This week (May 12-18) marks Women’s Health Week which aims to highlight women’s health issues and encourage women of all ages to prioritize their physical, mental, and emotional well-being. As an organization solely focused supporting & guiding women, I wanted to highlight one of the most frequent concerns & frustrations I hear from masters athlete clients: body composition.

Unfortunately, weight gain, and specifically fat gain, can occur abruptly during the menopause transition or perimenopause, which is typically the 5-10 years before the final menstrual period. These changes can be very concerning & distressing for active women, especially when paired with a myriad of other symptoms that can come along with the menopause transition. As a Menopause Health & Fitness Specialist, a graduate of Dr. Stacy Sims Menopause course and perimenopausal athlete, I wanted to share some of what I’ve learned about why we experience body composition changes in menopause and what you can do to address these changes.

The Role of Estrogen in Body Composition

Despite being labeled a sex hormone, estrogen plays an important role in many systems in the body exerting impacts on the brain, central nervous system, cardiovascular system, the liver, muscles, tendons & ligaments, and even our metabolism, in addition to its role in the reproductive system and breast tissue. Specific to metabolism, estrogen was described in an early research paper as a “master regulator of the metabolic system” (1) and plays a key role in regulating metabolism, muscle mass, and several other physiological processes related to body composition. But first, let’s cover the context of what is happening with estrogen during the transition and how these changes impact our body composition.

As we enter the menopause transition (~5-10 years before our final menstrual period), estrogen levels begin to fluctuate and eventually decline as we enter menopause, depicted in the chart below (2).   

Changes in the pattern and absolute level of estrogen can contribute to changes to our body composition – specifically lean mass, fat mass and bone mass. To help set the context of body composition changes that can occur during the menopause transition, attached is summary of a longitudinal analysis completed as part of the Study of Women’s Health Across the Nation (SWAN). The analysis examined weight & body composition changes before, during and after menopause for 1,246 women. The analysis found (3):

• Weight increases with age but does not appear to accelerate during the menopause transition (MT). Though, interestingly, the trend in weight gain slows & stabilizes approximately 3-4 years after the final menstrual period (FMP).  The bold, blue dashed line in the chart below represents the average trend 10 years prior through 10 years post the FMP.

• There are significant changes to body composition during the MT: lean mass loss and fat mass gain accelerates during the MT by a “2-4 fold increase”, but also slows and stabilizes post-menopause. The bold, blue dashed line in the chart below represents the average trend with the red dashed section represents a change to the average trend.

Before I cover the some of the underlying changes in our physiology driving these body composition changes, I wanted to share my observations & thoughts on this study.

• Interestingly, the researchers in this study observed that the net effect (i.e. lean mass loss relative to body fat gain) was positive, meaning on average, there is a net gain of fat. However, the gain was not significant enough at 80 grams or ~1/4 lb to impact the overall trend in weight. Thus, the conclusion from the analysis was that the MT doesn’t accelerate weight gain (despite stabilizing post-menopause…) which became a key, often shared headline from the study. However, missing from this analysis, though highlighted briefly in the paper, is that bone loss can also accelerate during the MT, potentially offsetting any changes in weight.
• Studies like this one are based on averages so it’s important to zoom in on individuals (like you & me) who can fall above, on, or below the averages and whose experience may be vastly different than the conclusions presented in this study. And IMHO, it’s not helpful or insightful to have well-respected, credentialed professionals in the menopause space make generalized statements based on this data eg “women don’t gain weight in menopause” when instead, they could be using the data from this study to advocate for improved access to better evaluation of body composition changes, and specifically changes in bone mass via DEXA scans before, during and after menopause – that are specific to each individual.
• Be aware that weighing yourself on a scale may hide some of these changes, particularly with respect to changes in bone mass, even if you have a body composition scale. For example, 1 in 2 women over the age of 50 have osteopenia, the precursor to osteoporosis (4) so waiting until age 65 to evaluate your bone health via a DEXA scan may be too late to take action. This is a key reason why we partner with DEXAFIT to provide our clients discounted access to these important, actionable and data-driven insights on their body composition.

