Navigating the Scales: Exploring Weight Gain During Menopause with a Functional Medicine Lens

Many women entering menopause experience an unwelcome companion: weight gain. While the bathroom scale might scream hormonal betrayal, the reality is more nuanced. As a functional medicine nutritional therapist, I believe in approaching weight gain during menopause with a holistic lens, delving beyond the simplistic "hormones make you fat" narrative.

While hormonal shifts undoubtedly play a role, understanding the intricate interplay between hormones, metabolism, gut health and lifestyle choices, empowers women to navigate this transition with grace and regain control of their well-being.

Menopause marks the cessation of menstruation, triggered by declining ovarian function. This translates to a significant drop in oestrogen and progesterone, steroidal hormones that orchestrate various bodily functions [1] such as regulating the development of the bones, brains and body systems. Progesterone also has a wonderful natural side effect when the body naturally makes it from around day of ovulation (typically day 14 of a woman’s menstrual cycle), and that is it has a natural calming, anti-anxiety effect (so this does not happen when a woman is on the combined contraceptive pill and progesterone production is compromised as ovulation is stopped).

Oestrogen, often hailed as the "feminine hormone," plays a crucial role in regulating metabolism, influencing fat distribution, and even muscle mass [2]. Its decline can lead to:

1. Shifted fat distribution: Oestrogen promotes fat storage in the hips and thighs. With its decrease, fat tends to accumulate more centrally around the abdomen, increasing health risks [3]. 
2. Decreased muscle mass: Oestrogen supports muscle building and maintenance. Reduced levels can lead to muscle loss, which contributes to a lower basal metabolic rate (BMR) – the number of calories your body burns at rest [4]. This translates to burning fewer calories even without changes in activity or diet.
3. Altered appetite regulation: Oestrogen and progesterone also influence hunger and satiety hormones, potentially leading to increased cravings and difficulty feeling full [5].

Are you reading this and perhaps wondering if you are not sure if you are in menopause or not? Many women find themselves navigating the uncertainties of perimenopause, the often-confusing years leading up to menopause. Irregular periods, hot flashes, mood swings, and sleep disturbances can leave them wondering: "Am I in menopause?" While the definitive diagnosis hinges on 12 consecutive months without a period, figuring out where you are on the journey can be tricky.

Functional testing offers valuable insights beyond simply confirming menopause. By analysing hormone levels like oestrogen, progesterone, and testosterone, a comprehensive panel can paint a clearer picture of hormonal imbalances that might be causing your symptoms. Additionally, tests like thyroid function panels and vitamin D levels can rule out other potential culprits.

Remember, menopause is a natural transition, not a disease, and understanding the root cause of your symptoms empowers you to seek personalised solutions, whether through lifestyle changes, dietary adjustments, or targeted interventions. So, if you're feeling lost in the perimenopausal fog, consider speaking to your healthcare provider about functional testing. It might just be the key to unlocking a smoother, more informed journey towards your next chapter.

It's important to remember that menopause coincides with other age-related changes that can impact weight. These include:

• Decreased physical activity: As we age, our activity levels often decline, further impacting calorie expenditure [6].
• Metabolic slowdown: Basal metabolic rate naturally decreases with age due to factors like reduced lean muscle mass [7]. (However this can be addressed somewhat with ensuring enough adequate protein is eaten daily).

While hormonal and age-related factors set the stage, lifestyle choices ultimately dictate weight gain or loss. These include:

• Diet: Processed foods, sugary drinks, and excessive portion sizes can contribute to weight gain regardless of hormonal status [8].
• Sleep: Poor sleep quality disrupts hormones like leptin and ghrelin, which regulate appetite and satiety, potentially leading to weight gain [9].
• Stress: Chronic stress elevates cortisol, a hormone that promotes fat storage, especially around the abdomen [10].

The functional medicine approach emphasises addressing the root causes of weight gain, not just treating symptoms. This involves:

• Personalised assessment: Understanding your unique hormonal profile, metabolic function, and lifestyle habits through questionnaires, lab tests, and detailed discussions. Remember: not all symptoms have the same cause.
• Dietary modifications: Focusing on whole, unprocessed foods, adequate protein intake, and healthy fats to support metabolism and satiety [11].
• Stress management: Implementing techniques like mindfulness meditation, yoga, or spending time in nature to reduce cortisol levels [12].
• Movement exploration: Finding enjoyable physical activities that fit your individual preferences and abilities, focusing on consistency over intensity.
• Sleep hygiene optimization: Establishing regular sleep patterns, creating a relaxing bedtime routine, and addressing underlying sleep disturbances.
• Nutritional supplementation: Considering targeted supplementation based on individual needs, such as vitamin D, magnesium, or fish oil.

Let’s for a moment hone in closely on the specifics of hormone balancing through food and what leading female health, Dr. Lara Briden, experts state is crucial for managing this transition. Dr. Briden emphasises the importance of specific nutrients for supporting healthy hormone levels. These include:

• Cruciferous vegetables: Rich in compounds that help the body eliminate excess estrogen, reducing hot flashes and other symptoms. Examples include broccoli, cauliflower, and Brussels sprouts.
• Healthy fats: Essential for hormone production and reducing inflammation. Opt for sources like avocado, olive oil, and nuts.
• Phytoestrogens: Plant-based compounds with weak estrogenic effects that can provide gentle support, found in flaxseeds, legumes, and tofu.
• Blood sugar balance: Maintaining steady blood sugar levels helps regulate mood swings and cravings, often attributed to hormonal fluctuations. Focus on whole grains, lean protein, and healthy fats.

Dr. Lara Briden also empahsises, as do I and other experienced health practitioners in this field, addressing gut health. This is because a health a healthy gut microbiome influences hormone metabolism and overall well-being. Incorporating fermented foods, probiotic supplements, and prebiotic-rich fibre can be beneficial.

Weight gain during menopause is a complex issue with various contributing factors, including oestrogen, testosterone and progesterone decline. Assessing all of these hormones, at the very least, can go a long way to finding out what could be causing your weight gain, especially if you are not sure if you are in menopause or perimenopause.

Blaming weight gain solely on hormones paints an incomplete picture however, even if you know you are in menopause. Taking a holistic approach through functional medicine empowers you to regain control and navigate this transition with confidence. Including addressing often simple but overlooked consequences of not sleeping enough each night and eating a poor diet as two examples, as both cause irregularities to occur with the hormones that tell you you are hungry or full.

Consulting a qualified healthcare professional, such as a functional medicine nutritional therapist, is crucial for personalised guidance and support and understanding functional blood tests surrounding hormonal status when it comes to navigating menopausal weight gain. Testing can be considered expensive in some instances, but the data derived from correct testing can save a lot of suffering for women who are still struggling to get adequate care from their doctors who are typically their first line of support.

Written by Amy Morris, BSc (Hons) Nutritional Therapy. Amy has been a nutritional therapist for 12 years, specialising in recent years as a functional medicine nutritional therapist. Women’s health, and pre-diabetes and type 2 diabetes prevention are Amy’s specialist areas. Diagnosed with a chronic condition called endometriosis at age 20, this is what motivated Amy to study nutrition. Amy has been in remission for 6 years now, attributing powerful nutrition, lifestyle and bio-identical hormone strategies she now shares with her clients.

Water for Health Ltd began trading in 2007 with the goal of positively affecting the lives of many. We still retain that mission because we believe that proper hydration and nutrition can make a massive difference to people’s health and quality of life. Click here to find out more.

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