Why your hormones may be working against you

You are eating better, exercising more and trying to manage your stress, yet the weight is not coming off the way it used to. Your sleep is changing, your energy is dipping, your mood seems less predictable, and your waistline appears to have a mind of its own.

Then comes the question many women eventually ask: Could my hormones be working against me? It is a question worth asking, particularly as women enter their 40s and 50s and begin experiencing the hormonal changes associated with perimenopause and menopause.

However, the answer is more complicated than simply blaming estrogen or progesterone for weight gain. Hormonal changes can influence body composition, fat distribution and other factors that affect how a woman experiences her body; but weight is also shaped by ageing, nutrition, physical activity, sleep, stress, genetics, medications and metabolic health.

The issue has particular relevance in Jamaica, where women carry a substantial burden of overweight and obesity.

The Jamaica Health and Lifestyle Survey 2016–2017 found that 67.6 per cent of Jamaican women were overweight or obese, compared with 38.8 per cent of men. The gender difference was even greater for obesity alone: 41.2 per cent of women were classified as obese, compared with 14.9 per cent of men. The survey also found that 67.9 per cent of women had an increased waist circumference.

The numbers become particularly striking in middle age. Among Jamaican women age 35–44, obesity affected 55.1 per cent, while the rate was 52 per cent among women age 45–54, according to the national survey.

That means the years when many women are approaching or experiencing the menopausal transition are also years in which obesity represents a significant health concern.

Estrogen and progesterone are best known for their roles in reproductive health, but hormonal changes can affect much more than the menstrual cycle.

During the menopausal transition, ovarian hormone production changes and women can experience alterations in body composition.

Research from the Study of Women’s Health Across the Nation, which followed women longitudinally through the menopause transition, found that the rate of fat gain doubled around the start of the transition, while lean mass began to decline. Those changes continued until about two years after the final menstrual period.

Importantly, researchers found that this did not mean women suddenly began gaining weight faster simply because menopause had started. Rather, the composition of the body was changing, with more fat and less lean mass.

According to functional medicine practitioner Dr Orlando Thomas, a woman may step on the scale and see a number that has barely changed, while noticing that her clothes fit differently or that more weight appears to be accumulating around her abdomen.

“Research has linked the menopausal transition with increased abdominal and visceral fat, while lean mass declines. A review of the evidence found that menopause is associated with increased total body fat and a tendency for that fat to accumulate around the waist,” he said.

So, are hormones making you gain weight? Not necessarily, and this is where the conversation needs some nuance. The evidence does not support the idea that menopause alone causes every pound gained during midlife.

“One large longitudinal study found that weight continued to increase before menopause but did not suddenly accelerate at the beginning of the menopausal transition. What did change significantly was body composition: fat accumulation increased while lean mass declined,” he said.

Another study involving more than 1,500 women found that changes in waist circumference and body size could themselves influence subsequent sex-hormone levels, suggesting that the relationship between hormones and weight is not simply one-way.

In other words, it is not as simple as saying, “My hormones caused my weight gain.” The relationship is more complex.

For women who have spent years maintaining a particular weight through diet and exercise, mid-life changes can be frustrating. The same routine that once produced predictable results may no longer produce the same changes in body composition.

“Part of the reason is that ageing and menopause can affect muscle mass, fat distribution and energy expenditure. Research has documented increases in fat mass and decreases in lean mass during the menopausal transition, while other studies have observed increases in visceral fat among women transitioning through menopause,” he said.

That does not mean women are powerless to influence their weight or health. Rather, it reinforces the importance of looking beyond the bathroom scale. A woman who is concerned about weight changes may need to consider her waist circumference, muscle mass, sleep, nutrition, physical activity, blood pressure, blood glucose and other markers of metabolic health.

The Jamaican statistics make this conversation even more important. According to the Jamaica Health and Lifestyle Survey, only 27.8 per cent of women fell within the normal BMI range, while 26.4 per cent were classified as overweight and 41.2 per cent as obese.

The survey also found that 67.9 per cent of women had an increased waist circumference, compared with 17.5 per cent of men.

Those figures point to an important distinction between simply asking, “How much do you weigh?” and asking, “Where is the weight being carried, and what does that mean for your health?”

Abdominal and visceral fat are of particular interest because their accumulation is associated with metabolic and cardiovascular risks. For women moving through mid-life, therefore, the goal should not simply be to chase a lower number on the scale. It should be to understand what is happening inside the body.

The growing interest in peptides has added another dimension to conversations about weight management, metabolism and wellness. Dr Thomas said this is an area where women should proceed carefully.

Not every peptide product marketed online or through the wellness industry has the same evidence behind it, and ‘natural’ or ‘targeted’ or ‘hormone-balancing’ does not automatically mean safe or appropriate.

Women considering any peptide-based treatment should understand what the product is, what it is intended to treat, what evidence supports its use, its potential side effects, and whether it is approved or medically appropriate for their individual circumstances.

The conversation should be about informed healthcare, not quick fixes. Perhaps the bigger issue is that hormonal health is about much more than weight.

A woman may be struggling with sleep, fatigue, changes in her menstrual cycle, mood fluctuations, hot flashes or changes in body composition and assume that she simply needs to exercise harder or eat less.

That does not mean every symptom is caused by hormones. Persistent or unexplained symptoms can have many possible causes and should be assessed by a qualified healthcare professional.

keisha.hill@gleanerjm.com