Many women notice around age 45 that fat seems to accumulate at their waistline more easily. And no matter what they try, it will not go away. This is typically due to fluctuations in hormones. Many women are told by their gynocologists that this is “normal”, so they just accept this as a natural sign of aging.

Well, this isn’t entirely true.

There are some steps you can take to minimize these changes, and to assure that your symptoms do not get worse as you transition into full menopause.

First, it is helpful to understand what it causing this change, then you can work towards rebalancing your hormones with a personalized lifestyle medicine approach.

Belly fat, specifically visceral and abdominal fat, increases during menopause when changes in hormones begin to shift fat storage patterns. Abdominal fat is biochemically different and more metabolically active than subcutaenous fat stored in other areas of the body. Abdominal fat secretes more pro-inflammatory cytokines. This type of fat has been linked with insulin resistance, impaired glucose control, and overall higher cardiometabolic disease risk and breast cancer risk. This means that preventing or reversing belly fat is a critical step in managing a woman’s overall health, and not just her appearance.

It is important to understand that this is a multifaceted approach – encompassing an understanding of how changes in sex hormones interact with other endocrine systems such as the thyroid and adrenals. While these changes seem to come on suddenly and ‘out of nowhere’, the best time to implement a lifestyle medicine approach is in the years leading up to a woman’s final mentral cycle— rather than waiting until mentration has ceased.

Here are the ‘Top 5 Hormonal Changes’ associated with the transition into menopause:

1. Estrogen and estrogen dominance: Menopause is often thought of as the loss of estrogen. But the road from pre- to post-menopause is paved with many fluctuations in your estrogen levels. Often times, it is actually estrogen ‘dominance’ that occurs in perimenopause. During this time, we begin to get a decline in progesterone. This reduced progesterone coupled with high and/or erratic estrogen is usually what is contributing to the onset of these symptoms.

Estrogen does decline, but it is in relative ‘excess’ compared to the sudden drop in progesterone. Estrogen dominance at this age is slightly different than estrogen dominance in your reproductive years. Rather than having issues with too much estrogen production or poor estrogen clearance, it is more likely that this ‘dominance’ is related to this decline in progesterone.

This is why women of this age first start to notice hot flashes, missed periods, and changes in their sleep quality.

As the weight starts to accumulate, the problem gets worse. Estrogen also gets produced in adipose tissue. So while you think your estrogen is decreasing due to your ovaries making less of it, you are actually now making more estrogen simply due to the added adipose (fat) tissue accumulating in your abdomen. This can become a viscious cycle which becomes increasingly more challenging to break. Aromatase enzymes, responsible for converting androgens (testosterone) to estrogens, are more active in visceral adipose tissue of post-menopausal women. This is why it is so important to get ahead of this in these perimenopausal years, rather than waiting until you have officially reached menopause.

You have a few years to work towards regaining balance before it becomes increasingly more difficult to rebalance insulin, cortisol, and estrogens.

2. Cortisol: Dysregularion of your HPA axis may cause excess cortisol production, resulting in increased visceral fat and metabolic disturbances such as insulin resistance. HPA axis is the communication between our brain to our adrenals, known as hypothalmus-pituitary-adrenal-axis (HPA axis).

Increased production of cortisol is common in post-menopausal women. Studies have shown an increased conversion of cortisone (inactive) to cortisol (active), indicating that increased cortisol conversion could also be contributing to metabolic dysfunction in these women.

Declining estrogen levels during menopause can have an effect on cortisol formation, and conversion enzymes have been shown to be upregulated particularly in visceral fat in post-menopausal compared with pre-menopausal women. This higher cortisol then contributes to further cortisol-induced aromatase activity, causing even more converstion of your already low testosterone levels to even more estrogen.

As you can see, this becomes increasingly more frustrating— the system continues to feed forward and it becomes more difficult to break this cycle.

3. Insulin: Fat cells accumulating in the abdomen are associated with insulin resistance (ie: poor glucose/carbohydrate tolerance). This is because the pro-inflammatory cytokines that are produced by abdominal fat interfere with insulin signaling. This results in the cells becoming less responsive to insulin, creating a cycle where greater production of insulin is required to manage blood glucose levels.

Insulin is a “gatekeeper” of metabolism. Rising insulin levels can set off a chain reaction that ultimately leads to a cycle of weight and abdominal fat gain.

Insulin can also lower production of sex hormone binding globulin (SHBG). Lower SHBG results in more free androgens and estrogens in circulation, again resulting in more visceral fat mass gained due to excess estrogens.

