Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

As we wrap up September and Menopause Awareness Month, Dr. Patricia Allen shares key strategies for weight loss and weight management in perimenopause.

Dear Dr. Pat,

I am 50 years old, married and have no children. I still have regular and heavy menstrual periods just as I always have.  I am overweight but started to work on losing weight beginning January 1st. I actually need to lose forty pounds. I have a wonderful job in a big city, where I am a respected project manager in a stable firm. However, it is a job where I sit most of the day. I am the primary breadwinner in our family after my husband lost his good job in the 2008 recession and now works ten-hour days making much less money than before.  I have worked for this company for fifteen years and would not consider changing jobs. We had to move further away from the city seven years ago and that is when the pounds began to creep on. We moved because our rental became a co-op and we couldn’t buy in. We also needed to be closer to the assisted living facility where my mother-in-law lives. I commute two hours to work, each way, on a bus, getting up at 5 a.m. and on the bus at 6 am.  I get back on the bus, most of the time at 5:30 or 6:00 p.m. and usually have snacks to keep me awake. We have dinner around 9 p.m. that is often something quick that my husband and I throw together and eat in front of the television because we need to chill out. I have a glass of wine with dinner and maybe a few cookies at 10 p.m. before I fall quickly to sleep. Many of the nights are totally disrupted from the hot flashes and night sweats. I get up to change clothes, throw cold water on my face and try to fall asleep again but mostly I ruminate about the disaster facing me in the morning when I will be exhausted. I need my sleep or I cannot function. On the weekends, I sleep in until 10 a.m. to recover. I also have sweats and hot flashes at work with a telltale red face. Let’s face it, everyone can guess my age and they know that I am having menopausal symptoms.  I am anxious with presentations now because I don’t know how to deal with these unpredictable symptoms.

I saw my gynecologist because I am certain that I am close to menopause and wanted hormone therapy to help me control these terrible hot flashes and night sweats that are ruining my sleep, destroying my energy, and interfering with my work life.  She told me that I may have a few years to go before I am past menopause and that she did not want to give me hormone therapy at this time. I asked her to do blood work for menopause markers and the tests she did showed that I have lots of estrogen.  I hated the birth control pill so I didn’t ask for that. She said that she could give me an antidepressant that might help with the flashes but didn’t have much else to offer in our brief visit. I don’t want to take that kind of medication. I have always been the kind of person who just puts her shoulder to the grindstone and gets the job done, usually with a good attitude and gratitude.  I have a good marriage and good health. But, I am feeling worn down now and it is affecting all areas of my life. What can I do to improve these symptoms, lose the weight, and prepare for that wonderful second half of life that you write about? (By the way, I am 5’ 4” tall and weigh 175 pounds).

Laura

Dear Laura,

Your story and question are such a familiar one to health care providers across the country who have an interest in menopause management.  You are one of the thousands of women who have long commutes, which is a stressful daily grind. But, as in most cases, there is nothing that you can do about this. You had to move farther away from the urban area where your work is simply because you had no choice financially and your mother-in-law needed more oversight as well. This is a story that many of us understand.

There are two primary problems in your life that we need to address:

1. Strategies for hot flashes and sweats during the day and night.
2. Today, let’s tackle that forty-pound weight gain you have acquired over the last seven years, due to difficult life circumstances, poor food choices, no exercise and no self care. We can calculate your BMI (body mass index), which is a method of estimating a person’s body fat levels based on weight and height measurement. Your BMI is currently 30, which is in the obese range. And, you are right:  you need to lose forty pounds. Your BMI will then be 23.5, which is in the normal weight range.

We interpret BMI results using this simple chart.  For adults, BMI results are interpreted as follows:
BMI below 18.5=Underweight
BMI 18.5-24.9=Normal weight
BMI 25.0-29.9=Overweight
BMI 30.0 and Above=Obese

The reason the BMI is used for screening the health of the general population is due to the strong correlation between being overweight or obese and having health problems, chronic disease, and premature death.

Anyone can calculate their BMI by going to a site such as  this.

Over the last decade, there has been a great deal of interest in not just what we should eat but when we should eat in order to lose weight and maintain weight loss. Research has documented that  biological clocks are an organism’s innate timing device. They’re composed of specific molecules (proteins) that interact in cells throughout the body. These biological clocks produce circadian rhythms and regulate their timing. A master clock in the brain coordinates all the biological clocks in our bodies. It is located in a part of the brain called the hypothalamus and keeps the clocks in many parts of our bodies in sync. The master clock area receives direct input from the eyes. Circadian rhythms are physical, mental, and behavioral changes that follow a daily cycle. This 24-hour body clock tells our bodies when to sleep, wake up and eat. This internal body clock is affected by environmental cues like sunlight and temperature. When circadian rhythms are disrupted, sleeping and eating patterns become very disrupted.

The premise of a new book, The Circadian Code by Satchin Panda, a professor at the Salk Institute and an expert on circadian rhythms research, is that our bodies function optimally when we align our eating patterns with our circadian rhythms. Dr. Panda’s research indicates that people improve their metabolic health when they eat their meals in a daily 8- to 10-hour window, taking their first bite of food late in the morning and their last bite early in the evening.

This approach, known as early time-restricted feeding, stems from the idea that human metabolism follows a daily rhythm, with our hormones, enzymes and digestive systems primed for food intake in the morning and afternoon.

Studies show that chronically disrupting this rhythm — by eating late meals or nibbling on midnight snacks, for example — could be a recipe for weight gain and metabolic trouble.

Weight loss and weight management should always be personalized for the best results. You described yourself as “the kind of person who just puts her shoulder to the grindstone and gets the job done, usually with a good attitude and gratitude.” You can choose to get this job done if you change when you eat, what you eat, how much you exercise and when you sleep. You can also decrease much of the stress in your life.