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Menopause increases abdominal fat, not weight

Oestrogen therapy does not cause women to put on weight and may prevent abdominal fat increasing after menopause
Professor Susan Davis

Going through the menopause does not cause a woman to gain weight, but, the hormonal changes are associated with a change in the way fat is distributed leading to more abdominal fat. The claims are made in comprehensive review by the International Menopause Society and published in the journal Climacteric.

“It is a myth that the menopause causes a woman to gain weight, it is really just a consequence of environmental factors and aging which cause that,” lead author, Professor Susan Davis, Monash University, Melbourne, Australia. “But there is no doubt that the new spare tyre many women complain of after menopause is real, and not a consequence of any changes they have made. Rather this is the body's response to the fall in estrogen at menopause: a shift of fat storage from the hips to the waist."

Women tend to gain on average around 0.5kg per year (1lb), around the age of 40. In general, more women than men are obese, and fluctuations in sex hormones have been proposed as being implicated in the weight gain.

The review group considered the evidence on why women gain weight around the menopause. They found that absolute weight gain is determined by non-hormonal factors, rather than the menopause itself.

The key finding was that the way fat is deposited changes at the menopause; studies indicate that this is due to the drop in oestrogen levels at menopause. After the menopause, women experience a shift in their fat stores to their abdomen regardless of whether gain weight not not.

The review notes that increased abdominal fat increases the risk of future metabolic disease, in postmenopausal women. It also noted that, contrary to popular opinion, oestrogen therapy (HRT) does not cause women to put on weight. There is good evidence that HRT can prevent abdominal fat increasing after menopause.

The report concluded that hormonal changes across the perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. Further studies are required to identify the women most likely to gain metabolic benefit from menopausal hormone therapy in order to develop evidence-based clinical recommendations.

The International Menopause Society is calling for women to be more aware of the problems associated with excess weight, and to take early steps to ensure that they don't gain excess weight after the menopause

“What this translates to in real terms is that women going through the menopause should begin to try to control their weight before it becomes a problem, so if you have not been looking after yourself before the menopause, you should certainly start to do so when it arrives,” said Davies. “This means for all women being thoughtful about what you eat and for many, being more active every day. Oestrogen therapy can also help. But each woman is different, so at the menopause, it is important to discuss your health with your doctor."

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