Question: I am 45 years old, 5’4 and weigh 150 pounds. I have gained about 5 pounds a year for the past 5 years. I looked my best and felt great at 125 pounds when I was 35. I work really long hours and don’t have lots of time for myself. I had a complete physical with my GP and I am in otherwise great health. My energy is really unpredictable and I have to eat in order to be able to concentrate.

My mother and her two sisters are overweight and both aunts have diabetes. I am convinced that I have a hormonal imbalance that is causing this weight gain, but my gynecologist refuses to check my menopausal hormone levels. She told me that I am perimenopausal and that these tests are inappropriate medical tests. My doctor then just said that I should eat less and move more! What tests would you recommend? –Suzanne

Dr. Pat: I agree that spending scarce medical dollars on measurement of FSH (follicle stimulating hormone) and LH (luteinizing hormone) and estradiol (estrogen) to establish whether or not a 45-year-old woman is in perimenopause is unwarranted unless the patient is undergoing fertility evaluation.

No matter what our mothers may have told us, menopause does not make you fat.

As we age, our metabolism naturally slows down by about 2 to 5 percent per decade after turning 40. So, the calculation is simple: Burn more calories or consume fewer calories.

But metabolism isn’t the only determining factor in weight loss. Unless there is an underlying medical problem that needs to be addressed (and your recent physical does not indicate this), eating too much of the wrong foods and not getting enough exercise is what dooms most of us.

I do suggest that women do more than just “eat less and move more.” You gave your gynecologist a real opportunity to begin an intervention and she did the minimum. Often doctors have to see so many patients each day that they do not have the time to discuss individual weight loss plans. And some doctors feel that their patients have no real interest or will power to make long-term lifestyle changes that don’t offer a quick and easy solution.

I can tell you that it is sometimes tricky creating a long-term weight loss program for a patient. Patients may feel that if they do not meet expected goals in a timely fashion, it is the fault of the program. They may also feel that their doctors will be disappointed in their efforts and then use this as an excuse to give up.

But the bottom line remains that in order to lose weight effectively, you need to embark on a new way of living. In a land of plenty, we eat plenty. And we fool ourselves into thinking we can undo or at least avoid the damage if we drink diet sodas with lunch or down caramel lattes while driving in lieu of eating nutritious meals.

We need to be more mindful of our eating habits and the impact this has on our health and general well-being. Being overweight or obese can affect your health in many ways, from causing extra stress on your joints to an increased risk of coronary heart disease. You already know that there is a history of diabetes in your family. It’s imperative that you adopt a healthy lifestyle today that will serve you well for life.

For starters, you need to eat foods that keep your energy stable so you don’t turn to inappropriate foods that cause your energy to zoom up, only to crash down 30 minutes later. If you’re unsure of where to begin, you may want to schedule an appointment with a nutritionist who can help you to learn more about healthy options and appropriate portion sizes and work with you to develop a sensible and nutritious eating plan.

It’s important to keep in mind that crash-dieting is not useful; your metabolism ultimately will slow down even further to conserve energy if you go overboard in calorie restriction. Instead, eat every four hours or so to keep your metabolism stabilized. Since you have a hectic work schedule, you may find it easier to eat mini meals throughout the day than to set aside time for breakfast, lunch and dinner. This is fine to do so long as you stick to the calorie limit that you and your doctor or nutritionist set for your desired weight.

What we eat is just as important as how much we eat. Many patients want to start a weight loss program in January, as part of their New Year’s resolution, but I find that the best time to start is now — i.e., whenever the motivation is in place. I’m writing this column in August, which is a great time to begin because of the abundance of fresh, healthy fruit and vegetables.

Visit your local farmer’s market where you’ll find food that has most likely been picked that day. Fresh food that hasn’t been packed up and shipped across the country is not only healthier, but it tastes better, too. Spice up your salads with lettuces and herbs you haven’t tried before (farmers are often happy to offer recommendations and tasting samples) and buy lots of tasty, low-calorie snack food, like green beans or blueberries, which are full of antioxidants.

When you’re at the supermarket, substitute complex carbohydrates for simple ones. Two easy dietary changes: buy whole wheat pasta instead of regular pasta and brown rice instead of white rice. Whole grains, lean meat or fish (or protein from vegetarian sources) and low-fat dairy items should be part of your daily diet.

Just as importantly, you need to find time to exercise. More studies show that even a little exercise can make a world of difference. If joining a gym or working with a trainer is unrealistic given your schedule or other constraints, then get outside and start walking. There was a terrific story in The New York Times that we pointed to recently about women banding together to walk on their suburban streets, local trail systems and even in parking lots. They developed healthier lifestyles and closer friendships.

