What is Menopause?

Menopause is defined by physicians as a stage in a woman’s life when menstrual cycles have ceased for at least 1 year and when lab testing reveals an FSH level greater than 50. Menopause occurs because the ovaries are no longer releasing eggs every month (ovulation has stopped) and hence the normal hormonal cycling associated with ovulation ends. The median age for menopause is 51, and around 1.3 million women become menopausal each year. Premature menopause can occur before the age of 40 and is caused by various medical conditions or illness, including surgical removal of the ovaries and uterus  (hysterectomy).

Some of the typical symptoms that women experience following  menopause include:

  • Hot flashes and night sweats
  • Pounding heart or skipped heart beats
  • Migraines
  • Weight gain
  • Fat accumulated especially around the midline
  • Muscle loss & joint pain
  • Vaginal dryness & atrophy
  • Urethral atrophy resulting in urinary tract infections
  • Lower libido
  • Insomnia & sleep difficulties
  • Anxiety & depression
  • Loss of skin tone and elasticity

Although all of the above symptoms are important because of their impact on quality of life, weight gain is one of the most serious symptoms following menopause because of its effect on the emotional and physical wellbeing of the woman. Weight gain in the post-menopausal woman has been associated with a decrease in a woman’s self-esteem and even more importantly a significant increase in her risk for all major chronic diseases including heart disease, stroke risk, diabetes, hypertension and cancer.

According to a study on 577 women, BMI (body mass index) was higher among perimenopausal and postmenopausal women compared to pre-menopausal women. Similarly, in another trial on 485 premenopausal women, women gained 2.25 kg (5 pounds) on average at the end of the 3-year period following menopause, with  20% of women gaining at least 4.5 kg (10 pounds).

Weight gain and a higher BMI creates concern in  post-menopausal women but even more concerning is the way that women gain weight after menopause. Studies show that menopause causes a redistribution of fat to the midline area, which increases the waist-to-hip ratio, making women more “apple-shaped” when fat is distributed around the waist vs hip and buttocks area. More specifically, the belly fat (visceral adipose tissue)  following menopause can increase from 5%–8% of total body fat prior to menopause to 15%–20% of total fat after menopause! In fact, a study on 131 women showed that postmenopausal women had 20% more fat and higher amount of upper body fat compared to premenopausal women!

What Causes Weight Gain During Menopause?

stepping on scale to assess weight gain during menopauseMenopause is a time of significant hormonal changes for women and is accompanied by both physical and mental shifts. But why do women gain weight after their menopause?

Hormonal Imbalance

Menopause is characterized by rapid shifts in a woman’s reproductive hormone levels, and these  hormones play a key role in body composition changes.

In animal studies, rats with removed ovaries had increased body weight and belly fat due to higher food consumption, decreased fat breakdown, less physical activity, and lower energy expenditure.

Women who enter menopause have lower estrogen levels, which decreases their metabolic rate -the rate at which their body converts stored energy into working energy- resulting in lower utilization of calories and increased body weight. In other words, lower estrogen levels slow metabolism and decrease lean body mass while increasing fat mass.

Furthermore, lower estrogen production causes less fat breakdown, which results in fat accumulation and further weight gain.

Moreover, during menopause the relationship between estrogen and  androgens shifts along with a decrease in the transport hormones for these sex hormones called SHBG. If the balance between estrogen and testosterone gets out of balance, the excess in androgens relative to estrogen along with the decline in SHBG (sex hormone-binding globulin) levels increases the risk of obesity.

Finally, during menopause, the levels of leptin, also known as the “satiety” hormone drops. Low leptin leptins signal the brain to increase feelings of hunger, which leads to hunger and eating more while burning less energy. The increased appetite and weight gain that women experience post-menopausally is caused by these major shifts in our hormones and biochemistry!

The good news is we have safe and natural ways to balance the hormonal imbalances after menopause that can be customized to each woman’s levels and needs.

Muscle and Bone Density Loss

Lower estrogen levels not only can increase body weight but can also decrease bone density and muscle mass.

According to a 10-year, multi-ethnic study on more than 800 premenopausal women, women lost around 10% of their bone density related to menopause, with 7% of the loss occurring during the perimenopausal and early menopausal years.

Furthermore, menopause is associated with lower muscle mass. Studies suggest that women suffer a 1.17% muscle mass decrease and a 0.6% muscle strength reduction per year after menopause. Lower muscle mass is associated with decreased resting metabolism,  making it easier to gain weight.

Lower estrogen levels also lead to lower bone density,  leading to osteopenia or osteoporosis. This in turn leads to a higher risk of fractures, and poorer muscle performance, factors that make it harder for women to exercise, leading to increased weight gain and fat build-up.


Due to the hormonal and physiological changes that occur as we get older, aging is a key factor in weight gain, for three main reasons;

On average, muscle mass decreases with age, and muscle is replaced by fat over time.

