I’m a working mom of three kids ages 18, 20 and 23, so I just thought the hustle and bustle of keeping up with everything was exhausting me. I continuously complained to my therapist that I am exhausted: I can’t remember things, don’t slept well and am hungry all the time. Oftentimes the response of my doctors had been that I just do a lot every day between working, kids and my competitive tennis schedule (I play up to 6 times a week). But one simple recommendation from my psychologist actually changed my life — and I was reborn.
Ten years ago I went through a contentious divorce — aren’t most divorces? My anxiety spiked, followed by years of therapy, which helped me evolve into the self-assured, successful, happy person I am today. But the weight gain, exhaustion and forgetfulness were still there. At 48, I saw my gynecologist and asked if I should go off the birth control pill and get my hormone levels checked. She told me, not until I am 50 or 51; that was the entire conversation.
It took a visit with a gynecologist who specializes in perimenopause and menopause to realize the solution may be a combination of hormone therapy and weight loss medications. I decided to share my story because every time I do, the response I get is, “I have those symptoms and don’t know where to find help.” I hope my story helps even one person who feels as helpless as I did when going through perimenopause.
[RelatedAt-Home Menopause Tests: Pros and Cons, What They Test and When to See a Provider]
Perimenopause: A Time of Transition and Change
About a year-and-a-half later, I had a session with my psychologist. I asked again about when to go off birth control. She suggested I find a gynecologist who specializes in perimenopause so I could have better guidance if and when I should go off birth control as it can affect the small dose of anxiety medication I was on. So I made an appointment with a local gynecologist who specializes in perimenopause.
At my appointment with Dr. Sadaf Lohdi, a gynecologist specializing in perimenopause, I was made aware that I was in the throes of perimenopause.
How long you go through perimenopause symptoms is based on the women’s genetics plus external factors like race and ethnicity, culture, lifestyle and environment. According to the National Institutes on Aging, symptoms related to menopause can last between two to eight years. White women go through perimenopause an average of seven years and Black women 10 years, according to Lohdi, who is also Founder and CEO of Femme Vie Health, a concierge medical practice focusing on sexual and menopausal health in Chappaqua, New York. Black woman are also more likely to have an early onset of menopause, experience more menopausal symptoms and have symptoms for longer, while Asian women are less likely to suffer from menopausal symptoms.
Menopause, technically defined, is when a woman goes without a period for twelve consecutive months. During this time the ovaries stop making estrogen, a hormone that helps control the menstrual cycle. The time leading up to the menopause transition is called perimenopause.
Although you might have heard of symptoms like hot flashes (or temperature dysregulation), trouble sleeping, exhaustion and brain fog, there are many other symptoms women can experience that may be related such as joint pain, hunger dysregulation, mood swings, anxiety, change in libido, dryness (vaginal, mouth), alcohol tolerance changes, body odor, body composition changes, brittle nails, thinning hair, vertigo and weight gain.
The Frustration of Perimenopause Weight Gain
One symptom that is very frustrating is weight gain. I have gained and lost 25 pounds weight before, and I had helped a recent guy I was dating lose thirty pounds. As a registered dietitian, I know how to get it done when warranted. However, no matter how healthy my lifestyle was, I just couldn’t get rid of those extra pounds, which got me upset, depressed and questioning my own career as a registered dietitian.
“Weight gain in perimenopausal women is primarily influenced by hormonal changes — especially the decline in estrogen, which affects how the body distributes fat, often leading to more abdominal fat,” explains Lohdi. “Age-related muscle loss (sarcopenia) further slows metabolism, making it harder to maintain your weight.”
Lower estrogen levels can also decrease metabolism and insulin sensitivity, promoting fat storage. But there are additional perimenopause symptoms that can contribute to weight gain. Lack of sleep, fatigue and increased food cravings can lead to poor dietary choices, along with reduced physical activity, which in my case was due to severe joint pain, lack of control with hunger cues and increased cortisol from stress all can contribute to weight gain.
Besides the obvious mental health issues and the changes in your body that lead to weight gain in many women, the effects of menopause can also increase the risk for various diseases, including cardiometabolic diseases, cancer, obstructive sleep apnea, osteoarthritis and cognitive decline.
[READ: Hormone Replacement Therapy for Menopause]
Checking In With Your Gynecologist
If you’ve been experiencing similar symptoms and hormonal changes, it might be time to visit your gynecologist. So what should you expect from your gynecologist visit?
According to Lohdi, “the physician will always will do a complete history and physical and assess what is going on with the patient and what are their symptoms.”
Lohdi provides the example that if she has a woman in her 40s who is reporting sleeping less, having hot flashes and night sweats, noticing weight gain and having irregular menses, then she is most likely in perimenopause.
