This excellent read by the bullet proof team explains why women often struggle to maintain their weight during menopause and some really practical ways to manage this. Menopause is a process and the bodies needs change throughout and so should your approach to staying healthy and energised.
People like to say that 50 is the new 40. But if you’ve recently entered menopause, you might not be feeling as sprightly as you once did. Along with the hot flashes and dry skin, you’re struggling to keep the weight off. You’re doing everything the same — eating a high-fat, low-carb diet and working out like you always have. And yet the number on the scale keeps climbing. Why is that? Find out why weight is an issue for women past 50, and how you can manage your hormones and your diet to stay at a healthy weight during this new phase of your life.
What is menopause?
You’ve entered menopause when you haven’t had a period for an entire year, or 12 consecutive months, because your ovaries no longer release eggs. Menopause is also the result of oophorectomy (when your ovaries are removed). If you have a hysterectomy, and your ovaries are removed at the same time, you’ll also enter menopause.
On average, American women start menopause between 48 and 51 years of age.
But before you enter menopause, you go through perimenopause. More on perimenopause later. Both menopause and perimenopause can be a really tough time for a lot of women. In the UK, the NHS (National Health Service) has created a whole new institute to address perimenopausal and menopausal health issues, because they recognize this time of life can bring significant health challenges for many women.
Perimenopause vs. menopause
Perimenopause is different from menopause for two reasons:
- You still have your periods, and therefore, you can still get pregnant.
- Your hormones are fluctuating — sometimes wildly.
During this time your periods may be regular, or irregular. Perimenopause lasts anywhere between 3 and 15 years. Seven to eight years is the average in North America. The average age of onset is 45, but I’ve had clients as young as 38 experiencing perimenopausal symptoms.
What are the symptoms of perimenopause and menopause?
During perimenopause, your body starts to produce less of the hormones estrogen, progesterone, and testosterone. It also starts producing higher levels of the reproductive hormones FSH and LH. These hormonal changes can cause:
- Hot flashes (a sudden feeling of intense heat)
- Weight gain
- Dry skin
- Night sweats
- Vaginal dryness (due to decreased local estrogen)
- Lower sex drive (primarily due to lower testosterone)
- Hair loss
- Mood swings
- Smaller, more tender breasts
Once you are fully in menopause, most of these symptoms have decreased, and some have disappeared completely. This is because your hormones are in steady decline, or have stabilized.
Menopause and your weight
It’s very normal for you to gain up to 10 pounds during perimenopause/menopause. In fact, it’s healthy and protective — if you get sick, it gives you some extra reserve. As your ovaries start down-regulating estrogen, your fat tissue up-regulates it.
But putting on significant weight during menopause is often a sign of excessive estrogen in relation to progesterone. These hormones need to be balanced –“normal” estrogen in relation to “low progesterone” can cause a whole host of issues.
I recommend two strategies to manage your weight — one, you need to get your hormones checked (you may be surprised which ones) and two, tweak your diet and workout routine. Read on to find out how.
Get your hormones tested
During perimenopause your estrogen and progesterone fluctuate, but over time they steadily decline. In menopause, they’ve dropped significantly and have stabilized.
But did you know that your ovaries also make testosterone, aka the male sex hormone? So when estrogen and progesterone decline, so too do your testosterone levels. Low testosterone can affect your libido and leave you feeling fatigued and depressed. It can also contribute to hair loss and drier skin.
So along with getting your estrogen and progesterone levels checked, you want to test for testosterone and your thyroid hormones — both help to regulate weight. When testing for thyroid hormones, make sure you get a complete thyroid panel: TSH, T3, T4, and thyroid antibodies. Checking only TSH, which is the standard in the US, is not enough.
After I check my clients’ hormone levels, I often suggest small doses of testosterone and thyroid hormones, and the results can be dramatic.
Get checked regularly and if on bio-identical hormones, adjust your hormone dosage
Keep in mind that perimenopause in particular is a process, and your hormones and how you feel change every few months. It’s normal and natural, so try not to get too frustrated when something was working and now it doesn’t anymore. If you’re gaining weight again or not feeling your best, I suggest seeing your doctor every 3 to 6 months to run hormonal tests (including thyroid).
