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  • Post-menopausal women gain an average of 1.5 pounds per year, and they may experience a shift in body shape, with more fat accumulating around the midsection.
  • Some of the weight and body composition changes occurring at mid-life can be chalked up to aging and a naturally slowing metabolism. But declining estrogen levels due to menopause (and menopause symptoms that intefere with sleep and mental health) also play a role.
  • Weight gain and increased fat mass—particularly around your middle—is associated with worse hot flashes and contributes to a host of health issues, including increased risk for cardiovascular disease and  insulin resistance (when cells don’t do an efficient job of taking up glucose from the bloodstream, which can lead to high blood sugar).
  • Now for the solutions. Making targeted shifts to your diet and lifestyle can help with weight at any age. For women at midlife, hormonal therapies that address menopause symptoms and estrogen-related weight changes at their root can be a powerful tool, as well.

Tell us if this sounds familiar: You haven’t changed your exercise or eating routine but you suddenly find it a battle to button your jeans. That once-steady number on the scale has been slowly but surely creeping up. And when you compare notes with female friends at this life stage, they immediately relate. 

Research confirms what you probably already know. On average, women gain 1.5 pounds per year after going through menopause, and fat distribution changes, too, with more accumulating around your midsection or waist as opposed to your thighs and butt (so a pear-shape might start looking more apple-like).

Of course, some of these weight and body composition changes are simply the result of aging. Our naturally slowing metabolism (due mainly to a loss of muscle mass), along with a decrease in activity, cause both men and women to gain weight  and fat mass as they get older. But waning female hormones associated with menopause are also a driving factor, which is why women often feel like these shifts come on quickly compared to men. 

So if you feel like you’re not in control of your body, join the club. Also, give yourself some grace. Our bodies evolve constantly, and obsessing over every pound or a little belly pooch isn’t worth your precious time. That said, it’s important to understand why these shifts are occurring in the first place, and the factors you can control as you age. Below, we’ll dive into the science behind body changes after 40, explain their impact on your overall health, and offer a range of solutions to maintain a feel-good weight, no matter what midlife throws at you. 

Why do women experience weight changes at mid-life?

Age plays a major role in the body composition changes both women and men experience at midlife, and it may have an even greater impact on weight than menopausal hormone shifts (we’ll get to those in a minute). But what exactly is it about getting older that makes it harder to stay at your happy, healthy weight? Decreasing muscle mass and increasing fat mass appears to be the main culprit. 

As you get older, you’re more likely to experience anabolic resistance, which just means it’s harder for you to build muscle even if your activity and eating haven’t changed. Starting around age 35, this can mean losing 1-2 percent of your muscle mass per year, and that rate speeds up over time. An adult who doesn’t make strength training a regular thing, for example, might lose 4 to 6 pounds of muscle per decade. 

That muscle loss doesn’t typically translate into weight loss, though. Instead, for most of us, it gets replaced with fat. And because it takes more calories to build and maintain muscle than it does to fuel fat, losing muscle is one reason women’s metabolism tends to slow down five to ten percent every ten years. All of that helps to explain age-related weight gain, but why do so many women see their weight go up like a hockey stick at midlife, while the men around them gain more gradually? In a word: hormones.

How hormonal changes affect weight and body shape

Declining estrogen levels and increased levels of follicle stimulating hormone (FSH) during the menopause transition both appear to play a role in women’s weight gain patterns.

Before the menopause transition estrogen levels stay consistently high, and that steady supply helps maintain muscle mass and strength and influences where our fat winds up (predominantly around the breasts, butt, and thighs, pre-menopause). Estrogen also helps regulate fat and glucose metabolism. During the menopause transition, however, declining estrogen may impact all of these processes, contributing to a loss of lean muscle and an increase in fat, with more of it around the belly. Another estrogen perk? It normally helps to rein in appetite; without it, hunger is stronger, making it harder to maintain your weight or drop pounds easily. A recent study of 667 postmenopausal women also found that higher levels of FSH (which goes up during menopause in response to lower estrogen) were associated with increases in body fat. 

Menopause symptoms that can drive weight gain

Trouble sleeping

Several common menopause symptoms may play a role in weight changes at midlife, too—and sleep is the first place to look when you’re trying to connect the dots. Women in midlife often struggle with all kinds of sleep problems, and we all know that consistently poor sleep leaves you exhausted, with zero energy or motivation to be physically active, which may contribute to weight gain over time. Lousy sleep may also disrupt normal levels of appetite hormones that regulate hunger and satisfaction, and drive cravings for foods high in fat and carbs.

Up to 47 percent of perimenopausal women and 60 percent of postmenopausal women are affected by sleep disorders and disturbances, according to the Study of Women's Health Across the Nation (SWAN). Here again, hormone fluctuations may be to blame. For example, fluctuating estrogen levels can lead to night sweats and a frequent need to pee, both of which contribute to lots of nighttime wake-ups.  Low levels of progesterone may constrict the upper airway, causing lapses in breathing (sleep apnea) that periodically wake you up, gasping for air. And, while it’s not fully understood why, menopause is also associated with significantly lower levels of the sleep hormone melatonin, which could make it harder to fall asleep. 

Mood problems

In one study involving 685 women published in the Journal of the North American Menopause Society, over 40 percent of perimenopausal and postmenopausal women experienced depression symptoms; and per the SWAN study, over half of women may experience anxiety at mid-life. Experts suspect fluctuating estrogen interferes with the normal supply of serotonin and norepinephrine, two neurotransmitters that help to keep your mood stable. Plus, classic menopause symptoms like hot flashes and poor sleep can be seriously distressing.