4. Leptin: Elevated insulin levels then have an effect on Leptin. Leptin is the hormone that signals satiety. Elevated insulin levels eventually lead to elevated leptin. But rather than increasing satiety and causing us to eat less, consistently elevated leptin levels lead to a dysfunction of leptin receptors. This causes those receptors to stop sending signals to the brain to tell you to stop eating. This is known as leptin resistance, and can make the problem worse, since you will now have increased hunger signaling. This mechanism is complex, but it is important to note that it is often made worse with high intakes of refined carbohydrates.

Therfore, managing your blood glucose and not overeating refined carbohydrates can be helpful in the management of perimenopause symptoms.

5. Thyroid hormones: Thyroid hormones can also become unbalanced as we age. Thyroid hormone is the one which regulates how quickly we burn calories and maintains our metabolism. If your thyroid is underactive, you may develop symptoms such as muscle weakness, fatigue, constipation, dry skin, hair loss, and weight gain.

Therefore it can be helpful to have your thyroid assessed as part of your anual labwork. You may be in a “normal” range according to your doctor, but an “underactive” range compared to what is ‘normal’ for you. So looking for trends in your thyroid hormone production, as well as conversionof T 4 to active T3, is an important part of managing perimenopause symptoms.

Many conventional medicine providers will have you believe that once your hormones change with menopause, abdominal adiposity cannot be reversed. However this is not entirely true.

Addressing hormones such as cortisol and insulin, and even thyroid, can have an impact.

By making modest and sustainable changes to dietary intake, you can make a shift towards reducing these changes in your body composition. 

Consider factors that influence insulin levels, such as overeating, or high carbohydrate intake, and intake of quick burning refined carbohydrates which require greater insulin to manage spikes in glucose levels.

It can be helpful to remove inflammatory foods (alcohol, fried foods, refined grains, processed seed oils, or dairy). It can also help to remove your personal trigger foods, such as those that do not agree with you. This is where and IgA/IgG food-sensitivity panel can be helpful. Since inflammation can contribute to insulin resistance, we want to figure out which foods are inflammatory for you. Testing to look for heightened immune response to certain foods can be very helpful for you to figure out which foods may be contributing to your sudden weight gain.

Adding foods rich in antioxidants will also help to promote detoxification. Estrogen is cleared via the liver the same way that environmenal pollutants and medications are. Having good liver detoxification pathways helps to eliminate any excess estrogen production.

Try eliminating alcohol which can effect your sleep quality, and also further contribute to inflammation.

Choosing your macronutrients to match your activity, as well as timing your meals with your exercise and sleep schedule can also be helpful. There are many different time-restricted feeding (TRF) protocols available. This is a type of intermittent fasting in which food is consumed during a specified number of hours per day, so that your body can expend those calories during the other hours. This is a helpful weight loss strategy that does not deprive you of calories, but does promote improved use of stored fat for fuel.

It may be helpful to consult with a professional to determine if you would benefit from modifying your exercise routine.

For example:

-High Intensity Interval Training (HIIT) promotes increased caloric expenditure post-exercise.

-Low-intensity long-duration aerobic activity allows you to burn more stored body fat.

-Weight lifting requires usage of stored glucose, to help lower blood sugar; and also builds muscle to help increase your resting metabolism.

-Yoga or Qigong practice has been show to help lower morning waking cortisol levels.

These are all effective strategies in resetting your metabolism and providing a new stimulus for the body to continue changing. But it may be helpful to ask for guidance for the appropriate recommendations.

Menopause and Perimenopause also bring changes in sleep quality due to the decrease in Progesterone. This is a time when restorative sleep is very important. 

Many studies have repeatedly shown a correlation between sleep duration and the risk of obesity and central adiposity.

Those who sleep 7-8 hours per night have been shown to accumulate less visceral fat mass than those sleeping for ≤6 hours per night.

Sleep deprivation has been shown to result in changes in leptin, greater feelings of hunger, dietary indiscretion, reduced physical activity, and insulin resistance. Therefore sleep should be a priority while working towards managing perimemopasue symptoms.

There are many helpful strategies to help improve the number of hours of quality sleep you are able to obtain. It is best to manage this by adjusting the time you eat your last meal, or making a slight change in your macronutrients at dinner time, or even with some gentle supplementation, rather than depending on sleep aids.

Sleep aids often do not address the cause of the poor sleep quality, and only act to mask the problem rather than address the cause.