More research needs to be done to understand what women’s bodily experiences and bodily apprehensions are at menopause, says Dillaway. Photo: 123rf.com
On top of the hot flushes that she was experiencing “almost all day, every day”, as well as low energy levels and bouts of fatigue now and then, Jolene Singam says that the “rolls of fat” that have suddenly appeared around her mid-section is one of things that has been causing her distress since menopause.
“My body changed. And I don’t mean that I was just piling on pounds – the shape of my body was changing. My waist got thicker and my arms too. I was a clearly defined pear-shaped woman all my life but now, I was becoming a thick straight line,” says Jolene. “And it’s something that seemed to have happened almost overnight. Or over a few weeks.”
On top of being a regular runner, Jolene practises yoga a couple of times a week and works out in the gym where she does weight-bearing exercises under the supervision of a coach. But her fit lifestyle doesn’t seem to have paid off – at least not where her belly fat is concerned.
“I started looking up ‘exercises for menopause weight gain’ online but found that all the moves that were suggested were things I was already doing. There were online articles offering diet tips but I am not a big eater to begin with. I was getting really frustrated. My menopausal life hasn’t been giving me much joy, so far,” she says.
The changes have left Jolene feeling “down and annoyed” and also, helpless.
“I am bothered by the weight gain. But more than that, what’s really distressing is that I feel that I don’t know my body anymore. I used to know how to shed excess weight – cut down certain food for a bit and amp up my exercise routine for a few weeks. But now, nothing seems to be working,” says Jolene.
The experience of menopause isn’t black and white: While many women sail through menopause without experiencing symptoms, some do feel weighed down by the (internal and external) changes their bodies go through.
According to Malaysia’s Clinical Practice Guidelines (CPG) on the Management of Menopause, symptoms include Vasomotor symptoms like hot flashes (about 50% of Malaysian women face this), night sweats (which correlate significantly with memory loss, alterations in brain function during rest, etc), mood disorders, vaginal dryness and other vaginal changes that can affect one’s sexual health; metabolic syndrome and weight gain; skin problems; issues with cognition and much more. (Visit http://bitly.ws/ETh2 for more information.)
Facing reality
Midlife weight gain is, unfortunately, a reality, says obstetrician and gynaecologist Dr Premitha Damodaran. “Even if there is no change in diet or level of activity, there can be a steady weight increase.”
This steady weight gain of 0.5kg a year, she says, is actually age-related. But, menopause just complicates things further.
“This has been extensively studied, with long-term studies taking into account menopause status, ethnicity, physical activity, etc. This weight gain is not menopause-related, but age-related. Unfortunately, ageing does make the body slow down. Loss of muscle mass slows metabolism down.
“However, menopause and the falling estrogen levels do affect weight distribution. Studies have shown that it starts at perimenopause (when the production of ovarian hormones – estrogen and progesterone – slows down) which causes a rapid increase in fat mass and redistribution of fat to the midriff. This then changes the woman’s shape from a pear-shaped to an apple-shaped body.
“Loss of estrogen further decreases the muscle mass and metabolism. So even if we eat right and exercise right, the weight may increase. It is especially frustrating for women who have always been eating right and doing their exercises regularly – fat accumulation still happens,” she says.
And there’s more.
Increases in waist and hip measurements then increase the risk of cardiovascular diseases, adds Dr Premitha who was the committee chairperson of the CPG on the Management of Menopause that was launched by former Health Minister Khairy Jamaluddin last year.
Although women will likely gain weight when they reach midlife – which coincides with menopause – it isn’t something they have to take lying down.
“Do we have to accept it? Not at all. But we need to know about it,” she says. “We need to work on it to minimise this accumulation and not just leave it as a consequence of menopause and/or ageing.”
There are also other concomitant factors that can contribute to this phenomenon.
“Some women are at a higher risk for weight gain during midlife: (Those with) family history of obesity, from a lower socioeconomic group, having many children, and an earlier marriage.
“Menopausal symptoms – hot flashes, sleep deprivation, mood swings and depression – have all been associated with weight gain. Sleep is so, so important.
“Changes to one’s lifestyle, such as retirement and a decrease in physical activity, changes in social structures at home, financial issues, empty nest – anything that increases mood disturbances also play a part,” she says.
