Sunday December 23, 2012
By DR NOR ASHIKIN MOKHTAR
This hormonal phase of life may be the cause of that belly fat you’ve been accumulating.
MANY of my middle-aged patients are afraid of their impending menopause for several reasons.
Of course, they are anxious about the possibility of hot flushes, sleep problems and low libido, but weight gain is also uppermost among their concerns.
Weight gain is a valid problem for women to be worried about, especially as they hit their fifties. Most women will find themselves putting on at least half a kilogram every year around this age.
Women aren’t just worried about weight gain because of vanity, but because many chronic conditions are linked to being overweight, including diabetes, heart disease, hypertension, knee and back problems, and even cancer.
Some recent studies have discovered fascinating information about the real relationship between menopause and weight gain (it’s not really the kilos, it’s about where the fat is), and I will share these insights with you here.
I will also shed some light on what this means for women who want to stay healthy throughout the menopausal and post-menopausal years.
Female ‘spare tyre’
For a long time, women and their doctors believed that menopause was the cause of weight gain among women going through this crucial hormonal stage in their lives.
However, a key study, published just this October, has overturned this thinking.
This study, led by Prof Susan Davis of Monash University in Australia, reviewed available scientific findings on weight gain and menopause.
The first significant finding was that weight gain among menopausal women was not due to the hormonal changes, but rather, lifestyle and environmental factors.
But many of my patients insist that their clothes are tighter, especially around the waist, and their stomach has grown bigger, so they must have gained weight!
They are not entirely mistaken. Prof Davis explains that the new “spare tyre” women complain of after menopause is real, as more body fat tends to be deposited around the abdomen, compared to anywhere else in the body.
Why would the body suddenly start storing more fat in the stomach area, compared to, say, the thighs or the buttocks? After all, isn’t the spare tyre the domain of ageing men?
Oestrogen and testosterone
This is where the hormone changes of menopause come into play. The body changes the way it stores fat due to the decrease of oestrogen caused by menopause.
While younger women find that a lot of their weight is concentrated slightly lower, around their hips, the loss of oestrogen in the body changes all this.
Suddenly, women in the menopause stage find something new to be concerned about – a flabby tummy, or what doctors call “visceral fat”.
A study back in 2009 looked at various factors that could possibly explain the increase of visceral fat during this period, including age, race, cardiovascular risk factors, and levels of testosterone and oestradiol (the main form of oestrogen) in the participants.
From the study’s findings, age, race and cardiovascular risk factors did not correlate significantly with the amount of visceral fat. Neither did oestradiol levels.
Instead, it turns out that testosterone is the culprit. As the level of oestrogen in the body dips with menopause, the level of active (or bioavailable) testosterone increases. It is this active testosterone that is the strongest predictor of visceral fat.
Visceral fat is a bad thing – and not just because it is fat. It turns out that there are different types of fat cells, and the fat located beneath the skin (subcutaneous fat) is different from the fat surrounding internal organs in the abdominal area.
Depending on where the fat cells are found, they behave differently. Visceral fat isn’t just made up of inert cells that cause weight gain; it is metabolically active and causes inflammation – contributing to premature atherosclerosis (narrowing of blood vessels) and risk of acute coronary syndrome.
The presence of too much visceral fat, also known as abdominal obesity, is part of the metabolic syndrome, which severely increases the risk of heart disease and diabetes.
This is why heart disease is the number one killer among post-menopausal women, although many people still mistakenly believe that only men are prone to heart disease.
A menopause message
While the hormone changes of menopause are inevitable, women can still be in control over their weight and health.
The menopausal phase is actually sending women a message, telling them that it is not too late to pay attention to their health.
For many women, the years leading up to menopause have been about their careers, families or social lives.
Finally, at a time when their children have grown up, they have retired, and their lives are finally about them, they can concentrate on taking care of themselves.
At this point, women should not only be talking to their doctors about addressing the symptoms of menopause, but also its effects.
They should review their overall health status, and start looking seriously at their cardiovascular risk factors.
This is also the time to grab the initiative and lead a much healthier lifestyle.
To counter the hormonal effects of menopause on abdominal fat, women need to eat healthily and become much more active. They need to balance their hormones with natural hormones and nutritional therapies.
Fortunately, there are many health centres and exercise classes that cater to women of all ages today.
So, don’t let menopause get you down. Instead, take it as a new step forward in staying healthy and trim!
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.