That’s why even though you had a hysterectomy years ago, you’ll most likely go through a type of menopausal transition again. As you reach the time in your life where you would naturally have stopped menstruating, you’ll notice your body changing, your moods changing, and your sleep patterns changing – for the second time. Your fat cells follow their prime directive, and you’ll gain the rest of your weight then and go through the rest of your transition.
Postpartum Fat Cells Entering the Menopause While Breastfeeding
This is as complicated as it sounds.
Because women are waiting longer to have children, an ‘over 40’ pregnancy, almost unheard of in our mothers’ generation, is now becoming quite common. If you get pregnant at the beginning of the transition, oestrogen levels soar instead of drop, and the fat cells in your buttocks, hips and thighs put on an extra 10 pounds. Then, after you deliver your child, oestrogen levels drop because you’re postpartum – and continue dropping because you are entering the menopause.
We don’t know where pregnancy weight gain ends and menopausal weight gain begins. We don’t know when postpartum depression ends and menopausal mood changes begin. Because of these blurred boundaries, many women, like Sally, are confused during this time: ‘I always knew that there was something more to my postpartum depression. It never went away. My midwife said it was the “baby blues” and would disappear within a couple of weeks. But two years later, I feel like nothing has disappeared – including my pregnancy weight.’
Women don’t have the time to lose the weight they gained during pregnancy before their fat cells realize that they are in the perimenopause, and want to multiply and store again for different reasons. Two of the most powerful fat-storing times in a woman’s life are occurring simultaneously. And if a third factor, breastfeeding, is added to this scenario, fat cells want to hold on to their fat for dear life – just in case that famine hits while your infant is dependent on your milk production for survival. Even though we read and are told that breastfeeding leads to weight loss, most women report that they don’t lose weight until after they stop breastfeeding. If pregnancy and breastfeeding are a part of your midlife weight gain experience, look on the positive side. You have a new child to go along with any extra weight. Most women are thankful to conceive later in life and grateful to know the reasons why they are gaining weight (instead of losing) in the years following delivery.
Genetically Overactive Fat Cells
If larger fat cells run in your family, expect more weight gain during the transition. The more you weigh as you enter the menopause, the more you’ll weigh by the time it’s over.
Some of my clients think this makes no sense at all. ‘I already have more than enough stored fat to produce the oestrogen my body needs, so why on earth would my body want to store more?’ Because the female body seems to want to gain a proportionate amount of fat during the transition. In Chapter 1, you learned that midlife fat cells increase their size by about 20 per cent during the transition. No matter if they are small, medium or large at the onset of your perimenopausal years, they are programmed to grow 20 per cent larger. One study found that overweight women gained an average of 1½ stone during the perimenopause, while women at a more comfortable weight gained just under 1 stone.
How do you know if you have genetically overactive fat cells? Laura asked this question, and we explored her lifestyle and family history for the answer. Her 5’9” body was the mirror image of her mother’s. They both had large bones, large breasts and large thighs, and gained a large amount of weight (1 stone 11 pounds) during the transition. Both Laura and her mother exercised, didn’t overeat and didn’t diet. This was where Laura’s body genetically felt the most comfortable. Her lifestyle was not responsible; her genetically overactive fat cells were.
If you are on the Pill or on hormone replacement therapy (HRT), another variable is added to the mystery of midlife weight gain.
Some women are on birth control pills to prevent pregnancy or add a little extra oestrogen during the transition (the Pill is sometimes recommended before HRT). That little extra oestrogen can cause a 1 to 2 per cent increase in body fat. If you’ve been on the Pill for years, you’ve already gained the fat associated with its use. But, if you’ve just started oral contraceptives, you can expect some increased fat in the buttocks, hips and thighs.
With HRT, the extra oestrogen can also cause storage in the lower body. Some studies have found that women on HRT gain more weight and body fat; others found no significant difference in the amount of weight gained, but a difference in where it was gained. Women on HRT gained more fat in the lower body because oestrogen feeds the fat cells of the buttocks, hips and thighs. In fact, a group of European researchers found that thigh storage increased by 50 per cent with HRT. This may not sound desirable to you, but larger thighs may be one of the reasons why HRT reduces the risk of heart disease. Being pear-shaped is good for the heart.
As one woman surmised, ‘I gained weight in the waist when I started the transition, then I went on HRT and I gained weight in the thighs. Now I have more fat everywhere!’
This woman also asked if going off HRT would lead to weight loss. Discontinuing hormone replacement might trigger some weight loss in the lower body, but it is beyond my realm of expertise to advise for or against HRT. We need to weigh the risks against the benefits, discuss the options with our GP and, if we determine that our bodies need hormone replacement to improve our quality of life, then any weight gain in the thighs will have to be accepted as part of the package.
Women are under more stress than ever before in history. According to the United Nations Report on the Status of Women, we do two-thirds of the world’s work for one-tenth of the world’s wages. We are so stressed doing the work of the world that we don’t have enough time to exercise. Not a good combination. Other than removing stress from your life (a seemingly impossible feat), exercise is the most effective way to tame your body’s response to stress.
During the fight-or-flight response, a release of adrenaline, Cortisol and other stress hormones causes a cascade of reactions to increase your chances of survival – to fight for your life or to flee as fast as you possibly can. The problem with many of the sources of contemporary stress is that fighting or fleeing is unrealistic. You cannot necessarily knock out your boss or run away from a deadline. I guess you could, but then you’d have to deal with the stress of lawsuits and unemployment.
So the stress of day-to-day life keeps building, the stress hormones keep accumulating, and you keep gaining weight. Stress causes additional menopausal weight gain in three ways:
1 Increased fat storage. Stress threatens your fat cells and stimulates more fat-storage enzymes in response to the potentially life-threatening situation. But stress is selective in which fat cells it activates: The thigh area is ignored while the abdominal area is targeted because these fat cells can more easily come to your aid with a burst of energy to save your life.
2 Decreased oestrogen production. From years of stress, your adrenal glands have been so busy producing the stress hormones that they are too worn out to produce the needed testosterone to make oestrogen in your fat cells. To offset lower oestrogen levels, the fat cells in your waist grow bigger and bigger to try to get the job done.
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