How to manage menopause symptoms like weight gain

St. Joseph's/Candler Urogynecologist Dr. Elizabeth Dotson offers advice to say comfortable and confident when dealing with the side effects of menopause

It’s not your fault.

You’ve stayed consistent with your activity levels and nutrition. Your doctor gives you a clean bill of health every year. In fact, you pride yourself on sticking to your routine.

But somehow, your favorite jeans—the ones that fit perfectly a year ago—are tight around the middle. And that one dress doesn’t complement your silhouette the way it used to.

So what changed? Your body did, and it’s completely natural. The extra pounds—just like the hot flashes and restless nights—are a very common effect of menopause.

“Around 70 percent of women will experience some form of weight gain through the transition of perimenopause to menopause,” explains urogynecologist Elizabeth H. Dotson, DO, of SJ/C Physician Network – Gynecology.

Perimenopause is the beginning of the gradual end of a woman’s reproductive years, when hormone levels begin to fluctuate. This can start a few years, or sometimes even a decade, before menopause.

“The average age of menopause, which is defined as 12 months without menstruation, is 52,” Dr. Dotson says. “But this can vary based on your family and genetics. We tell women that you’re most likely to go through menopause around the same age that your mother and grandmother did.”

This Is Normal

During perimenopause, the production of estrogen and progesterone begins to decline. While progesterone declines steadily, estrogen can fluctuate erratically, leading to symptoms such as sensations of intense heat, known as hot flashes, and night sweats. Sleep disruption, sudden mood shifts, and vaginal dryness are also common symptoms.

As a urogynecologist, Dr. Dotson notes that for some women, menopause causes urinary urgency, or feeling the need to go to the bathroom frequently, especially at night. This can exacerbate sleep difficulties.

Treatment options for these symptoms may include hormone replacement therapy, through which estrogen (and often progesterone) is replaced in the body. There are also non-hormonal medications and lifestyle interventions that can help provide relief. Dr. Dotson will discuss all options with her patients and develop an individualized treatment approach.

Declining estrogen can also lead to a slowing metabolism and a loss of lean muscle mass. The loss of muscle, which burns more calories than fat, is a factor in weight gain during perimenopause.

“I tell my patients, ‘this is normal; it isn’t something you’ve caused,’” Dr. Dotson says. “Many women who are going through menopause come into the office frustrated. They’re eating the same number of calories and doing the same amount of exercise, but they are still gaining weight.”

What You Can Do

Understanding the natural process of menopause can help alleviate some of the frustration and anxiety surrounding the bodily changes that are beyond your control. But there are also proactive steps that patients can take to manage their symptoms.

“I recommend that women focus on things that can increase lean muscle mass, such as incorporating weight lifting and resistance training into their fitness routine,” Dr. Dotson says. “I also ask women to focus on their protein intake and to see if they can get more of their calories from protein sources.”

Dr. Dotson says vegetarians can do this successfully as well, with foods such as lentils, beans, tofu and peanuts.

“Generally, I ask my patients to target around one to two grams of protein per kilogram of body weight,” she says. “That typically means including a good source of protein at every meal.”

Menopause also can affect how a woman dresses, and not only because of weight gain. Hot flashes, for example, may create the need for breathable fabrics, such as cotton and linen, along with the importance of wearing layers that can be removed or added easily. Dr. Dotson sees this as an opportunity for women to find clothing that helps them feel both comfortable and confident.

“I remind my patients that it’s not about the size,” she says. “Because we already know that what one brand or store calls a size 6 could be much different from what another brand says is size 6. So switch your focus off of size and look for designs that perhaps accentuate the waist, for example. Don’t worry so much about how your body composition may bring you up a size. Instead, find joy in the clothing that fits and flatters you.”