According to a report written for the online Johns Hopkins Medicine newsletter and reviewed by Jennifer Payne M.D., menopause lasts one day in the life of women. That day takes place 12 months after she has had her last period. That is the technical definition of menopause. But women going through menopause know that prior to that one day, they must get through perimenopause and, following the big M day, post-menopause. These two periods of hormonal transition can last years and may cause emotional, cognitive, and even physical disruptions to their lives.
Unless a woman is continuously pregnant or dies before the end of her childbearing years, she will experience this hormonal milestone. Usually, it occurs naturally, but sometimes menopause is the consequence of medical or surgical elimination of ovarian function. The average age of menopause in the United States is 51, but this varies, as does the age of the first decline in ovarian function, the perimenopause. The hormonal changes of perimenopause are usually noticed in a woman’s forties but have been known to start a decade earlier.
Physical, Emotional, and Cognitive Changes
Perhaps because experiencing menopause is almost universal among women, and because it seems to be built into their physiological systems, the many behavioral and physical changes that accompany it are often disregarded. Is this because those not paying attention have, until relatively recently, been male physicians? Or because eventually, if a woman lives long enough, most of the symptoms disappear or are accepted as part of the aging process, that is, sleep disturbances, dry skin, and changes in fat distribution being some side effects.
What is not disputed is that women experience a constellation of changes from perimenopause to post-menopause. The Australian Longitudinal Study on Women’s Health surveyed 8,623 women between 45-50 years of age before menopause (baseline measurements) and when they had reached menopause. The scientists found significant worsening of health, especially in physical functioning and a sense of general well-being compared to the pre-menopausal measurements.
Mood and Sleep Disturbances
Moods may change during this time. When perimenopausal women were tested on a scale that measured irritability (along with other mood changes) 70 percent of them reported irritability as their major mood change. The authors also cite research showing a significant increase in the symptoms of major depression in the perimenopausal age group.
The most prevalent complaint during the transition to menopause is disturbed sleep, according to a report by the 2005 National Institutes of Health State-of-the-Science Conference panel. Hot flushes are thought to be the major cause of sleep disruption, although other factors that tend to disrupt sleep at any age such as stress, anxiety, travel, and shift work, may also contribute. Anyone who has experienced chronically disrupted sleep knows that the effects linger the following day: fatigue, cognitive changes such as difficulty in word retrieval, disinterest in exercising, and a need to eat to feel more energetic.
If one were to add these up as some possible causes of overeating, the list is pretty good so far: stressful moods, disrupted sleep, and decreased exercise. But perimenopause offers another opportunity for weight gain, namely by an increased appetite for carbohydrates caused by low estrogen and serotonin. Think PMS cravings, but for months instead of days.
Carbohydrates, Serotonin, and Appetite Control
The underlying cause of a yearning for carbohydrates during the perimenopause cycle is probably related to the effect of decreased estrogen levels on serotonin activity. I and my co-contributors posited many years ago that the carbohydrate craving characterizing PMS was most likely related to decreased serotonin neurotransmission associated with low estrogen levels. The consumption of sweet and or starchy carbohydrates in response to the cravings would result in an increase in brain serotonin. Their insulin, secreted after eating a potato or pasta, would result in an increased uptake into the brain of tryptophan, the amino acid out of which serotonin is made. And presumably, their cravings would decrease.
We tested this hypothesis by looking at eating behavior, mood, and cognition of premenstrual women after they consumed a beverage whose carbohydrate content would lead to an increase in brain serotonin. The behaviors were compared with those made after women consumed a high-protein beverage that would prevent serotonin synthesis and two placebos. (Each beverage was tested in a separate premenstrual month.) The consumption of a carbohydrate beverage significantly decreased the appetite, mood, and cognitive impairments of PMS; the other drinks had no effect.
The Right Carbs for Appetite Control
Weight gain associated with menopausal carbohydrate craving may be related to what carbohydrates are being eaten. If the cravings are satisfied with pretzels, very low-fat breakfast cereal, plain baked potatoes, oatmeal, and steamed rice, it is unlikely that weight will be gained. These fat-free carbohydrates have the same number of calories as protein. Moreover, only about 120 to 130 calories of a starchy carbohydrate have to be eaten to increase serotonin.
But often the carbohydrate chosen is high or even higher in fat calories than carbohydrate calories (ice cream, chocolate, chocolate chip cookies), and the amount eaten is in excess of what is needed. It is hard to discipline one’s eating when dealing with exhaustion from disrupted sleep, anxiety, and depression. Moreover, the late forties and early fifties of a woman’s life may be filled with stress from teenage children, elderly parents, the need to enter and or stay in the job market, and so on. This stress often exacerbates the cravings already high because of the menopausal transition.
Shedding Light on Menopausal Weight Gain
Is enough being done to understand the causes of menopausal weight gain? Is there enough attention given to the mental health problems exacerbated by the menopause cycle, and their effect on overeating? Are women being adequately helped with their sleep disturbances and difficulty exercising or mood changes to prevent the weight gain that might result?
According to a report in Harvard Medicine Spring 2021, not enough attention is being given to any of these aspects of the menopause: “women are suffering in silence.” And perhaps the result is that they are gaining weight in silence.
If you’d like support to navigate menopause and address your weight loss concerns, we’re here for you! We invite you to sign up for a consultation to learn more.
“The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome,” Sayegh, R., Schiff, I., Wurtman, J., Spiers, P., McDermott, J., and Wurtman, R.J., Obstet. Gynecol, 1995; 86:520-528.