Menopause, and especially perimenopause, is unpredictable — you might feel great all week, then all of a sudden, without having done anything differently, you’re bloated and feel like getting out of bed is akin to running a marathon, on crutches!
Your tolerance to stress can suddenly decrease, and things that you took in your stride can now cause anxiety or frustration. This can leave you (and your family) wondering if you’re going crazy. That’s par for the course, and is a sign that your hormones have started shifting again.
Sometimes symptoms appear, last for a while, and then disappear, for no apparent reason. That’s why it’s important to monitor your hormones on a regular basis, and adjust the program.
How and what to eat to keep the weight off
If you’re already following the Bulletproof Diet and filling up on healthy fats, nutrient-dense vegetables, and high-quality proteins, you’re doing well. But when your hormones start changing, you may need to do more than just eat healthfully to stay at your desired weight. Here are my suggestions on how to modify your diet to keep your weight steady and leave you feeling good:
Practice intermittent fasting: Intermittent fasting — when you extend the time between two of your three daily meals — is a great way to manage your weight. Fasting diminishes your body’s glucose reserves — its primary energy source from food. Without glucose, your body switches over to burning fat for fuel. Intermittent fasting carries all kinds of other benefits:
- Increases energy
- Promotes cellular repair
- Helps you live longer
- Improves memory
- Reduces insulin resistance
- Builds resilience, both physical and mental
There are different types of intermittent fasting. I recommend eating all your daily calories within a shortened period of between 8 and 10 hours, primarily during the afternoon and early evening. Fasting too much can be taxing for women, which is why I suggest doing it 4 or 5 days of the week. On days you don’t fast, add collagen to your Bulletproof Coffee, or eat breakfast. Find out everything you need to know about intermittent fasting here.
Bulletproof Coffee is a meal on its own. If you’re eating breakfast, such as bacon, eggs, and toast, and then add a full cup of BP coffee on top of that, you’ve essentially eaten two breakfasts. On days I eat breakfast, I drink my coffee black.
Eat collagen every day: You want to eat 3 scoops of collagen protein powder (aka collagen peptides) each day. Collagen keeps your skin smooth and plump, and your hair and nails strong. This becomes even more important as you get older. You can learn more here about why your skin needs collagen to stay young.
Don’t snack: Try not to eat between meals. When you snack, your body releases insulin, a hormone that carries sugar to your cells to be used as energy. If you don’t eat for a few hours, your body switches from burning sugar to burning fat from your fat stores. Snacking also adds extra calories to your day that you don’t need. Rather, focus on nutritious meals with lots of vegetables, healthy fats, and a moderate amount of protein, which will keep you full for longer.
Eat some carbs: I tell my clients to make sure they get carbs like sweet potatoes, white rice, squash, and fruit to curb any cravings. You can have up to1/3 -1/2 cup with lunch and dinner.
Switch from a big plate to a small plate: You don’t need as much food as you think. But habits that are 20 to 30 years in the making will keep you loading your plate as if you were in your twenties. As you get older, your metabolism slows down, and you need to eat less to maintain your weight. A smaller dish will give you the same feeling of satisfaction, but you’ll consume one-third less than you usually would.
Cut down on protein: Most people eat way too much protein. You need mostly vegetables (fresh and organic whenever possible), a good amount of fats, and a small amount of protein a day. You don’t need to eat a 10-ounce piece of fish, or a whole can of sardines. Whatever protein you don’t metabolize gets converted into fat.
Four ounces of meat with one or two meals a day is really all you need. You can even have protein-free days. Just keep those vegetables and fats on the menu.
What I eat in a day
When I was 44, (and after two babies), I could still fit in the same jeans that I wore when I was 20. I was one of those lucky women that could eat whatever they wanted and not gain weight. Needless to say, I didn’t appreciate it at the time. I simply assumed this was how my metabolism was wired, and it would continue into old age. If only!
The day I turned 45, perimenopause started with a vengeance — hot flashes, sweats, nausea, and mood swings. And after 3 months of this, I couldn’t fit into those jeans to save my life.
