Managing Midsection Weight Gain in Perimenopause and Menopause: A Holistic, Evidence-Based Approach

Perimenopause and menopause bring profound changes to a woman’s body, with midsection weight gain being a common and frustrating concern. This visceral fat accumulation affects appearance, self-esteem, and health, increasing risks for metabolic disorders. At FROM WITHIN, we explore the causes of this weight gain, emphasising the role of clinical nutritionists in addressing it internally, the insights provided by functional testing such as the DUTCH test, and the critical interplay of hormones, metabolic health, lean muscle mass, stress, sleep, and diet.

Causes of Midsection Weight Gain

Hormonal fluctuations during perimenopause and menopause significantly drive midsection weight gain. Declining oestrogen levels alter fat distribution, promoting visceral fat storage in the abdomen over subcutaneous fat in the hips and thighs (Ko & Jung, 2021). Visceral fat is metabolically active, contributing to insulin resistance and cardiovascular risk (Fenton, 2021). Progesterone and testosterone also decline, affecting mood, water retention, and muscle maintenance, further complicating weight management (Greendale et al., 2019). Metabolic health deteriorates with age, exacerbating weight gain. Basal metabolic rate (BMR) decreases due to sarcopenia, the age-related loss of lean muscle mass, which reduces calorie expenditure (Volpi et al., 2020). Muscle is metabolically active, and its decline makes weight maintenance challenging without dietary or activity adjustments (Beaudart et al., 2017).

Stress, sleep, and diet are additional contributors. Chronic stress elevates cortisol, promoting abdominal fat storage and muscle breakdown (Chao et al., 2017). Poor sleep, common due to menopausal symptoms such as hot flushes, disrupts appetite hormones, ghrelin and leptin, leading to increased hunger and cravings (St-Onge et al., 2016). Diets high in refined carbohydrates and sugars worsen insulin resistance, further driving fat accumulation (Ludwig et al., 2018).

The Role of FROM WITHIN: A Personalised Approach

At FROM WITHIN, we provide evidence-based, individualised strategies to address menopausal weight gain from within. We assess health history, lifestyle, and biochemical markers to develop personalised plans, moving beyond generic calorie restriction, which can exacerbate muscle loss and be unsustainable (Castro-Barquero et al., 2020). We focus on optimising hormone balance, gut health, and nutrient status to support metabolic health. For example, we may recommend an anti-inflammatory, Mediterranean-style diet rich in vegetables, lean proteins, healthy fats, and low-glycemic carbohydrates to stabilise blood sugar and reduce visceral fat (Estruch et al., 2018). Addressing nutrient deficiencies, such as vitamin D or magnesium, is also key, as these are linked to metabolic dysfunction and common in menopause (Holick, 2017). FROM WITHIN also integrate stress management and sleep hygiene strategies to holistically address weight gain’s root causes.

Functional Testing: Insights from the DUTCH Test

Functional testing, such as the Dried Urine Test for Comprehensive Hormones (DUTCH), offers a detailed view of hormonal and metabolic imbalances. The DUTCH test measures sex hormones (oestrogen, progesterone, testosterone), adrenal hormones (cortisol, DHEA), and their metabolites, revealing patterns of hormone production and metabolism (Newman et al., 2019). This is particularly valuable during perimenopause, when hormonal fluctuations contribute to weight gain and other symptoms. The DUTCH test can identify whether oestrogen metabolism favours pathways linked to inflammation or fat storage, guiding targeted interventions (Santonja et al., 2021). It also assesses cortisol rhythms, which, if dysregulated, promote visceral fat accumulation (Chao et al., 2017). Based on these results, we may recommend dietary changes to support hormone detoxification, supplements to balance cortisol, or exercise to improve insulin sensitivity, creating a precise and personalised action plan.

Hormones, Metabolic Health, and Lean Muscle Mass

Hormonal changes are central to menopausal weight gain. Oestrogen decline impairs insulin sensitivity, leading to fat storage, particularly in the abdomen (Ko & Jung, 2021). Progesterone reduction affects mood and appetite regulation, indirectly influencing eating behaviours (Greendale et al., 2019). Testosterone, critical for muscle maintenance, also declines, accelerating sarcopenia and lowering BMR (Volpi et al., 2020). Metabolic health is tightly linked to these hormonal shifts. Insulin resistance, worsened by oestrogen decline and poor diet, impairs glucose metabolism, promoting fat storage (Ludwig et al., 2018). Maintaining lean muscle mass is essential, as muscle enhances insulin sensitivity and calorie expenditure (Beaudart et al., 2017). Resistance training, guided by a qualified trainer, can preserve muscle, improve metabolic health, and reduce visceral fat (Willoughby et al., 2018).

Stress and Sleep: Overlooked Contributors

Chronic stress and poor sleep significantly influence weight gain. Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, increasing cortisol, which promotes abdominal fat storage and muscle breakdown (Chao et al., 2017). Mindfulness-based interventions, such as meditation or yoga, can reduce cortisol and support weight management (Pascoe et al., 2017). Sleep disturbances, prevalent in perimenopause, disrupt metabolic and hormonal balance. Inadequate sleep elevates ghrelin, stimulating appetite, and reduces leptin, impairing satiety (St-Onge et al., 2016). At FROM WITHIN, we may suggest sleep hygiene practices, such as limiting evening screen time or avoiding late caffeine, to improve sleep quality and aid weight control.

Diet: A Foundation for Weight Management

Dietary choices profoundly impact menopausal weight gain. Diets high in refined carbohydrates and sugars exacerbate insulin resistance and inflammation, driving fat storage (Ludwig et al., 2018). Conversely, a diet emphasising protein, fibre, and healthy fats supports muscle maintenance, satiety, and metabolic health (Castro-Barquero et al., 2020). Adequate daily protein intake can preserve muscle and enhance thermogenesis (Paddon-Jones et al., 2015). At FROM WITHIN, we may recommend foods to support hormone balance, such as cruciferous vegetables (e.g., broccoli) for oestrogen detoxification or omega-3-rich foods (e.g., salmon) to reduce inflammation (Calder, 2017). Meal timing, such as eating larger meals earlier in the day, can improve insulin sensitivity and reduce fat accumulation (Garaulet et al., 2017).

Building an Effective Action Plan

An effective action plan integrates functional testing, nutritional guidance, and lifestyle changes. For example, DUTCH test results showing elevated cortisol might prompt us to suggest adaptogens such as ashwagandha or stress-reduction techniques (Pascoe et al., 2017). If insulin resistance is identified, a low-glycemic diet and resistance training can be prioritised (Willoughby et al., 2018). Regular consultations with us can ensure the plan adapts to evolving needs, maximising effectiveness.

Midsection weight gain during perimenopause and menopause stems from complex interactions between hormonal changes, metabolic decline, muscle loss, stress, sleep disruptions, and dietary habits. At FROM WITHIN, we offer personalised, evidence-based solutions, using tools such as the DUTCH test to uncover hormonal imbalances and guide interventions. By combining dietary optimisation, resistance training, stress management, and sleep improvements, women can address weight gain holistically, improving both health and quality of life during this transformative phase. Book here to make a consultation today.

References

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