Estrogen-Driven Changes Impacting Body Composition

Next, let’s dive into some of the specific changes in our physiology due to the decline in estrogen. Warning: this part is a bit scienc-ey but I hope you will read it through to get an appreciation for some of the drivers of body composition changes that occur during the menopause transition. They include:

• Insulin Sensitivity: Estrogen plays a role in maintaining insulin sensitivity. Lower estrogen levels can lead to increased insulin resistance, which can directly contribute to accumulation of fat, particularly visceral abdominal fat and can result in weight gain (5, 6, 7).
• Increased Anabolic Resistance: Estrogen enhances the anabolic response to protein intake and resistance training, aiding muscle protein synthesis and muscle repair. Reduced estrogen levels can diminish these anabolic effects, making it more challenging to build and maintain muscle mass (8).
• Decreased Muscle Mass, Quality & Strength: Estrogen helps preserve muscle mass. As its levels drop, women may experience sarcopenia, the loss of muscle mass and strength and increased muscle fatigue (7) along with changes in muscle quality and net protein balance (9).
• Declines in Metabolic Rate & Fat Oxidation: Estrogen influences metabolic rate and whole body fat oxidation. A decline in estrogen can lead to a slower metabolism and reduced ability to oxidize fat, making it easier to gain weight even without changes in diet or activity levels (10). Estrogen also plays a crucial role in regulating energy homeostasis and metabolic health, affecting the brain’s ability to control energy balance and body weight (11, 12, 13, 14).  

Addressing Body Composition Changes

While these changes are disconcerting, they are not inevitable! There are several strategies to help you address body composition changes during menopause:

• Eat enough for what you are doing! Restricting energy intake and/or increasing training is a common response to weight gain. However, this strategy is often ineffective and can often make matters worse by putting you at risk for additional health & performance consequences e.g. Low Energy Availability/Relative Energy Deficiency in Sport. Research suggests targeting 45 kcals/Fat Free Mass^kg/day for optimal health & performance (15).
• Ensure adequate protein intake. Higher protein intakes help to offset anabolic resistance & increase protein balance which is crucial to maintaining muscle mass. Target 1.8g – 2.2g/kg/day of protein daily (i.e. 0.8g – 1g per pound of body weight), evenly consumed throughout the day and with a big dose asap after training (15).
• Eat those carbs! Do not avoid carbohydrates as your body needs them for energy, health & performance! But it can be helpful to be more attentive to carbohydrate composition (simple vs. complex) and timing of intake relative to exercise. (16)
• Lift heavy & incorporate high intensity interval training. Incorporate resistance training (2-3x a week) along with sprint interval training to help offset estrogen related changes in insulin sensitivity, anabolic resistance, changes in muscle strength, size & quality and to help boost metabolic rate (16, 17).

While menopause is inevitable, the accompanying body composition changes don’t have to be! Not sure where to start? Let us help you navigate menopause with confidence with our new 60′ Menopause Consultation. Reach out today to schedule a complimentary information call to learn more.

References

1. Rettberg, J. R., Yao, J., & Brinton, R. D. (2014). Estrogen: a master regulator of bioenergetic systems in the brain and body. Frontiers in Neuroendocrinology, 35(1), 8-30. https://doi.org/10.1016/j.yfrne.2013.08.001

2. Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol. 2019 Jan 15;9:1834. doi: 10.3389/fphys.2018.01834. PMID: 30697162; PMCID: PMC6341375.