In the first 6 months, not only did I feel like I was perpetually morning sick, I also gained 10 pounds. That amazing “metabolism”, which had kept me slim for 30 years, was broken. My hormones were all over the place, and I realized that it was time to make some serious changes. Here’s what I eat in a day, to give you some ideas:
I fast most mornings. When I wake up, I have a big glass of water to hydrate with a pinch of Himalayan sea salt and half a freshly squeezed lemon (you can learn more about how much salt you should eat here). This is an Ayurvedic tradition going back thousands of years. I then have a cup of green tea and a small cup of Bulletproof Coffee (if you don’t drink coffee, you can make a Bulletproof Matcha.)
Around 10am, I have another big cup of green tea. I don’t eat lunch till about 1pm. In case you wonder if you can exercise on this “empty stomach”, yes, you can. I do yoga, bike ride, swim, and hike. Hydration is key.
Having said that, if you feel dizzy or nauseous, eat something. It can take up to 2 months before your body is accustomed to intermittent fasting, and has built up enough resilience to accommodate exercise in the morning.
My meal is usually two-thirds vegetables — a fresh green salad or steamed vegetables. I typically have some carbs, but not a lot, perhaps 1/3 of a cup of butternut squash, sweet potato, or white rice. If I don’t have any carbs or starches, then around 4pm I feel a little tired. That’s only begun in perimenopause.
If I’m going to be exercising in the afternoon, and feel this energy dip, I eat a handful of nuts (pili nuts are my favorite, followed by macadamia and walnuts). l also have some protein with lunch — a small serving (4 or 5 ounces) of grass-fed meat or fish.
I make sure to get plenty of healthy fats into the meal — I usually mix Brain Octane Oil and grass-fed butter into the vegetables.
More or less the same thing as lunch — mostly vegetables, some starch, and a little bit of fat and protein, like raw cheese or yoghurt. I’ll follow the meal with fruit maybe three times a week with whatever’s in season.
I do still eat dessert on a regular basis, but since I entered perimenopause, it’s once a week, instead of 3 to 4 times per week. This does help to maintain my weight. If we go out for dinner, I’ll enjoy a nice sorbet if they have it, or a cup of mint tea with a dash of honey.
I sometimes drink a small black decaf coffee in the evenings, with one or two small squares of dark chocolate. That’s before 7:30pm though, because even decaf coffee has caffeine, and so does dark chocolate. You don’t want your treat to keep you up at night! I don’t consider dark chocolate dessert — it’s jam-packed with antioxidants and polyphenols, and it’s a mood-booster. However, if you eat half the bar or the whole bar, then you’ll gain weight.
A note on when to eat: We’re programmed by sunshine and daylight, so you should try to eat dinner before it gets dark. In winter, that can be challenging, especially if you live in a place where it gets dark in the late afternoon. In that case, try to eat within an hour of sunset — so in winter, we eat at 6pm. In the summer, you can eat around 7pm. Try to have dinner 3 hours before you go to bed.
Menopause and exercise
Exercise is good no matter how old you are — it balances your hormones and reduces stress by lowering cortisol levels. However, it can be a pretty rough and tiring time for the female body when hormones start to fluctuate, so it’s better to do more moderate exercise, like swimming, yoga, hiking, pilates, or weightlifting.
I generally don’t recommend very rigorous exercise, like 45 minutes of weightlifting followed by an hour on the treadmill at high speed, unless you’ve done it your whole life and still feel great doing it.
And as your hormones decline, your ligaments get looser, including the ligaments around your uterus. Some women notice mild urinary incontinence (when coughing, sneezing, jumping). It’s important to do exercises to keep your pelvic floor strong, and also to avoid high impact exercise that can over-stretch or wear out your pelvic ligaments.
These are general recommendations. I know there are women out there who continue with marathons, triathlons, endurance sports, and high impact exercise in their fifties and beyond and feel fantastic. We are all individuals. One size does notfit all. So keep active and listen to your body.
Your body also needs fats, amino acids, and energy to build hormones and repair itself. If you are constantly using that energy and those building blocks to exercise rigorously many times a week, your body will allocate it to the “exercise account” and take it out of the “hormone and repair” account. To your body, running on a treadmill at high speed for an hour is the same as running away from a tiger that wants to eat you — it creates stress.
You do need to get your heart rate up, break some sweat, challenge yourself, and use weights to strengthen muscles and joints. An afternoon of paddle boarding, for instance, will not put too much stress on your joints, but it will definitely give you a good workout. Or hiking for 2 to 3 hours in mixed terrain, with enough uphill.
