Post-Menopausal Females and Recalcitrant Weight Gain

 

 

“Dear Doctor, I am 55 years old. I have been watching what I eat. I work out with a trainer. I don’t eat any carbs. I fast.  I avoid alcohol. WHY I AM STILL NOT LOSING ANY WEIGHT.  Is there anything that I can do to save my body and my sanity?”

Because we get so many similar questions to the one above, we went ahead and put this post together to help you understand a little more about your body and why it is so hard for post-menopausal women to lose weight and retain the figure they once owned.  The hormonal milieu is very complex and hormones will interplay on each other’s biological function. Some of the most important hormones involved in weight maintenance are the sex hormones testosterone, estrogen, and progesterone.  Read below to see why these particular hormones are vital in maintaining a healthy weight. 

Testosterone

 As women age past the age of 50, ovarian function begins to decline. As such production of essential sex hormones such as testosterone, estrogen, and progesterone fall. Women start to feel their age. Testosterone serves a number of functions in the body of females including maintenance of bone density and maintenance of skeletal muscle mass.   In postmenopausal females, production of testosterone declines significantly.  Without testosterone women lose skeletal muscle mass and maintenance of muscle declines abruptly.  An article by Van Geel in the European Journal of Endocrinology found a direct correlation of the loss of lean body skeletal mass and loss of BMD, bone mineral density, to a decline in testosterone and estrogen in post-menopausal women (1).   We know that muscle is more metabolically active than fat.  The basal metabolic rate of postmenopausal women decline greatly because of the loss of skeletal muscle mass closely related to the decline in testosterone following menopause. Without sufficient muscle mass, many women experience weight gain in their postmenopausal years despite eating their typical regular diet.  Hormone optimization specifically testosterone supplementation along with resistance training can restore postmenopausal females’ skeletal muscle mass and, thus, improve their basal metabolic rate.

Estrogen

Another vital hormone that declines in the postmenopausal years is estrogen. Estrogen is a vital hormone for female thinking and cognition. The hormone also maintains skin and helps prevent cardiovascular disease. With declining ovarian function, estrogen production declines alongside the other sex hormones.  The body still has heavy requirements for estrogen for skin health, bone health and brain function. As such, fat cells, which contain aromatase enzymes, convert other steroid hormones and precursor molecules into estrogen to supply the body with vital estrogen.  These fat cells can increase in size thus contributing to the weight gain that many postmenopausal women experience.  Providers will frequently check FSH levels in order to determine if the body is asking for more estrogen. Elevated FSH levels indicate estrogen deficiency.  The lowest effective dose of estrogen should be used. Estrogen supplementation should only be undertaken after talking to a bioidentical specialist. Women who take synthetic estrogen have experienced a number of unwanted side effects of synthetic estrogens including pre-cancerous cervical cells and breast fibroids.  Unopposed estrogen is also something that should be avoided.  It is very important to balance the effects of estrogen with progesterone. 

Progesterone

Progesterone is the third hormone that we link to ovarian function or dysfunction in the case of postmenopausal females. Progesterone is known as the calm, cool, collected hormone. It serves to balance the estrogen in our body.  Progesterone plays a vital role in our brain function and restoration.  With declining progesterone levels in postmenopausal women, we see significant alterations in sleep function. Postmenopausal women frequently complain that their sleep is very light and they don’t get deep restful sleep.  They feel tired in the morning.  They wake several times in the night and find it very difficult to get back to sleep.  Progesterone helps women get deep restful REM sleep. Without REM sleep, postmenopausal women experience declines in the secretion of vital hormone that are specifically released during REM sleep like leptin and growth hormone. Leptin is a satiety hormone.  Growth hormone is an essential restorative hormone that helps repair the body and maintain muscle mass. Without restful sleep, postmenopausal women complain of increased hunger because of increases in levels of ghrelin, the hunger hormone.  Increase hunger can lead to increased eating and further weight gains for the postmenopausal woman. 

 

–If you are doing all the right things, but still find that you can’t get the weight off. It’s time to talk to a specialist about your hormones. You want to avoid synthetic hormones because of the adverse biological effects. Bioidentical hormones can get your feeling better and get you back to the weight that you once enjoyed. 

 

1.  Van Geel TA, Geusens PP, Winkens B, Sels JP, Dinant GJ. Measures of bioavailable serum testosterone and estradiol and their relationships with muscle mass, muscle strength and bone mineral density in postmenopausal women: a cross-sectional study. Eur J Endocrinol. 2009 Apr;160(4):681-7. doi: 10.1530/EJE-08-0702. Epub 2009 Jan 27. PMID: 19174532.