Where Did My Waist Go?

Of all the body changes that come with perimenopause, I think weight gain, usually in the form of abdominal fat, is the meanest. Weight gain in the abdomen is one of the most common complaints of women whose hormones have begun to change signaling perimenopause.

There are a number of factors that contribute to this phenomenon, including hormonal imbalance, the body's inclination to hold onto estrogen-producing fat cells in midlife, high cortisol levels from ongoing stress, lack of sleep and years of exposure to toxins in our food and environment.

By the time women are in their later thirties or early forties, the aging ovary cannot produce enough progesterone to maintain balance with the body's estrogen. In essence, women then have a relative excess of estrogen in relation to progesterone. This "estrogen dominance" results in weight gain around the middle.

So often in midlife, stressors pile on to women. Children are being launched and leaving the nest, parents are aging, health issues for herself or her partner may increase, work circumstances may be stressful. These stresses cause our bodies to release cortisol. If the negative situations continue on for some months and cortisol levels are high, one result will be gaining abdominal weight. The stress hormones actually block weight loss.

There is more research in recent years on the importance of sleep and this area, too, can contribute to weight gain. Lack of sleep (less than a full eight hours) causes an imbalance in the hormone that makes a person feel hungry and the one that signals the brain that our appetite is satisfied and we can stop eating. When these hormones are out of balance, you will feel constantly hungry and will not feel satisfied after eating what should be a sufficient amount of food. The result: weight gain.

Additionally, for women living in America, exposure to environmental estrogens occurs every day. These "xenoestrogens" are in cosmetics, pesticides and heavy metals, in beef, poultry and dairy, in paint and cleaning fluids, and are even being leached from plastic in water bottles or plastic containers you may use to heat foods. This artificial waste, which can't be easily eliminated, is stored in fat cells and can contribute to significant difficulty in losing weight.

So, there's the bad news. It is not a myth that it is easier to gain weight in midlife and harder to lose. However, there are ways to combat the trend. The first, and high on the list of importance, is bioidentical progesterone. The ovaries stop producing progesterone long before the body runs low on estrogen. Correcting the imbalance through the use of prescription-grade bioidentical progesterone stimulates the body to release the extra fat around middle and also helps to reduce cravings. Many patients who have been exercising faithfully and being nutritionally astute come back the office saying that-since the progesterone-their efforts at weight loss are paying off. Proper nutrition is obviously key.