*Originally published in Women’s Lifestyle Magazine


A reader writes:


Dr. Lasater, may I ask your advice? I have been in menopause for about three years now, and because I was so bothered by hot flashes and night sweats, my doctor finally agreed to put me on an estradiol patch, after I had begged him to do so for over a year. I do feel better now, and my hot flashes and night sweats, while not totally gone, have become tolerable. But I keep struggling with weight gain, having put on over 15 pounds in the last three years. Also, I still feel a lot of fatigue, even though I generally get a good night’s sleep. My doctor has advised that I watch my calories and that I exercise regularly, both of which I really try to do, but it isn’t helping. What can I do? Please help!

Mary C.


Dear Mary,

I frequently hear this from new patients in my office, getting the impression, when voicing complaints of this sort, that they have in essence been told, “Welcome to the human race!” by friends, acquaintances, and on occasion even by their own physicians. But that is not a compassionate solution, and there are a number of steps that can be taken to help them.

Weight gain after menopause is extremely common, and has a number of possible causes. Certainly a woman whose lifestyle has changed as she ages, typically by having less physical activity and oftentimes by eating more calories than in the past, will almost certainly gain weight. It is so important to develop and maintain good habits of regular (preferably daily) exercise as well as to consistently eat healthy, both in the amounts of food as well as in the types of food that one consumes; these factors become even more important as a woman ages, both around the time of her menopause as well as in her post-menopausal years.

The type of diet with the most robust and convincing medical evidence supporting its health benefits is the Mediterranean Diet, which emphasizes whole grains, fruits and vegetables, fish rather than red meat, olive oil rather than dairy products, and, if one consumes alcohol, wine in moderation. Adherence to a Mediterranean Diet has been shown to reduce the incidence of cardiovascular disease, cancer, Alzheimer’s disease, as well as other diseases and problems. Note that the Mediterranean Diet is neither a weight-loss diet nor a diabetic-type diet per se, but it can be easily modified to achieve these ends by reducing the amount of carbohydrates, especially simple carbohydrates, that one chooses.

Another common factor that often contributes to weight gain after menopause is that a woman may be lacking in testosterone. (I discuss testosterone for women at length here.) Among the many benefits that testosterone provides is that adequate levels of testosterone in the body helps a woman maintain muscle mass and keep fat off!

(Does this get anyone’s attention?)

In combination with a healthy diet and a moderate exercise program, muscle mass can often be maintained or even increased, and belly fat in particular will often diminish.

Having adequate levels of testosterone can also help a woman feel more energy and avoid fatigue; having sufficient amounts of estradiol provided after menopause certainly is necessary in this regard, but adequate replacement of the woman’s missing testosterone can also help a lot.

One final word about a woman’s exercise plan: it’s very important to include both regular aerobic exercise, such as running, biking, swimming, rowing, etc., as well as regular resistance exercise, such as weight training or resistance bands. This does not mean that a woman needs to aggressively “pump iron” in an attempt to develop huge muscles, but that she should do some resistance training to maintain healthy muscles. This helps to reduce the risk of diabetes, of cardiovascular disease, and of osteoporosis, among others.

About the author:

Steve Lasater MD practices Bio-Identical Hormone Replacement and Age Management Medicine at Optimal Wellness Medical Group in Grand Rapids. He is committed to improving the overall health of men and women by using cutting-edge clinical principles that are both evidence-based as well as being customized for each individual. See more at http://www.OptimalWellnessMedical.com.