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Facilitating open discussions during perimenopause and menopause helps foster trust and mutual understanding between patients and practitioners.

Women are aware their bodies are changing, and hearing these changes are expected during can potentially help ease fears and help patients navigate the changes, said Nicole Kerner, MD, associate professor of obstetrics and gynecology at Duke University School of Medicine in Durham, North Carolina.

Weight during these years could be especially concerning for female patients. “If women understand what is happening to their bodies, they may feel less frustrated that they are gaining weight despite their best efforts,” said Kerner.

As women age, there are specific changes that begin about 2 years ahead of the final menstrual period, she said.

“As we know, aging in general causes weight gain. The drop in estrogen and progesterone stimulate the pituitary to release FSH [follicle-stimulating hormone] in effort to get the ovaries to produce,” cited Kerner. “High FSH levels can potentially stimulate fat deposition in areas where FSH receptors are expressed, such as visceral fat.”

Recommended Lifestyle Modifications

Also, as estrogen levels drop, there are lipid changes that are independent of age-related changes, which include decreasing levels of high-density lipoprotein, with increased levels of low-density lipoprotein, total cholesterol, and triglycerides, she outlined.

“While genetics may contribute to increased fat distribution during menopause, lifestyle modifications can still be helpful,” Kerner said.

Helping patients understand that not everything is in their control can help.

“Recognizing that menopausal body composition changes are due to physiologic changes and not due to a person’s sudden lack of effort at the gym, or change in dietary habits can be helpful,” added Kerner. “I am grateful we are talking about this, and women should hopefully find some relief in the knowledge that diet and exercise can be powerful, and medication is available if needed to assist.”

Explaining Why Weight Gain May Happen

Weight gain during menopause may result from many factors, so work to make sure patients understand them, said Sara Deatsman, MD, a clinical assistant professor in the Department of Obstetrics and Gynecology at the UF College of Medicine in Gainesville, Florida.

She attributes weight gain for this patient population to decreasing estrogen that leads to increased fat storage, which often tends to be in the abdominal area; a decrease in muscle mass due to decreased calorie burn; and also how patients may become more sedentary with age.

“Weight gain tends to be in the abdominal area, both around the internal organs and in the skin tissue,” said Deatsman. “And if someone has family with increased weight in the abdominal area, there may be a genetic component that leads to where this weight is deposited.”

Approaching Patients With Sensitivity

Although it’s a sensitive time of life for female patients, a primary care physician can be a trusted resource for charting a course toward wellness. Creating a safe space for such conversations is a good starting point.

“It’s reasonable to see if the patient has question about changes in mid-life and to provide anticipatory guidance about what they may experience,” Deatsman said.

Recommended Health Strategies With Clinical Evidence

Some patients may ask you about hormone therapy to manage weight gain, but Deatsman noted it may relieve menopause symptoms, not prevent weight gain. “Focusing on maintaining muscle mass and continuing to be active are better options,” she affirmed.

Lifestyle modifications will always be the cornerstone of preventing and reversing adverse changes in body composition, said Kerner.

“Diet and exercise are more important than ever. The Mediterranean diet has the most data for weight loss in menopause. This diet focuses on vegetables, fruits, whole grains, and legumes, with limited intake of animal fats,” Kerner said.

How GLP-1 Medications Play a Role

GLP-1 medications aren’t for everyone. To qualify, patients typically need to meet specific criteria: have a BMI ≥ 30 or a BMI > 27 with a weigh-aligned health condition, such as high blood pressure, high cholesterol, type 2 diabetes, heart disease, or sleep apnea. GLP-1’s should be considered in patients when lifestyle modifications have been unsuccessful, said Kerner. “There is great promise showing menopausal hormone therapy and GLP-1s together have synergistic effects on weight loss in menopause, and are superior to either intervention on its own,” she said.

Deatsman said self-advocacy and provider-care management in tandem can benefit patients. “Weight gain is typical with aging in general, she said, but significant weight gain can be avoided by following the recommendations above,” Deatsman said. “The important thing for overall health is to stay active and try to keep up strength.”

Deatsman reported having no disclosures. Kerner reported being co-founder and chief medical officer of Venus Health Science (Alubri intimate wellness products).