“Knowing a patient’s history is key to understanding how best to help them. Also understanding what is bothering the patient the most and then helping them understand the phases of a woman’s life will make a huge difference,” explains Lohdi. Ultimately, the gynecologist goes by clinical symptoms, the biggest one being no period for one full year, as that is the definition of menopause.
The gynecologist may or may not check hormone levels. However, it is important to exclude other conditions that may contribute to weight gain like thyroid disorders, so testing your hormone levels can help rule out other health issues.
Once other health issues are ruled out, medical hormone therapy (MHT), also known as hormone replacement therapy (HRT), may be an option for some women.
“If someone is experiencing symptoms related to perimenopause besides weight gain or changes in body composition, then they should be offered MHT with a thorough discussion of risks and benefits and what to expect as a result,” says Dr. Basma Faris, a board certified obstetrician-gynecologist and laborist at Mount Sinai West in New York City. She explains that MHT does not result in significant weight loss. “However, it can help to prevent weight gain.” And she notes that hormone replacement therapy has been associated with reductions in belly fat in some studies.
Although MHT isn’t a weight loss treatment, it may support weight management in perimenopausal women by addressing factors that contribute to weight gain.
“MHT can help mitigate these changes by improving insulin sensitivity, enhancing lipid oxidation and preserving lean muscle mass, potentially leading to modest reductions in body fat when combined with healthy lifestyle habits,” explains Lohdi.
Plus, by alleviating menopausal symptoms like sleep disturbances and mood swings, MHT may indirectly support weight loss by enabling better adherence to diet and exercise routines. Further, MHT holds promise for promoting a healthier body composition and has been associated with a decrease in total fat mass and better blood lipid levels, like cholesterol and LDL (“bad” cholesterol).
When is hormone replacement therapy not recommended?
According to Lohdi, MHT is generally contraindicated for women with a history of estrogen-sensitive cancers such as breast, ovarian, endometrial, triple negative breast cancer, unexplained vaginal bleeding, history of coronary artery disease, stroke, myocardial infarction, history of or inherited high risk for venous thromboembolism (like deep vein thrombosis or pulmonary embolism) and severe active liver disease. In some cases, hormone therapy in symptomatic patients with a history of triple negative breast cancer may be considered if five years has passed from diagnosis and treatment.
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GLP-1s for Perimenopause and Menopause Weight Gain
With the rise in weight loss medication, specifically GLP-1 antagonists like Ozempic and Wegovy, many women who may be in perimenopause are being put on these meds or ask to hop on the weight loss medication bandwagon. Many physicians just look at a woman’s weight and health risks, but they forget to have the women check in with their gynecologist to see if a hormonal imbalance can be contributing to midlife weight gain. According to Lohdi, as estrogen levels decline, along with progesterone and testosterone, low estrogen can significantly impact metabolism, body composition and insulin sensitivity.
“Jumping straight to weight loss drugs without evaluating a woman’s hormonal status can overlook important aspects of her health, including mood, sleep and bone protection,” says Lohdi, who as an OBGYN strongly recommends that women consult with a gynecologist first to assess whether MHT may be appropriate, especially if they’re experiencing symptoms of estrogen deficiency. ”
If someone has obesity, a GLP-1 agonist or other anti-obesity medication may be appropriate, and research reveals a possible synergy between MHT and GLP-1 agonists. A published retrospective study found that postmenopausal women on both hormone therapy and semaglutide experienced approximately 30% greater weight loss over 12 months compared to those on semaglutide without hormone therapy.
“This combination not only aids in weight reduction but also improves cardiometabolic health markers, including blood glucose, cholesterol and blood pressure,” explains Lohdi. She adds that the synergistic effect may be due to estrogen’s role in enhancing GLP-1’s impact on appetite regulation and fat distribution. While this approach appears promising, it’s essential to consult with a health care provider to assess suitability and monitor for potential side effects.
At six months into MHT, I am able to walk several miles a day, do Pilates and play tennis with no joint pain. I am also not nearly as hungry any longer, so eating healthy has been much easier without too many strong cravings. At this point, I have lost over 10 pounds, so I am opting to stay with healthy lifestyle changes — and continue consulting with my doctor.
[READ: What to Eat — and Avoid — on GLP-1 Weight Loss Medications]
Finding Help
The first step in this process is to find a gynecologist who is well-versed in the latest recommendations of medical hormone therapy. Some of these specialists who take insurance may have a long wait, and a concierge option may not be feasible. In addition, some smaller towns may not have any gynecologists who are knowledgeable in this treatment as of yet. Luckily, telemedicine is now available for people who do not have access to someone local.
If you choose to add in weight loss medication, consult with an endocrinologist or gynecologist who is also knowledgeable in obesity medications. If you do choose to go on weight loss medications, look for a program or practitioner who works together with nutrition and lifestyle counseling. Research shows much better success when these supports are also part of the plan.
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What Women With Perimenopause Weight Gain Should Know Before Going on GLP1s originally appeared on usnews.com
