition changes profoundly: more fat mass, less muscle and more dangerous abdominal fat. Your total weight on the scale may barely shift, yet something genuinely significant is taking place.
During the menopause transition, the rate at which fat mass increases doubles. This accelerated fat gain continues until roughly 2 years after the final menstrual period and is not a normal consequence of ageing, but is linked to the transition itself. At the same time, the body loses muscle mass during that same period.
Strikingly, total body weight on the scale does not rise more quickly because of the menopause transition. Weight was already gradually climbing before menopause and actually levels off afterwards. What does change is the ratio of fat to muscle: at exactly the same weight, you can have far more fat and far less muscle than before.
Particularly concerning is the shift towards deep abdominal fat surrounding the organs. Women who remained premenopausal did accumulate subcutaneous fat with age, but not this more dangerous type of abdominal fat. That increased specifically in women who went through the menopause transition. This deep abdominal fat raises the risk of cardiovascular disease and disturbances in blood sugar regulation.
The body also burns less: resting energy expenditure falls, partly because muscle mass declines, and fat oxidation dropped by roughly one third in women who went through the menopause transition. On top of that, women move less on average for more than 2 years before menopause officially begins, and that lower level of activity persists. Together, this means that the same diet and the same amount of exercise lead more readily to fat gain after the menopause transition.
The loss of oestrogen also impairs blood sugar regulation, which raises the risk of type 2 diabetes. Hormonal therapy with oestrogen can partly counteract the shift towards abdominal fat and improve insulin sensitivity. However, which women benefit most from this has not yet been precisely established. If you are considering hormonal therapy, discuss this with your doctor.
This answer is based on several review studies and a long-term study in which women were followed throughout the menopause transition, including a study that specifically distinguished between women who remained premenopausal and women who became postmenopausal. The findings on fat mass, muscle mass and visceral abdominal fat are robustly supported and recur across multiple sources. The findings on energy expenditure and physical activity rest on fewer sources and are somewhat less certain. On hormonal therapy, the results are predominantly positive, but the researchers themselves emphasise that more research is needed to determine which women benefit most.
Which hormone levels are tested during menopause?
During menopause, the hormones measured most commonly are FSH, LH, oestradiol, progesterone, testosterone and AMH; elevated FSH combined with reduced oestradiol (below 20 pg/ml) is the most reliable sign that menopause has begun, but always have your results explained by your doctor, as body weight and background influence reference values.
Can you delay menopause with lifestyle or diet?
Avoiding smoking, eating less red meat, and eating more citrus fruit and oily fish appear to have a favourable influence on the age of menopause. However, evidence from controlled experiments is still entirely lacking.
What does the menopause do to my heart and bones in the long run?
The menopause accelerates bone loss, and hormone therapy measurably reduces that loss. At the same time, hormone therapy increases the chance of a stroke and a blood clot.
What complaints are most common during menopause?
The most common menopausal complaints are joint and muscle pain, fatigue and sleep problems; hot flushes are the most characteristic but do not top the prevalence rankings. If you recognise several of these complaints, it is worthwhile discussing them with your GP, who can consider what may help for each one.
Does the menopause disrupt my sleep, and what can help?
The menopause genuinely disrupts your sleep, mainly through hot flushes and hormonal changes. A talking therapy designed specifically for sleep problems is the best first step; hormone therapy or melatonin may come into the picture after that.
What does menopause do to your risk of cardiovascular disease?
Menopause demonstrably increases your risk of cardiovascular disease, primarily through unfavourable changes in fat distribution, cholesterol, and blood pressure. If you experience early menopause or are considering hormone therapy, discuss your personal risk profile with your doctor.