Besides the weight changes, fat distribution shifts in the perimenopausal woman as well. Waist circumference and belly fat increase with women after menopause at a greater rate than total weight.

Regardless of your physical activity, the older you get, the less muscle mass and muscle strength most women have. This means that age-related weight gain will happen even if you are still active. In order to avoid weight gain, women should change the type of physical activity they perform as they age to maintain or build lean body mass and optimize hormones. Our practice has designed specific exercise regimens to accomplish these goals in the post-menopausal woman.

Inadequate Sleep

According to a huge, multi-ethnic study on more than 3,000 women, menopause is linked to sleep disturbances. After menopause, women suffer from poor sleep due to lower estrogen levels and higher follicle-stimulating hormone (FSH) causing trouble with both falling asleep as well as staying asleep. And menopausal and perimenopausal women can suffer from sleep-disordered breathing affecting the quality or depth of their sleep. If that is not enough, studies show that inadequate sleep can lead to increased hunger, higher appetite and lower energy expenditure, and mood disorders all factors associated with  weight gain. Because sleep is critical for health as well as weigh maintenance, we use natural substances like melatonin, 5-HTP, and GABA which can be customized in our office to make sure both the quality and quantity of your sleep are ideal for weight maintenance and health.

Surgical Menopause

Following surgical removal of the uterus (hysterectomy), there are abrupt changes in hormonal balance. It is estimated that women who undergo surgical menopause have a 78% increased risk of obesity and 5 times increased odds of developing severe obesity! Creating hormonal balance immediately after surgery can prevent the risk of obesity and alleviate the unwanted symptoms of menopause that many women experience immediately after surgery.

Insulin Issues

Based on a study on 86 postmenopausal women, loss of ovarian function caused increased insulin levels (hyperinsulinemia). High insulin levels hinder weight loss by boosting fat accumulation,  increasing the risk of obesity. Lower estrogen levels also lead to insulin resistance, which increases fat mass and makes losing weight more difficult. Rebalancing your macronutrients (the amount of carbohydrate, fat and protein) after menopause is critical for your health. The blood work profiles we use in our practice will help to determine exactly how much of each of these macronutrients are just right for you.

How Can I Prevent Weight Gain In Post-Menopause?

Maintaining a healthy weight and lifestyle after menopause is an important goal as weight gain especially around the trunk is associated with an increased risk  for all chronic degenerative diseases. Focusing on a proper exercise regime, nutrition, getting adequate sleep and following a balanced and biochemically identical hormonal replacement therapy program treatment can help you not only counteract postmenopausal weight gain but improve other menopausal symptoms as well.


kettlebell for exerciseWith age, people become less active, however, physical activity plays an essential role during menopause. Research indicates that exercise can not only help you lose weight and/or prevent weight gain, but it can also minimize fat redistribution around the midline, protect your muscles, prevent bone loss, and improve mood swings.

Studies suggest that non-impact types of exercise such as spinning/cycling and rowing can help perimenopausal and postmenopausal women reduce total fat mass, waist circumference, waist-to-hip ratio, belly fat,  and BMI while lowering blood cholesterol  and blood sugar levels. These types of exercise are also low impact which prevents injury. Additionally, you can do a form of training called HIIT (high intensity interval training) while spinning or rowing which have been shown to be more beneficial than aerobic exercise in the post-menopausal woman.

Resistance training has also proven beneficial in its ability to increase metabolism and decrease belly fat while gaining muscle mass, muscle strength, and lowering the risk of metabolic syndrome as supported by a study of more than 140 postmenopausal women.

Moreover, a  2016 study suggests that doing yoga for two hours per week may increase estrogen and improve the quality of life in postmenopausal women.


bowl of fruitA proper diet is essential for everyone, but it is even more important for menopausal and post-menopausal women. Without a plan, post-menopausal women burn less calories during rest, which is why a specific diet and exercise plan designed specifically for post-menopausal women is recommended. Various types of eating programs should be recommended and customized to each woman to suit each post-meopausal woman since there is no one size fits all.  Some general recommendations are listed below. However, in my medical practice, which program is best suited for each woman is carefully determined by measuring a woman’s blood chemistry and hormones and custom designing an eating program for her based on this information as well as her food likes and dislikes and her personal lifestyle

Low Carb Diet

A low-carb, moderate-fat, and high-protein diet not only helps you lose weight, but can also decrease belly fat, waist circumference, and increase insulin sensitivity. In a study of 94k postmenopausal women following four different diet regimes, the low-carb diet was the most successful in preventing weight gain. Furthermore, according to the Nurses’ Health Study on 86,621 women, a high-vegetable, high-fruit, low-carb diet reduces the risk of breast cancer for postmenopausal women.

Mediterranean Diet

The Mediterranean diet consists of moderate fat consumption and a high intake of olive oil, fruits, vegetables, whole grains, nuts, and legumes. Not only does this diet help prevent obesity, but it can also decrease the risk of heart diseases and metabolic syndrome in perimenopausal and postmenopausal women.

