Nurse specialist in menopause Ruth Bailey explains how women are susceptible to weight gain in perimenopause and menopause, and how nurses can support women to manage their weight and the related health risks
The impact of weight gain in perimenopause and menopause
Metabolic changes that occur in perimenopause and menopause mean that weight gain, particularly around the middle, is common. Women may experience around 1.5 kg of weight gain per year, on average.1
A higher BMI is associated with a greater frequency and intensity of hot flushes, night sweats and heavier menstrual bleeding, affecting wellbeing and quality of life. Hence weight management is an important element of menopause treatment.
Women with a BMI of 30 kg/m2 or over are also at an increased risk of type 2 diabetes mellitus, hypertension, cardiovascular disease, venous thromboembolism, breast and endometrial cancer.2
NICE guidance recommends that healthcare professionals including GPNs advise women on lifestyle changes and interventions that could help their health and wellbeing as a component of individualised management.3
Women frequently report weight gain as a factor that impacts negatively on their self esteem and it can result in a loss of personal confidence and increased isolation. Supporting a weight loss strategy can be pivotal in reducing health risks, improving control of menopausal symptoms and establishing a foundation for healthy ageing.
HRT and weight again
There is no reliable evidence that hormone replacement therapy (HRT) causes weight gain or weight loss. However, HRT can be effective in managing symptoms of the menopause that impede healthy lifestyle strategies. It is difficult for women to exercise if they are experiencing hot flushes or fatigue. Low mood and anxiety can also affect motivation to make lifestyle changes in nutrition and exercise and so effective symptom management is essential in menopause care.
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Practical resources to support patients with nutrition
It is useful to ask women about their current diet and to explore their own ideas on making small manageable changes to improve nutrition.
Women may benefit from healthy eating advice to reduce portion size, avoid processed food, include five portions of fruit and vegetables and fibre daily, and reduce alcohol and calorific fizzy drinks. Inclusion of protein at every meal can help patients feel nourished and full, avoiding post-meal energy slumps.
The British Menopause Society provides some useful factsheets and video resources on its wellbeing hub. Patients may also be signposted to the free NHS weight loss app, or local weight loss specialist services.
Practical resources to encourage movement and exercise
Encouraging movement and exercise is an essential part of a weight management strategy and has the additional benefits of maintaining bone-strength, muscle-mass and flexibility. Movement and exercise can also be effective in reducing anxiety and stress, increasing a sense of wellbeing.
The natural decline of oestrogen in post-menopausal women decreases bone mineral density, muscle mass and strength, which can increase the risk of osteoporosis.2 Patients should be advised to take weight bearing exercise and include calcium in their diet to avoid this. The Royal Osteoporosis Society provides excellent fact sheets and a calcium calculator that can be used to assess intake.
Current NHS guidance on physical activity for adults recommends that adults should aim for 150 minutes of moderate exercise or 75 minutes of vigorous exercise and include strengthening activities at least 2 days a week.5 Patients should be advised to aim to take 10,000 steps a day which can be recorded on a pedometer on their mobile phone.
It is helpful to talk to patients about their current activity and help them identify opportunities to increase movement. This can be achieved through simple changes like extending a current dog walk, introducing a lunchtime stroll or signing up for a weekly exercise class.
Overcoming barriers to making lifestyle changes
Nurses are skilled in addressing concerns and negotiating care, and small suggestions can result in dramatic change. Some of the key barriers women face are:
- Psychological
Stress, anxiety and low mood can impact on motivation to make changes. Counselling or therapy can be accessed through local NHS providers or employer support schemes. Support through Apps can be helpful, such as the Calm or ShinyMind App. Patients with clinical depression or overwhelming anxiety should be assessed by the GP so that an appropriate plan can be put in place.
- Lack of time
It is common for women to cite lack of time as the reason they are unable to exercise or stick to a healthy eating plan. Women are frequently juggling work, family and caring commitments and often supporting their own parents as well as their children and grandchildren and have very little, if any, time for themselves.
Menopause is a time of transition, and it can be helpful to encourage women to use this as an opportunity to reassess their priorities and identify time for selfcare. Practical exercises and advice on how to do this is available in an easy-to-read book based on cognitive behavioural therapy by Hunter and Smith.6
- Cost of living
Liaison with social prescribers to access community groups, gym membership on prescription and support with accessing benefits can be invaluable.
The NHS couch to 5K programme has benefitted many and the national ParkRun organisation provides a free event in many parks across the UK where participants run or walk 5K.
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- Stress incontinence
Stress incontinence and vulval discomfort are common issues that prevent women from exercising. Discussion of genital symptoms of the menopause should be included in menopause assessment for the relief of symptoms and improvement of quality of life. Symptoms can be treated with topical vaginal oestrogen and encouragement to practise pelvic floor exercises. The award winning SqueezyApp is an effective tool to support this and many women will benefit from referral to a women’s health physiotherapist.
Summary
Weight gain in menopause is common, causes distress and is associated with greater severity of symptoms and significant health risks. The provision of evidence-based information and practical resources can radically improve women’s wellbeing.
References
- Denby, N. Menopause; Nutrition and Weight Gain. Post Reproductive Health. 2023;29(4):232-234
- Hillard T, Abernethy K, Hamoda H et al. Ayres J and Currie H. Management of the Menopause. Sixth edition. The British Menopause Society, Marlow
- Menopause: Diagnosis and management. [NG232] 2015
- Aparicio VA, Borges-Corsic M, Ruiz-Cabello P et al. Association of objectively measured physical activity and physical fitness with menopause symptoms. The Flamenco Project. Climacteric 2017; 20: 456-461
- NHS Guidance: Physical Activity guidelines for adults aged 19-64. 2021. Available at:www.nhs.uk/live-well/exercise/exercise-guidelines/physical-activity-guidelines-for-adults-aged-19-24. Last accessed July 24
- Hunter, M and Smith M (2021). Living Well Through the Menopause: An evidenced based cognitive behavioural guide. Robinson London
Useful Resources
Calm – The #1 App for Meditation and Sleep
Menopause Wellness Hub – Women’s Health Concern (womens-health-concern.org)
Lose weight – Better Health – NHS (www.nhs.uk)
Related Article: Study reveals teenage girls’ own views on low mood and anxiety increase
Osteoporosis: Calcium (theros.org.uk)
home | parkrun UK
ShinyMind – Mental Health & Wellbeing App co-created with the NHS
Home Page – Squeezy (squeezyapp.com)
