Combatting weight gain after menopause

If you are newly entering menopause, you might be surprised to find yourself suddenly gaining weight—as if hot flashes, insomnia, and night sweats weren’t enough. You might turn to trusted diet and fitness routines that have always worked to slim you down, only to find that the scale isn’t budging in the slightest. And when you visit your gynecologist and share your concerns, you are given some generic advice about watching your diet.

This is sorely insufficient for several reasons, one of which is that you are not being told why the “change of life” means additional pounds for so many women. Menopausal weight gain is not only a nuisance; it can also have serious long-term effects on your health. A weighty issue, indeed. You deserve to know this so you can take proactive steps to stay healthy—but scores of women are not given this information by their doctors. Part of my mission as a doctor in the media spotlight is to reverse this trend.

Simply put, estrogen loss is to blame for the bulge. Estrogen is the primary female hormone and when it begins to tank between your mid 40s to mid 50s, the way you burn and store fat also changes. Menopausal weight gain tends to accumulate around the middle, giving women that apple shape we detest so much.

But belly fat isn’t just unattractive; it’s a key risk factor for serious health problems such as insulin resistance, Type 2 diabetes, heart attack, stroke and cancer. In one recent study, a larger waist circumference was directly associated with a rise in the incidence of breast cancer in postmenopausal women. Research consistently shows that abdominal, or visceral fat actually pumps out hormones and inflammatory chemicals that profoundly influence our health—so it may be more accurate to think of that muffin top or spare tire as an extra endocrine gland! And you thought your thighs were the problem.

While it’s true that diet and exercise play a role here, they are not enough to counteract the estrogen deficiency that can cause more fat accumulation during menopause. The good news is that there is a safe, effective option that can help you balance out your hormones and maintain a healthy weight, but you may not have heard about it from your doctor or your girlfriends. It’s called bioidentical hormone replacement therapy (HRT). There is a ton of controversy over all forms of hormone therapy—ranging from concerns about breast cancer to the common misconception that it induces—rather than prevents weight gain.

Part of why bioidentical HRT gets a bad rap—and so many women miss out on the relief it provides—is because conventional HRT, in which synthetic hormones are used, was shown to increase risk of breast cancer, heart attack and other problems for women in a 2002 landmark study called The Women’s Health Initiative. As a result, many doctors were too quick to assume that all hormone replacement therapy is dangerous. But it just isn’t so. These women were taking synthetic, non-bioidentical hormones that are different from what the body produces naturally. Synthetic hormones pose higher risks because they aren’t the same as what your body produces—so they have unnatural consequences.

Bioidentical hormone therapy, by contrast, uses more natural hormones that biologically mirror those made by your ovaries. Research shows that the specific combination of bioidentical estradiol and progesterone improves bone strength, reduces weight, and improves cholesterol levels in women. And in case all the hype about hormone replacement and breast cancer has scared you, rest assured: A very large study in France showed that there was no increased risk of breast cancer among women taking a combination of estrogen and progesterone. Progestins, however, are the synthetic of progesterone and have been shown to increase breast cancer risk—so you’ll want to avoid those.

While the goal of bioidentical HRT is to get your estrogen levels back up, which will help ward off the pounds, keep your bones strong and your heart healthy, it cannot be safely pursued unless progesterone is also prescribed. When speaking with your gynecologist, I recommend that you ask for estradiol, the most commonly prescribed bioidentical estrogen, through the skin, as well as micronized progesterone, a form that is the same as what your body produces naturally. These medications are available by prescription from your doctor. For a more personalized hormone therapy approach, you may consider seeing a hormone specialist with additional training in bioidentical hormone replacement therapy.