But what’s the mental health-weight connection? There are a few. Chronic stress is associated with higher levels of hormones like cortisol, which can lead to overeating of sweet, salty, and fatty foods, weight gain, and increased abdominal fat. Depression may also lead to more emotional eating and increased appetite. And anxiety has been associated with higher caloric intake among women. 

Why is midlife weight gain a health risk?

Whether or not it dents your body image, weight gain at midlife comes with a host of risks for your physical health, especially if it pushes you into the obese category and you gain dangerous abdominal fat. According to an article on weight gain in women at midlife published in Mayo Clinic Proceedings, these two factors are associated with poorly regulated blood sugar and insulin resistance (which lays the ground for type 2 diabetes), elevated blood lipid levels (including cholesterol), high blood pressure, and increased risk of cardiovascular disease, which is the leading cause of death in postmenopausal women. 

Increased abdominal fat is also associated with chronic inflammation and may up your risk for certain cancers; and obesity can worsen other menopausal symptoms, including hot flashes.

So you probably don’t need convincing:  Maintaining a healthy weight and body make-up at midlife is key. Fortunately, there’s a lot you can do. 

4 Ways to combat midlife weight gain

1. Move your body, every day

Not only will exercise help counter weight gain and fat accumulation, it can also promote quality sleep and help alleviate the mental health symptoms that undermine healthy eating.  While all exercise is great, strength training is particularly important for building  lean muscle mass, which can help you burn more calories (remember, more muscle means a higher metabolism) regardless of your weight. But what matters most is doing things you enjoy enough to stick with—consistency is key!

  • Aim for at least 150 minutes of moderate aerobic exercise per week (for example, 30 minutes per day, five days a week) such as brisk walking, a nice yoga flow, cycling, swimming, using the elliptical, and even heavy-duty cleaning chores; or 75 minutes of vigorous aerobic exercise (eg, 15 minutes per day, five days a week) such as hiking or jogging. 
  • Aim for strength training workouts at least twice a week, which includes lifting weights, using resistance bands, climbing stairs, and performing body-weight exercises (push-ups, squats, lunges, planks, etc.). 

2. Defend your sleep 

 You can do a lot with your lifestyle to help offset some of the menopause-induced sleep problems that drive weight gain. Here are a few things you can try out as soon as tonight:

  • Light exposure at night can suppress the sleep hormone melatonin, so start dimming the lights, turning off laptops and TVs, and scaling back your smartphone use before bedtime—ideally two hours before, but any amount helps. And if you need to work late, consider wearing a pair of blue-light blocking glasses
  • Avoid working out in the late afternoon and evening, as exercise can act like a stimulant and interfere with sleep-promoting melatonin. Exercise in the morning or early afternoon appears to be best for sleep.
  • Aim to go to bed and wake up at the same time every day and get between 7-9 hours of sleep per night—even on weekends. This helps your body establish a consistent, healthy circadian rhythm that will help you fall asleep and wake up easily.
  • Get in the habit of using your bed for only sleep, sex, and reading (nothing stressful, in other words). 
  • Establish a calming pre-bedtime routine. Chamomile tea, spritzing lavender essential oil on your pillow, stretching, deep breathing—try a bunch of little rituals and stick with what works for you. 
  • In some situations, melatonin supplements may help. Talk to your clinician about the right dose and source, since many supplements contain unnecessarily high levels. 

3. Eat foods that nourish you

The best eating pattern for weight maintenance or weight loss is the one that works for you. Pinpointing it will likely require some trial and error, and guidance from a Midi clinician can help. That said, the advice below is pretty much healthy-for-all and will get you started: 

  • Eat a diet rich in whole or minimally processed plant foods, which contain filling fiber and a range of vitamins, minerals, and phytochemicals essential for good health. 
  • Choose complex carbohydrates (found in beans, lentils, brown rice, quinoa, oats, and barley, among other foods) over simple carbs (found in anything containing refined flours and added sugars such as white bread, pastas, crackers, cereal, and baked goods). Low-quality carbs can promote abdominal obesity and interfere with sleep.  
  • Get enough protein to help maintain that precious muscle mass. Research suggests that protein requirements increase with age. As a good general rule, aim for about 20-30 grams of protein per meal from sources such as legumes, minimally processed soy, and high quality meats and fish. 

4. Consider prescription medications

We’ve discussed how menopause symptoms contribute to weight gain for many women in midlife, so it makes sense that improving those symptoms can help with weight as well. Research suggests that when hormone replacement therapy (HRT) is individualized to your needs, age, and family history, it’s the most effective treatment for the hot flashes and night sweats, as well as genitourinary symptoms (e.g. increased need to pee). Again, both of those issues can mess with your sleep, promoting weight gain. Research also suggests HRT may help alleviate the menopause-related depressive symptoms that impact weight. 

And while HRT is not prescribed as a weight loss drug, research does suggest it holds a lot of promise for promoting a healthier body composition. It’s been associated with a decrease in total fat mass and that dangerous abdominal fat, and women who receive HRT often have improvements in insulin resistance and blood lipid levels such as cholesterol. HRT isn’t right for everyone—some women can’t take it, others prefer not to—but weight is just one more reason to consider it with a trained clinician guiding you.

More targeted weight loss drugs may make sense for some patients, depending on their weight and health risk factors. For example, Midi prescribes two relatively new medications, semaglutide and liraglutide (eg, Wegovy, Ozempic), that have shown good results and are FDA approved for people with a body mass index of 30 or above, with at least one health complication related to obesity. But the most important thing to know about these and other prescription medications is that they only work if patients also make needed lifestyle changes—namely, moving more and eating well. Those shifts support your weight goals, and  also strengthen every aspect of your wellbeing, from your long term health to your everyday mood. 

Ultimately, no one knows your body better than you do. Your Midi clinician can partner with you to come up with a sustainable, research-backed approach to weight that supports your long-term wellbeing—physical and emotional. 

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