Either with a partner or on your own, set out on a brisk walk at least three or four times per week (or walk on a treadmill if this is safer or easier for you). Start in small increments, if you need to, then build your way up to 45 minutes or one hour. Exercise boosts serotonin levels, so you’ll feel better mentally and physically. I bet that you even start to look forward to your walks — and the more you enjoy doing something, the easier it is to prioritize it in your busy schedule.

Now I’m also going to recommend that you try to incorporate some strength training exercises. A combination of weight bearing exercises (like running, walking or stair climbing) and resistance exercises like weight lifting not only help to increase metabolism and burn calories, but they also strengthen muscles and improve your bone strength. This is particularly important for women, because as we go through menopause we lose estrogen, and the loss of estrogen accelerates bone loss and the risk of osteoporosis.

Finally, as you already know, perimenopause can be a stressful time. If you find that you’re more prone to anger or sadness, or that you’re turning to food when you’re stressed, talk with your doctor about relaxation techniques, such as yoga or meditation, or find someone you can talk to about the changes in your life.

We cannot change our genetic make-up just yet, but 45 is a great time to change what we can.

* * * * *
Dr. Patricia Yarberry Allen,
director of the New York Menopause Center, is a gynecologist affiliated
with New York-Presbyterian Hospital and a board certified fellow of the
American College of Obstetrics and Gynecology.
Have a question about sex, women’s health or the menopausal transition? Write to [email protected].

Join the conversation

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  • Karen O'Kane August 14, 2007 at 11:53 am

    Truly examining your eating and exercise habits may reveal why you are gaining weight. Eight years ago I sounded very much like you: I was 47, slowly gaining weight and blaming perimenopause. For most of my adult life I had maintained a normal weight. I too lead a very busy life, work more than full time, and was not carving out enough time for me. I thought I was practicing healthful habits. I exercised – but not enough. I ate healthy food – but too much. With the support of my gynecologist who thankfully is concerned about the total well being of her patients, I began losing weight. Along with diet and exercise, portion control was a big factor for me. I was not a “junk food eater”. I was eating too much of a good thing.
    I maintained my weight loss for eight years. Now at the age of 55 I slipped a little and gained some weight back over the past year. I was beginning to go down the road of blaming hormones again–this time menopause. Once again I evaluated my eating and exercise habits and it was no surprise to see that I was eating too much and not exercising enough. Once again with the support of my gynecologist I lost 10 pounds. Metabolism and hormonal changes definitely occur during these perimenopausal and menopuasal times which is all the more reason to take care of ourselves. It is possibe to lose weight during perimenopause and menopause unless as Dr. Pat said, “there is an underlying medical cause”.
    You need to practice healthful eating habits on a daily basis which includes portion control. You don’t have to run a marathon or turn into a super athlete either. But you do have to exercise almost daily. Two or three times a week is not enough.
    Dr.Pat is offering excellent advice regarding eating habits, exercise and food choices. Following her advice should lead to succesful weight loss.

    Reply
  • Karen O'Kane August 14, 2007 at 11:53 am

    Truly examining your eating and exercise habits may reveal why you are gaining weight. Eight years ago I sounded very much like you: I was 47, slowly gaining weight and blaming perimenopause. For most of my adult life I had maintained a normal weight. I too lead a very busy life, work more than full time, and was not carving out enough time for me. I thought I was practicing healthful habits. I exercised – but not enough. I ate healthy food – but too much. With the support of my gynecologist who thankfully is concerned about the total well being of her patients, I began losing weight. Along with diet and exercise, portion control was a big factor for me. I was not a “junk food eater”. I was eating too much of a good thing.
    I maintained my weight loss for eight years. Now at the age of 55 I slipped a little and gained some weight back over the past year. I was beginning to go down the road of blaming hormones again–this time menopause. Once again I evaluated my eating and exercise habits and it was no surprise to see that I was eating too much and not exercising enough. Once again with the support of my gynecologist I lost 10 pounds. Metabolism and hormonal changes definitely occur during these perimenopausal and menopuasal times which is all the more reason to take care of ourselves. It is possibe to lose weight during perimenopause and menopause unless as Dr. Pat said, “there is an underlying medical cause”.
    You need to practice healthful eating habits on a daily basis which includes portion control. You don’t have to run a marathon or turn into a super athlete either. But you do have to exercise almost daily. Two or three times a week is not enough.
    Dr.Pat is offering excellent advice regarding eating habits, exercise and food choices. Following her advice should lead to succesful weight loss.

