Hormonal Weight Gain and the Midlife Woman
Many of my midlife patients at the Women’s Mood and Hormone Clinic at the University of California, San Francisco, complain about weight gain even though they feel as if they aren’t eating any differently. They haven’t changed, but their brains have.
As you enter perimenopause, your brain becomes less sensitive to estrogen. This, of course, can trigger a cascade of familiar symptoms: hot flashes, fatigue, depression, changing libido. But in many women, it can also cause raging hunger. Estrogen affects your brain’s levels of serotonin, dopamine, norepinephrine, and acetylcholine — neurotransmitters that control eating, mood, and memory — so changes in estrogen wreak havoc on your appetite control.
Your appetite is controlled by your brain’s energy thermostat, located in the hypothalamus. There, hormones and neurotransmitters signal your appetite to turn on or off. So the easiest way to control your hunger — whether you want to lose weight or just maintain it — is to work with your hormonal currents rather than to fight them. To help you understand how to do this, I’ve created composites of my real patients. The woman I’ll refer to as Liz is a Girl Scout when it comes to hunger management; she does pretty much everything right. And Donna — well, we’ve all had days when we are Donna. Here’s how they navigate the hormonal ups and downs of a typical day.
Hormonal Hunger in the Morning
Early Morning: Rise, Shine — and Eat
The simple act of waking up and getting on with your day can become challenging in the perimenopausal years. That’s because sleep is often interrupted by one or more nighttime awakenings, perhaps accompanied by a hot flash or two.
Once you’re out of bed and moving around, your stomach begins to produce the hunger hormone ghrelin, which signals your brain that your body needs food.
This is the time of day when you should listen to your body and feed it properly.
Liz, 47, turns off the alarm and gently stretches. Whether or not she has slept well, she gets up at the same time every morning, because she knows this will keep her sleep, mood, and appetite cycles regular.
Liz heads to the kitchen for a breakfast of an egg white omelet, then takes her dog on a brisk one-mile walk. She won’t have time for a full-fledged workout today, but by sneaking in 10- to 15-minute bouts of activity, she can meet her goal of getting at least 30 minutes of cardio a day. Liz lost 15 pounds last year and credits exercise with helping her do it, so she’s committed. (The perimenopausal body functions better when muscles are active and fit: They release endorphins, feel-good chemicals that travel to the brain, giving you a sense of well-being.)
Meanwhile, Donna, slightly overweight at 46, hits the snooze button and pulls the covers over her head. After a restless night of tossing, turning, and hot flashes, she’s exhausted. She drags herself out of bed at 7:45 and makes coffee. She’s so cranky that the thought of food doesn’t even cross her mind. Symptoms of irritability, lack of focus, and fatigue can be caused by low estrogen during perimenopause, and lack of sleep only makes them worse.
Liz drops her son off at high school on her way to work. In her purse are several sticks of low-fat string cheese — some days it’s a high-fiber energy bar. She knows this will stave off her midmorning doughnut craving, should it strike.
After Donna dresses and gets her kids off to school, her stomach starts growling. It’s pumping out ghrelin, and her brain gets the message loud and clear: Eat now, or else! (Alas, this signal seems to be stronger in women than in men.) So she makes a quick stop at the deli en route to the office and has a bagel with jam and a large latte. The carbs quickly turn to sugar, and her brain starts releasing feel-good neurochemicals like noradrenaline and dopamine, which dampen her hunger and give her a mood and energy boost that is only temporary.