Guest Author - Denise Howard, M.D., M.P.H.

Weight gain is one of the most common concerns voiced by the women in my gynecology practice. They have noticed a gradual increase in their weight. They are frustrated by their inability to shed these extra pounds despite regular exercise and good eating habits.

It is true that the risk of becoming overweight is increased in menopausal women. This stage of a woman’s life is associated with a gain in total body fat and a change in the distribution of this adipose tissue. This change is from lower body predominance to an abdominal distribution. This change in distribution is due to a decrease in estrogen and progesterone production. These hormones promote fat distribution to the lower body while androgens promote an abdominal distribution. Once a woman reaches menopause there are less female hormones available to counteract the effect of the androgens.

Obesity is associated with an increased risk of developing heart disease, diabetes and hypertension. Abdominal fat distribution is more specifically associated with coronary heart disease and heart attacks. This increase in weight in menopausal women has serious potential health consequences.

This increase in body weight in menopausal women is primarily due to a decrease in physical activity, a decrease in their resting metabolic rate and an increase in caloric intake. The decrease in metabolic rate is a result of loss of muscle mass and a loss of the “luteal phase increase in energy expenditure”. Muscle loss is a known consequence of aging. This loss is certainly exacerbated by a sedentary life style. The luteal phase refers to the second half of the ovarian cycle after ovulation has occurred. This phase no longer occurs in menopausal women.

A weight control strategy in menopausal women should include aerobic activity, decreased caloric intake, and weight bearing exercises increase muscle mass. Starting and maintaining an exercise program requires motivation and commitment. Controlling caloric intake requires some knowledge of nutrition and will power. Incorporating a weight control plan into one’s daily life will require an execution strategy since sustaining such changes over a lifetime can be challenging. An overall lifestyle modification is however the desired result in order to prevent the development of chronic diseases and problems associated with age.