Vegan Diet

Studies suggest that a vegan diet can reduce body weight and enhance metabolic rate in overweight postmenopausal women.

In addition, some specific foods and herbs can increase estrogen levels, decrease body weight, and promote fat loss. These include:

Of course, the combination of physical activity and the right diet will bring the best results, as evidenced by a 5-year clinical trial where 535 postmenopausal women lost weight, reduced their waist circumference, and managed to maintain a healthy weight.

Hormonal Treatment

hormanal treatment medicationsNutrition is only one part of the picture for achieving optimal health. A fully personalized integrative postmenopausal health program  includes the evaluation of hormonal needs for each individual woman. Because hormonal imbalance is one of the main reasons for weight gain and fat redistribution during menopause, it should not come as a surprise that bioidentical hormonal replacement therapy (HRT) can prevent weight gain and fat build-up.

A study of 1500 postmenopausal women showed that estrogen therapy carefully balanced with progesterone and testosterone will reduce total and belly fat, BMI, and waist-to-hip ratio, while improving blood fat levels and lowering the risk of metabolic syndrome! The key to hormonal success is to make sure a woman is taking the right form of hormones (natural or biochemically identical hormones), in the right amounts  and in the right balance. Most women have heard of “natural hormones” but remain unclear about what “natural bio-identical hormones” are. The term “natural” refers to the fact that these hormones come from naturally occurring sources such as soy or yams. While this is important, the most important thing is that bioidentical hormones are identical to the hormones that you naturally make in your own body.

As women  approach mid-life, many women wonder whether hormone therapy is right for them. Indeed, we have lived in a very confusing time regarding the risks and benefits of hormone replacement therapy. Countless studies, including the large Women’s Health Initiative Study in July 2002, have shown that traditional (synthetic) prescription hormone replacement therapy can increase the likelihood of various types of cancer and heart disease. However, the benefits and risks of bioidentical hormone replacement therapy are very different. Bio-identical hormones are more appealing when dealing with menopause because they are derived naturally allowing our bodies to use and metabolize them properly. In addition, bio-identical hormones are specifically designed to match your individual hormonal needs – unlike synthetic pharmaceutical hormones, which use a one-size-fits-all approach to symptom relief.

There is an overwhelmingly large body of evidence that supports the claim that bioidentical hormone therapy is safer and more effective than synthetic hormone replacement and can help to resolve or prevent disease. For this reason, many patients are now taking the natural, more balanced approach to hormonal replacement with customized bio-identical hormone replacement therapy. However, it’s important to remember that no drug, supplement or herb is 100% safe unless provided by an experienced medical doctor. That’s why it’s critical for women  to work with an experienced and trained physician before beginning any hormone therapy regimen.

Laboratory testing is critical to scientifically evaluating your hormone levels, for creating hormonal balance, and ensuring safety. Dr. Harper emphasizes the importance of regular laboratory testing and has found that while many patients may be on natural bioidentical hormones, if their hormonal blood levels are not balanced, they will still not experience the full benefits of hormone replacement therapy and may not feel their best. Based on your hormone levels, Dr. Harper will personally tailor a bioidentical hormone regimen designed just for you. The hormones she prescribes will be identical to what your body produces, creating balance and harmony just like nature intended.

How Long will I Stay on Hormones?

Studies show that when the women stopped bioidentical hormone replacement therapy, the benefits of the hormonal treatment stopped too, making it imperative for postmenopausal women to consider taking bioidentical hormones throughout their lifetime.

Natural hormones are an opportunity to replace what your body originally had in its ideal state when your hormone levels were most optimal and your body was disease free and youthful. These are the hormones that your body is able to recognize and utilize most effectively. Women prefer natural bio-identical hormones because of better results, greater quality of life and minimal side effects when taking them throughout their lifetime after menopause occurs . It makes sense to replace and balance your hormones only with what nature originally gave you for a long and healthy life.

Where Do I Get Bioidentical Hormones?

Bio-identical hormones are not typically available through traditional pharmaceutical prescriptions because bio-identical hormones are not patentable and dosages are individually tailored to each woman’s hormonal needs unlike prescription hormones where there are only standard dosages that may not fit your needs. With compounded hormones custom-made in a compounding pharmacy, a personalized regimen is specifically formulated to treat each patient on an individual basis.

Dr. Harper’s is one of the most experienced physicians in the United States having utilized bioidentical hormone replacement therapy in her personalized integrative health practice with over 10,000 patients over 20 plus years. She specializes in treating women during all stages of life with a special focus on women in perimenopause and menopause and her innovative and comprehensive solutions to health and hormones will allow each woman to experience renewed energy, restored youthfulness for a longer, healthier life. For more information please call our office 512 343-9355, email us at rfh@ruthieharper.com or visit our website ruthieharper.com. We look forward to hearing from you!