I also recommend HIIT (high intensity interval training) — short (20 to 60 seconds) bursts of high intensity (sprinting, spinning, doing burpees), alternating with lower impact exercise, such as jogging, or jogging in place, or even walking fast.
Make sure you’re in reasonable shape before you try HIIT. Start out with 3 months of light to moderate exercise like walking, jogging, swimming, and weightlifting.
This is important because your ligaments take 2 to 3 months to get into shape and become strong, unlike muscles, which take only about 2 to 3 weeks. A ligament injury is painful and can take months to heal.
Other ways to keep the weight off and feel balanced
Track your menstrual cycle
When you’re in perimenopause, your periods may start to become irregular. Even if you don’t get a period for 3 or 4 months, monitoring how you feel — both mentally and physically — during this irregular “cycle” can be helpful. You might be able to identify some patterns, so you can adjust what you eat or how you exercise depending on how you’re feeling.
For instance, when it’s ovulation time, you might be more bloated and feel more irritable. Give yourself a bit of space and prioritize sleep. You can track your cycle using the MyFLO or Period Calendar apps.
Stress can throw your hormones out of whack, so learning to manage stress is one of the best ways to keep you feeling balanced and in charge. There’s a lot you can do to calm your nervous system, including:
- Massage with or diffuse essential oils like lavender, rose, or ylang ylang.
- Get acupuncture (you can search for a qualified person in your area on acufinder.com).
- Take a magnesium supplement or soak a couple of times a week in an epsom salt bath.
- Meditate every day, even if it’s just for 5 minutes.
- Use a float tank once a week.
Get more sleep
A good night’s sleep helps to regulate your hormones. When you don’t sleep well, your body produces more of the stress hormone cortisol, and too much cortisol can cause weight gain. If sleep is an issue — which it is for a lot of women during menopause — talk to your functional medicine doctor or acupuncturist. Read more about how to hack your sleep here.
What to do when your hormone tests are normal but you’re still gaining weight and feeling terrible
It can be frustrating when your hormone levels come back as “normal” but you’re still putting on weight, getting hot flushes every hour, and waking up at 3am drenched in sweat. This happened to me. I had terrible insomnia and hot flashes, even though all my tests were textbook normal. And my periods were like clockwork, every 28 days!
My family doctor said he couldn’t understand why I was having all these symptoms because my estrogen and progesterone levels were “perfectly normal” and my FSH and LH were not elevated at all. With these levels, I should have been sleeping like a baby, with not a hot flush in sight.
This was confusing, both to him and me, so I went and did my own research. And I discovered information I had never learned in medical school. Namely, it’s not just the hormone levels that matter and cause perimenopausal and menopausal symptoms.
Your hormone receptors — special proteins on or within a cell — become less sensitive as you age. Hormones like estrogen and progesterone attach to hormone receptors, triggering changes within a cell.
Sometimes it might look like you have enough of certain hormones, but you don’t. Rather, your hormones aren’t binding effectively with the receptor, or releasing the hormone too soon, which means your cells aren’t receiving the information they need to keep you feeling balanced. As far as I’ve been able to find, there are no readily available tests to measure hormone receptor sensitivity, other than in breast cancer tissue.
So what should you do? Regular exercise, enough sleep, no sugar, and managing your stress can help make your receptors more sensitive to passing hormones.
Also keep in mind that even if your hormone tests do come back normal, “normal” is a range based on lab results taken from tens of thousands of individual patients. What may be a sufficient estrogen level for your best friend, may not be optimal for you.
This is where an experienced functional medicine doctor comes in. They understand that your “optimal level” may be above what’s “normal” or in the “higher range of normal”.
In my case, my doctor suggested a very low dose of additional testosterone, thyroid, and progesterone, as well as local (vaginal) estrogen. And these very small doses were just enough to help me feel much better, but not enough to cause side effects. These were all bio-identical compounded hormones, and used for a shorter period of time (1 or 3 years). This type of mild HRT is generally considered very safe.
I also have clients who have opted for acupuncture, herbs, traditional Chinese medicine, Ayurveda, ice baths, and chi gong, to name a few. Though sometimes challenging, this is a fascinating time in our lives as women, and when managed well, can lead to a place of resilience, glowing health, and more peace of mind.