Weight gain is a typical issue for women who are ageing. About two-thirds of women aged 40–59 and three-quarters of women who are older than 60 years old are overweight (body mass index higher than 25 kg/m2) within the United States.
Ekta Kapoor, M.B.B.S., a consultant for the Women’s Health Clinic, General Internal Medicine, Endocrinology, Diabetes Metabolism, and Nutrition on Mayo Clinic’s campus situated in Rochester, Minnesota, says: “Midlife women may gain up to 0.7 kg a year and experience a change in the distribution of body fat, from the premenopausal pattern (greater low-body fat) towards the postmenopausal android patterns (greater higher-body fat).
“Weight gain and body fat distribution changes are responsible, at least in part, for the greater risk of cardiovascular disease in postmenopausal women in comparison with younger women with intact ovarian function. Cardiovascular disease is the leading cause of mortality in postmenopausal women, and the importance of risk factor modification cannot overemphasised.”
When women are ask specifically about the effects hormone treatment can have on weight gain in menopausal women, it is more complex due to the complicated interaction of their symptoms and age-related changes.
There has been some debate over the role of menopausal ageing and ageing in weight gain among midlife women. Stephanie S. Faubion, M.D., of the Women’s Health Clinic and General Internal Medicine at Mayo Clinic in Rochester, Minnesota, says: “The current literature supports the theory that ageing and menopausal changes, in and of themselves, will not lead to significant weight increases. But it does cause changes in body fat distribution, a preference for the deposition of fat in the central region, and an increased incidence of abdominal weight. This is despite adjustments to ageing, body fat, and decreased exercise level, and all of these factors independently enhance visceral fat accumulation.”
Weight gain due to ageing is common, occurs across both genders, and is usually attribute to the decline of lean mass as well as physical activity levels (which could bvery subtle). The result is an increase in active and resting energy expenditure. So, unless there are modifications to the diet or physical activities, the ageing process may result in weight gain.
Alice Y. Chang, M.D., an expert in endocrinology, diabetes, metabolism, and nutrition at the Mayo Clinic in Rochester, Minnesota Notes: “Midlife women during the menopausal transition may experience distinct issues that lead to weight gain, which include vasomotor symptoms, depression, mood disorders, muscle and joint pains, as well as sleep disorders.
“Perimenopausal women tend to underestimate the effect of vasomotor symptoms on many areas of their lives.” For instance, those with extreme vasomotor issues, particularly at night, may not know how severely fatigue affects their ability to stay physically active. The women of the world are particularly susceptible to developing mood disorders during the perimenopausal stage, and this can hinder their motivation to make lifestyle changes that are often necessary to stop weight gain.
“On the other hand, women who are overweight or obese tend to have worse hot flashes than their normal-weight counterparts, and weight loss improves vasomotor symptoms. Resistance exercise training, which can prevent muscle loss and decrease in energy expenditure relate to ageing in general, is not only shown to effective in perimenopausal women but can also help preserve bone mass during a period of accelerate bone loss and improve musculoskeletal symptoms.”
Dr. Faubion says: “Menopausal hormone therapy (MHT) is the most effective treatment option for vasomotor issues in women. It should contemplated in newly postmenopausal (less than 10 years have passed since the last menstrual cycle) women suffering from vasomotor symptoms ranging from moderate to severe, even if there are no contraindications to using estrogen in a systematic manner.
“In young, recently postmenopausal women without pre-existing cardiovascular disease, low-dose transdermal estradiol does not increase the risk of cardiovascular disease and may even be protective. Similarly, the risk of breast cancer does not seem to increased with oestrogen monotherapy but may higher in regimens using oestrogen with synthetic progestogens. However, the current MHT regimens most commonly use micronized progesterone, which does not seem to associate with the same risk of breast cancer. In addition to alleviating vasomotor symptoms, MHT also improves sleep and mood for most women, although it is not recommend as primary therapy for sleep or mood disturbances.”
While MHT isn’t responsible for weight changes in its own right, it can lead to a positive distribution of your body’s fat. The doctor, Kapoor, explains: “Women with MHT are more likely to have an increased distribution of central fat towards the peripheral sites. However, MHT usage is not recommend for the prevention or control of weight gain. Women who use MHT to treat vasomotor issues should, however, be advised about its positive effects on the distribution of body fat.
“In addition to standard recommendations regarding a hypocaloric diet (500–750 kcal deficit per day), increased intake of whole grains, fruits, and vegetables, use of meal replacements, and regular exercise (150–175 minutes per week), patients should offered psychological support geared towards identification of barriers to change, monitoring behaviours, problem-solving, strategizing, and reinforcement. This support can be provided by a psychologist in individual or group settings, depending upon the patient’s needs and preferences.”
Dr. Kapoor continues: “Weight-loss medication should considered in the right circumstances (BMI greater than 30 kg/m2 or 27 kg/m2 in cases of problems). However, it is crucial to aware of the potential risks associated with the use of medications, such as costs, adverse effects, moderate effectiveness (5–10 percent weight reduction), and the possibility of weight loss despite continued usage.
“Finally, bariatric surgery (for BMI greater than 40 kg/m2 or greater than 35 kg/m2 with complications) and endoscopic bariatric therapy (for BMI between 30 and 40 kg/m2) should considered when appropriate. Endoscopic bariatric therapies comprise the fastest-growing treatment for obesity and offer promise to bridge medical and surgical therapy. However, the procedures continue to evolve and are not routinely cover by insurance. There is also the potential for weight regain after procedures such as intragastric balloon placement.”
When women are ask about the impact of MHT on their weight maintenance and weight loss objectives, MHT cannot recommended as a treatment option to aid in losing weight. A thorough individual evaluation should conducted to determine if MHT has significant effects on symptoms associated with menopausal changes and impacts overall health.
Dr. Kapoor concludes: “Weight management for women in midlife requires an in-depth understanding of menopausal changes, symptoms, or both, in order to understand and eliminate any obstacles in the implementation of a behavioural programme to reduce weight. The ideal approach is the multidisciplinary method, which includes a variety of experts, such as psychiatrists, psychologists for behavioural issues, dietitians, exercise specialists, and life coaches. In addition to suggesting lifestyle modifications, they must carefully assess patients for menopausal-related symptoms like hot flashes, sleep problems, and mood issues and then appropriately treat the symptoms. Screening helps ensure that the behavioural intervention is effective.