Menopause, Menopause Hormone Therapy, Metabolism, and Weight Gain/Loss
Untangling the Connections
I’ve always wanted to bring one of my live talks to this platform, but I am not sure many people want to sit through a video of a 40-minute presentation (although I could be wrong, and if that does sound appealing, or maybe in smaller chunks, let me know, and I can start putting up videos). So, I thought, why not bring you a write-up of a portion of a talk?
I’ve been working on one called Menopause Myths and the Media: a Practitioner’s Guide to Credible Care for a group of OB/GYNS. I am focusing on three aspects of menopause that are frequent targets for misinformation: testosterone, supplements, and weight gain/loss. These are three of the most common topics I am asked about in the office and online, and I suspect that is the experiences of many other OB/GYNS. I have also noticed that when I write posts or Instagram videos on these subjects, they are shared more widely and attract far more attention. And so these are important topics to discuss so people can be armed in advance with facts.
If you’ve read my recent piece on testosterone (here), you already know about 80% of what I plan to say in the talk. (I have also promised a post on testosterone for libido, so watch this space). If you have read some of the posts in my supplement section here, you know most of what I plan to discuss.
Which brings us to weight gain/loss. Claiming that menopause hormone therapy, usually “bioidentical hormones” or hormone pellets, can be valuable tools for weight loss is a pretty standard gift. While preparing my talk, I quickly found several egregious examples from telehealth companies, pellet peddlers, and influencers with large social media footprints online. One of the big issues is this disinformation is often presented in a classic bullshit sandwich of two truths and a lie, where the lie benefits from being presented next to the truths. When I was researching the talk, I was especially irritated by one of the telehealth websites that claimed menopause hormone therapy helps with weight loss. Yet, the reference used, an excellent review article from 2022, mentioned many approaches for weight loss but did not mention hormone therapy once. I really, really, really hate it when someone abuses references this way because people see the reference and think, “Oh, this must be good!“ Especially if it’s in a respected journal, like Menopause, as it was in this case.
Before We Begin
I know that reading about weight isn’t for everyone, so if it’s triggering for you, feel free to ignore or bookmark this for later when it’s a better time.
Also, there is no fault to ascribe here. When I quote a study that describes weight gain over a period of time or what percentage of women are meeting the daily exercise requirement, this is just data and is not a value judgment. To make an informed decision, knowing what the science shows is essential.
Weight Gain and Age
In Western Societies, aging is associated with weight gain for both women and men. Here’s the breakdown from one study that looked at 10-year weight gain for both women and men:
Between ages 40-49, a woman will gain, on average, 7.7 kg (17 lb) over the previous 10 years and a man 5 kg (11 lb).
Between the ages of 50-59, women will gain on average 5.9 kg (13 lb) over the previous 10 years, and for men, 2.7 kg (6 lb).
These are averages, so obviously, some people will gain more and some less.
Why this happens isn’t well known, but a significant factor is decreased energy expenditure.
What is fascinating is that this weight gain happens even to those who are physically very active. For example, among male runners who run more than 24 km/week each year, a man must increase his runs by 2.24 km/wk (or reduce calorie intake accordingly) to prevent age-related weight gain. I still remember reading that article when it came out in 1997 and feeling utterly exhausted.
Even though men gain weight in middle age, just like women, we hear a lot more about women because we’re the ones who are judged most harshly by a patriarchal society. A woman aged 45 or 50 is often compared with her 20-year-old self or a 20-year-old actor or model, whereas men are not held to the same impossible standard. Have you ever heard that George Clooney (insert the name of any attractive male star over age 50) looks good for his age? Instead, he’s a silver fox and is getting better every year, and People Magazine sure doesn’t put his “age-defying” rituals on the cover.
Weight Gain and Menopause
How much weight gain is aging, and how much is menopause?