By Dr Nina Silberstein, BA.
Women who are in perimenopause, menopause or post-menopause sometimes feel like they’re living in a different body. Many have a hard time losing or controlling their weight—whether it’s due to shifting and declining hormones and a slowing down of metabolism combined with stress.
We sat down with integrative physician, Jade Teta, to talk about the role of hormones and weight, why he thinks some women are having difficulty losing or controlling their weight, and what they can do about it. As a practitioner of naturopathic medicine, Dr. Teta is an expert in nutrition, exercise, and supplements, with a specialty in integrative endocrinology.
Q: Dr. Teta, can you tell us about hormones and their role in weight loss?
A: There’s no doubt in my mind that hormones dramatically impact weight loss because they either directly or indirectly influence what we eat, what we crave to eat, and how much we eat. They influence appetite, sleep, and have everything to do with stress management, so they play a profound role in all of this.
Q: Which hormones are we talking about?
A: When most people think of hormones that pertain to weight, they’re thinking of estrogen, progesterone, and testosterone. But I would say the most important hormones are thyroid and adrenal, and more importantly, the appetite hormones (for example, leptin, ghrehlin, cholecystokinin, glucagon-like peptide-1, gastric inhibitory polypeptide). Estrogen and progesterone do play a pretty pronounced role—that’s for sure.
Q: How does estrogen influence a woman’s weight?
A: When estrogen is higher than progesterone during the menstrual cycle (a different metabolic reality compared to clinical estrogen dominance), a woman can eat more without storing as much fat. She’s more likely to build muscle. She can eat less and is less likely to have hunger and craving issues and is more likely to burn fat versus muscle. Estrogen makes a woman’s metabolism more flexible, and she will respond better to diet and exercise. She’s more insulin-sensitive and less cortisol reactive. Metabolism usually works in a “Goldilocks” zone—not too much, not too little, but just right. Estrogen helps find that zone.
Q: What about progesterone?
A: Progesterone has some opposite effects. While estrogen makes the body more insulin sensitive, progesterone makes the body more insulin resistant. When estrogen is dominant or higher in the first three weeks of the menstrual cycle, during the follicular or early luteal phase, the female metabolism is more responsive, flexible, able to handle more stress and, more or less, calories.
Q: When do the weight issues for women begin?
A: Once progesterone falls at perimenopause and women stop ovulating as much, stress becomes a bigger issue for a woman. One of the first major changes in perimenopause is that a woman is going to be more stress reactive. What ends up happening in perimenopause is that a woman will say, “My body is shifting. I feel like the same diet and exercise program are not as effective,” and she makes one key mistake here. She is dieting harder and exercising more. At this point in time, the dieting and exercising she was doing when estrogen and progesterone were at sufficient levels was probably not an issue. The body was handling it fine. But once she loses the influence of progesterone, that is more stress on the body.
Q: What can women in perimenopause do about this?
A: When first moving into perimenopause, I recommend that women move away from more exercise and harder dieting to more rest and recovery, easier workouts, more massage time, slow walking, time in nature and with pets, “woosah” activities, sauna therapies, and a more moderated diet—not going to extreme in calorie reduction or exercise. The Goldilocks zone we talked about earlier becomes far more important when progesterone starts to drop. A lot of women have the exact opposite intuition at this time.
Q: How does stress fit into the weight loss/control picture then?
A: Let’s think about when women go on vacation, and they stop dieting and exercising. They lie out in the sun, sleep in, and generally just want to have a great time. When they return, they say, “How could this be possible? I lost weight.” What you’re seeing are the stress-reducing effects showing up. The metabolism is really a stress management system, not a calorie management system. Ultimately, at perimenopause, you want to give your metabolism a vacation and not make it work harder. When progesterone falls at perimenopause, it’s about stress reduction.
Q: What about when women enter menopause and post menopause?
A: Moving into menopause, estrogen falls off, and not only do women need to manage stress even more, but they have to take the rest and relaxation to the extreme. Start resting more and taking it easy. But now women are more insulin resistant, which means in mature women the percentage of calorie reduction coming from carbohydrates may make more sense because carbs are more of an insulin-producing macronutrient. When estrogen falls at menopause, it’s about carb reduction. It’s the time to start moderating sugar and starch intake and begin to elevate vegetable, fiber-based foods, protein-based foods, and maybe even more fat in lieu of carbs to deal with the insulin resistance. Testosterone also becomes a little more dominant during post menopause, so women should do more resistance training versus cardio.
Q: Can a hormone imbalance trigger women to put on weight?
A: When someone uses the term “hormone imbalance,” I say that it’s a stress management issue and stress management issues create hormone imbalances, primarily. By stress, I mean nutrient depletion, too many or too few calories, too much or too little exercise, and inflammatory mechanisms. All of these are stress. Normally when there’s a hormonal imbalance as a result of any stress mechanism, the first thing we’re going to see is a discrepancy between estrogen and progesterone. Progesterone is going to fall and/or estrogen is going to rise. Either way, whether it’s progesterone deficiency or estrogen excess (here I am referring to clinical estrogen dominance) this happens for many reasons. It happens in perimenopause naturally and whenever there’s prolonged or unremitting stress.
Q: What’s the solution?
A: When we think of hormone imbalance, it normally means that estrogen is going to be high, and progesterone is going to be lower. The way to deal with that is by using adaptogens. If a woman is tired but wired, one of the ones I love that’s over the counter and women-specific to combat this would be something like vitex. It tends to help the hypothalamus function a bit better, deal with some of the stress it’s under, help ovulation occur, and help the luteal phase not be defective in any way, meaning you get estrogen and progesterone to kick back up. Certainly, things like ashwagandha and rhodiola would work well too, although I see that more for women who are just tired.
Q: What are other options for women besides the adaptogens?
A: Let’s get the micronutrients on board that have been depleted with stress. That really can make a big difference in the number one place where women get hit—thyroid function. Women have far more thyroid disorders compared to men, and we know that zinc, selenium, and magnesium are helpful for thyroid and adrenal function. The other micronutrient I would add is vitamin D.
Q: If all else fails, what’s next?
A: I recommend then moving to hormone replacement therapy. The best one during perimenopause is oral progesterone therapy if what mentioned above doesn’t work. It can be a godsend for women under stress and is typically for women who are leaner and healthier who don’t have lot of body fat as they start going from perimenopause into post menopause. Slightly overweight women tend to fare better in terms of symptoms. Oral progesterone therapy would come before moving on to using topical estrogens and oral progesterone.
From ZRT: Each woman has a unique body chemistry, so what works for one woman does not necessarily apply to her friend, sister, or next-door neighbour. An effective approach to a woman’s weight gain certainly includes lifestyle and dietary improvements, stress-lowering techniques, key vitamins, minerals, herbs and/or bioidentical hormones as needed, to replenish and restore balance.
If women want to test active bioavailable hormone levels that correlate more closely to any symptoms they may be experiencing during perimenopause, menopause or post-menopause, saliva testing is one of the best options because it captures the “free” fraction of hormone that has left the blood stream to become active in the target tissues of the body.