New study suggests best chance for battling menopausal weight gain is during perimenopause

Most women going through menopause complain about the added weight. Menopause is often accompanied by accelerated adverse changes in body composition, hot flashes, and an increased risk of such chronic diseases as osteoporosis and heart disease. A new study suggests that lifestyle interventions aimed at managing these problems are most valuable during perimenopause. Study results are published online today in Menopause.

Much focus is on the adverse symptoms of menopause. The reality is that many of the changes associated with a decreased quality of life, productivity, and intimacy take place in the period before menopause, known as perimenopause. Studies have documented that menopause is associated with a gain in fat mass, as well as a redistribution of fat toward the abdomen, with perimenopause being a key transition point for these changes. Some studies have also shown that menopause can additionally cause loss of lean mass, as well as bone mass.

It is well known that energy expenditure during rest and exercise is reduced with age, but few studies have evaluated the menopause transition as an independent factor that may influence metabolism. In this new study, researchers evaluated women at all stages of menopause (premenopause, perimenopause, and postmenopause) to understand changes in resting and exercise metabolism in conjunction with body composition. A secondary aim was to identify relationships between body composition and select lifestyle factors such as dietary habits, physical inactivity, and sleep, which are important contributors to changes in body composition and metabolism.

The researchers concluded that perimenopause may be the most opportune window for lifestyle intervention, because this group experienced elevated percentages of fat, lower lean body mass, and a shift toward central obesity. The greatest changes in the overall percentage of fat were observed between the premenopause and perimenopause periods, indicating that that the menopause transition stimulates the changes that later stabilize in postmenopause. The greatest differences in exercise metabolism were highlighted during moderate-intensity exercise, with postmenopause displaying the poorest metabolic flexibility (defined as resting energy expenditure and substrate utilization during exercise). These differences in exercise metabolism occurred despite greater average physical activity reported in the perimenopause and postmenopause groups.

To prevent unwanted changes in resting metabolism, as well as metabolic flexibility, it is suggested that menopausal women engage in activities that help maintain lean mass, such as resistance exercise, as well as maintain or increase oxidative capacity with moderate- to high-intensity exercise.

Study results are published in the article "Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism."

"This study underscores the adverse body composition and metabolic changes that occur during the menopause transition, which contribute to the increase in cardiovascular risk associated with menopause. Additional research is needed to determine whether there is an opportunity to prevent menopause-related shifts in body composition and metabolism with sustainable lifestyle interventions," says Dr. Stephanie Faubion, NAMS medical director.