    Reply
  • Karen O'Kane August 14, 2007 at 11:53 am

    Truly examining your eating and exercise habits may reveal why you are gaining weight. Eight years ago I sounded very much like you: I was 47, slowly gaining weight and blaming perimenopause. For most of my adult life I had maintained a normal weight. I too lead a very busy life, work more than full time, and was not carving out enough time for me. I thought I was practicing healthful habits. I exercised – but not enough. I ate healthy food – but too much. With the support of my gynecologist who thankfully is concerned about the total well being of her patients, I began losing weight. Along with diet and exercise, portion control was a big factor for me. I was not a “junk food eater”. I was eating too much of a good thing.
    I maintained my weight loss for eight years. Now at the age of 55 I slipped a little and gained some weight back over the past year. I was beginning to go down the road of blaming hormones again–this time menopause. Once again I evaluated my eating and exercise habits and it was no surprise to see that I was eating too much and not exercising enough. Once again with the support of my gynecologist I lost 10 pounds. Metabolism and hormonal changes definitely occur during these perimenopausal and menopuasal times which is all the more reason to take care of ourselves. It is possibe to lose weight during perimenopause and menopause unless as Dr. Pat said, “there is an underlying medical cause”.
    You need to practice healthful eating habits on a daily basis which includes portion control. You don’t have to run a marathon or turn into a super athlete either. But you do have to exercise almost daily. Two or three times a week is not enough.
    Dr.Pat is offering excellent advice regarding eating habits, exercise and food choices. Following her advice should lead to succesful weight loss.

    Reply
  • Patricia August 14, 2007 at 10:25 am

    I am a 48 year old mother of two working a full time demanding job, who found myself a year ago without a sex drive, seriously overweight and struggling with my relationship with my husband of 25 years, and even myself. The complete loss of sex drive was a pretty big nail in the coffin in trying to work out my relationship with my husband.
    It was at that point that I sought professional medical help from a gynecologist specializing in menopause, and finally listened to the advice given. I started eating small meals every few hours (up to 6 a day), and kept to a balance of protein, carbs and fat to level my blood sugar and keep my energy up. I joined an exercise class, at first only once a week, but worked up to 5 times a week. I took a high dose of B vitamins prescribed by my doctor to counter/assist with the dryness I was experiencing during intercourse.
    When I undertook this journey, my husband was at first resistant to the idea of change in schedule and eating habits, but became an enthusiastic supporter as the resulting changes emerged. With the weight loss, which is now 55 pounds, and 12 from my ideal weight, as well as the exercise, my sex drive has increased multi-fold. The vitamin supplement also helped take care of the lubrication problem. The combination of my personal successes and renewed sex life has allowed my husband and I to reconnect, and allowed me to regain confidence I thought long gone.
    I would seriously encourage any woman out there with similar symptoms that she feels are related to menopause, to seek professional help. Sometimes it’s easier to blame it on this time in life, and give up, but believe me, it’s worth working with your doctor and your body, and following the common sense guidelines that we so often ignore.

    Reply
  • Carolyn Hahn August 13, 2007 at 8:27 pm

    My two cents: yes, you do have to add some exercise, even if you work long hours. There is nothing “hormones” can do that changes the need for aerobic/weightbearing exercise. I (late 40’s) have always weighed pretty close to the same amount, lately it’s a good 8 pounds more. Drives me crazy. But I have a husband who cooks and I’ve been doing a lot more weight bearing exercise (weight training, stairmaster) so what the hell.
    My suggestion: keep two ten pound weights at the office. Do twenty or so of whatever it is you’re supposed to do when nobody is looking. It actually feels good, too. TAKE A WALK AT LUNCHTIME (I only have 30 minutes, I can eat at my desk and still spend 30 minutes walking). Join a health club (your health is worth it), go walk 20-30 minutes on the way home after work at a slight incline on the treadmill while watching the news. You’ll break a little sweat, you would have sat and watched the news anyway, etc.
    Bottom line:to maintain weight, health, sanity, bone density post menopause, ya gotta do exercise. And trust me: I’ve thought of every way not to do this. So–make it easy for yourself. Join the health club. Rent the locker and keep your stuff there, so you can never BS yourself by not having anything there you can wear–no excuses. Don’t feel like 30 minute’s worth of exercise? Promise yourself you’ll do 20 and then leave.
    PS: NY sports club is everywhere. There’s one five minutes from where I work, and on days when it’s too crappy to even take a walk, I go there at lunch and walk,without changing clothes, thanks, even for 15-20 minutes on the treadmill, to the inspiring sounds of CNN (which, God bless it, is on all the time, otherwise I would go crazy with boredom).

    Reply