3. Greendale, G. A., Sternfeld, B., Huang, M., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein, J. S., Jiang, S.-F., & Karlamangla, A. S. (2019a). Changes in body composition and weight during the Menopause Transition. JCI Insight, 4(5). https://doi.org/10.1172/jci.insight.124865

4. Johns Hopkins Arthritis Center. (2019). Osteoporosis information. Retrieved from: https://www.hopkinsarthritis.org/arthritis-info/osteoporosis-info

5. Santoro, N., Sutton-Tyrrell, K., Lasley, B. L., et al. (2018). The Study of Women’s Health Across the Nation (SWAN): overview of cohort development and descriptive findings. Menopause, 19(4), 393-402. https://doi.org/10.1097/gme.0b013e31824d58ff

6. Mahboobifard, F., Safaei, M., Moradi, S., Askari, G., & Miraghajani, M. (2022). The effects of isoflavones on glycemic control, serum lipids, and biomarkers of oxidative stress and inflammation in postmenopausal women: a systematic review and meta-analysis. Journal of Diabetes Research, 2022, 1-15. https://doi.org/10.1155/2022/1546240

7. De Paoli, M., Zakharia, A., & Werstuck, G. H. (2021). The Role of Estrogen in Insulin Resistance: A Review of Clinical and Preclinical Data. The American Journal of Pathology, 191(9), 1490–1498. https://doi.org/10.1016/j.ajpath.2021.05.011

8. Collins, B. C., Mader, T. L., Cormier, Z. J., et al. (2019). Decreased anabolic signaling response to resistance exercise in early postmenopausal women. Medicine & Science in Sports & Exercise, 51(3), 409-417. https://doi.org/10.1249/MSS.0000000000001790

9. Smith-Ryan, A., Hirsch, K., Cabre, H., Gould, L., Gordon, A.,; Ferrando, A. Menopause Transition: A Cross-Sectional Evaluation on Muscle Size and Quality. Medicine & Science in Sports & Exercise 55(7):p 1258-1264, July 2023. | DOI: 10.1249/MSS.0000000000003150

10. Carr, M. C. (2003). The emergence of the metabolic syndrome with menopause. The Journal of Clinical Endocrinology & Metabolism, 88(6), 2404-2411. https://doi.org/10.1210/jc.2003-030242

11. Brown, L. M., & Clegg, D. J. (2010). Central effects of estradiol in the regulation of food intake, body weight, and adiposity. The Journal of Clinical Endocrinology & Metabolism, 95(9), 4692-4701. https://doi.org/10.1210/jc.2010-0907

12. Hevener, A. L., Clegg, D. J., & Mauvais-Jarvis, F. (2018). Impaired estrogen receptor action in the pathogenesis of the metabolic syndrome. Molecular and Cellular Endocrinology, 471, 22-35. https://doi.org/10.1016/j.mce.2017.04.017

13. Monferrer-Marín, J., Roldán, A., Monteagudo, P. et al. Impact of Ageing on Female Metabolic Flexibility: A Cross-Sectional Pilot Study in over-60 Active Women. Sports Med – Open 8, 97 (2022). https://doi.org/10.1186/s40798-022-00487-y

14. Tao Z, Cheng Z. Hormonal regulation of metabolism-recent lessons learned from insulin and estrogen. Clin Sci (Lond). 2023 Mar 31;137(6):415-434. doi: 10.1042/CS20210519. PMID: 36942499; PMCID: PMC10031253.

15. Sims ST, Kerksick CM, Smith-Ryan AE, Janse de Jonge XAK, Hirsch KR, Arent SM, Hewlings SJ, Kleiner SM, Bustillo E, Tartar JL, Starratt VG, Kreider RB, Greenwalt C, Rentería LI, Ormsbee MJ, VanDusseldorp TA, Campbell BI, Kalman DS, Antonio J. International society of sports nutrition position stand: nutritional concerns of the female athlete. J Int Soc Sports Nutr. 2023 Dec;20(1):2204066. doi: 10.1080/15502783.2023.2204066. PMID: 37221858; PMCID: PMC10210857.

16. Sims, S. T., & Yeager, S. (2022). Next Level. Rodale Books.

17. Sipilä, S., Taaffe, D. R., Cheng, S., Puolakka, J., Toivanen, J., & Suominen, H. (2013). Effects of hormone replacement therapy and high-impact physical exercise on skeletal muscle in post-menopausal women: a randomized placebo-controlled study. Clinical Science, 101(2), 147-157. https://doi.org/10.1042/cs20020311