Changing how, how often and to whom we talk about menopause can help women go through the transition that happens in their midlife better. Photo: Freepik
Physical activity, strength training
“Let’s take an example of a teacher who has been teaching for 30 years – walking up and down the stairs in school, PE and (carrying out) other activities, who suddenly retires. She still exercises three time a week and feels she is eating (the same) ; there is still a change in lifestyle, possible more regular meals, overall less activity. There are mood changes (because she is retired) and maybe even financial problems creep in. So many things happen during the menopausal time that can together contribute to weight issues,” she explains.
The solution is to “move, move, move”, she says.
“If your body is used to a certain routine for many years, you need to change that routine to break the metabolism rut. Concentrate on gaining muscle and losing fat. Realistically, not many can achieve the recommended hours of exercise: Moderate exercises of 150 minutes per week (you can talk while exercising but not sing), cardio exercises of 75 minutes per week (you can only say a few words during the exercise, but not have a conversation), strength training exercises twice a week.
“The more practical advice is to not be sedentary. We must find an exercise we enjoy and stick to it,” she says.
Food is also important: Eat 200 calories a day less during your 50s than you did in your 30s and 40s; eat healthily; dinner should be early and light and no sugar after 6pm.
“Limit alcohol to less than two units a week or less. Even a 5% weight loss cuts down the risk of cardiovascular disease, diabetes and cholesterol,” she says, adding that women should also “quit smoking, find a hobby, find a support group, and be happy”.
Menopause and the falling estrogen levels do affect weight distribution, says Dr Premitha.Dr Premitha adds also that menopausal hormone therapy is safe for women going through the menopausal change and experiencing hot flashes, night sweats, mood swings, brain fog and sleep disturbances.
"Once these symptoms are taken care of, weight is more controlled. Hormone therapy does not change weight (up or down); but it improves general health which in turn helps with diet and exercise and weight management," she says.
Finding an online group to talk about what she was going through really helped Eloise Tee deal with her anxiety issues about menopause.
“Though we were just a group of women letting off steam with each other, it was helpful to talk about the changes that were happening. We were not just exchanging notes but also tips.
“What I learnt is that everyone’s experience is so different. Even the type of hot flashes we suffer are so different. What’s the same is the frustration about how, even though we were free from the monthly bleeding cycles, we had a whole new set of things to deal with,” says Tee, 48, for whom perimenopause started when she was 45 and went on for two years.
Tee is grateful that a friend included her in this “support group” because she found she couldn’t share her journey with many others in her life.
“At work, I was afraid my sharing would be used against me and my performance. At home, I felt that my experience was brushed off as ‘just PMS-like symptoms’. And my friends are not going through it yet so they aren’t really interested.
“I think that we – both women and men – should talk about menopause more. I don’t think we should spare men from knowing about how our bodies work. Maybe that way we will break the stigma and not be discriminated against,” she says.
Feminist outlook
While changing our routine and diet is important, so is changing the way we look at menopause and ageing is also imperative.
In (Un)Changing Menopausal Bodies: How Women Think and Act in the Face of a Reproductive Transition and Gendered Beauty Ideals, researcher Heather E. Dillaway of the Department of Sociology, Wayne State University in the United States, says that the way women feel about themselves during menopause is also impacted by societal norms. As such, she says, looking at menopause through a bio (mainstream) medical lens isn’t enough; we need to understand how women perceive menopause and look at their transition in a social context too.
“Biomedical literature suggests that menopause primarily represents negative change in women’s lives. Feminist literature on menopause proposes that it can represent positive change or is a neutral experience for individual women,” she states.
Most of the women she interviewed for her study looked at the transition negatively – “their feelings were often about changing physical appearances or external bodies”. Many also expressed how they would attempt to “prevent/mask bodily change in order to remain attractive, visibly feminine, and desirable in the eyes of men”.
According to Dillaway, gendered beauty ideals seem to affect how women perceive menopause, with many of them admitting to going through a “category crisis” during this time.
She emphasised that more research needs to be done to “understand what women’s bodily experiences and bodily apprehensions are at menopause” to help women navigate this transition.
“Feminists must continue to ask what women define as their physical or bodily experience of menopause, how women define and feel about their menopausal bodies, what women’s concerns or apprehensions are about menopausal bodies, and how women act in response to menopausal bodies, so that biomedical researchers no longer dictate the knowledge on or boundaries of women’s physical/bodily experience.
“Until we explore research questions such as these, we lack a full understanding of the meanings and experiences of menopause or the impact of the corresponding discourses that potentially affect women’s perceptions and actions,” she says in her paper.
