"It's not about the fat"
A new study + why we need to think differently about the body composition changes during the menopause transition
No matter how hard I have worked to leave behind dieting and diet culture, I have found myself slipping back into old thought patterns with surprising ease the past few years. I can feel my adolescent self sitting on my shoulder, criticizing the way my body is changing shape and getting softer with age. She notices how hard it is to feel like myself in my own body these days.
When I think about it, it makes sense. The menopause transition is the bookend to puberty. Just as it was a struggle to adapt to my body as a teenager and young adult, I’m struggling with what it means to live in an aging, older female body.
It feels silly and vain but then I stop and remind myself that my body IS literally changing on a physiological level. My hormones are taking my body on a wild rollercoaster ride.
More than 80 percent of menstruating people experience physical and psychological symptoms associated with the menopause transition—the period marked by abnormal fluctuations in hormones that eventually leads to the cessation of the menstrual cycle. On average, people spend seven years in this transition phase. (7 years!)
The most noticeable—and most griped about—changes people experience are weight gain and increased body fat. It’s the thing we talk about, complain about, and obsess about. It’s the thing that we often blame for all the bad things associated with the menopause.
However, a recent study suggests that we need to think differently about the body composition changes that happen during the menopause transition. And in doing so, we might be able to identify ways to mitigate menopause-related symptoms and improve health and quality of life.
The relationship between body composition, physical activity, and menopause symptoms
A group of researchers, lead by Dr. Abbie Smith-Ryan at the University of North Caroline at Chapel Hill, wanted to look at the relationship between body composition, physical activity and menopause symptoms.
They recruited a group of 72 women—one-third were premenopause, one-third were in perimenopause, and one-third were post-menopause. The participants answered questions about their symptoms and the researchers then tallied them up to determine the total number of menopause symptoms experienced. The women also wore an activity tracker for a week and were asked to keep their normal sleep and exercise habits.
Sam Moore, the lead author of the study and doctoral student at UNC, presented the preliminary findings at the Female Athlete Conference last June and the study officially published in the journal Menopause two weeks ago. The study provides more data, particularly data across the menopause transition so that we can better understand the trajectory of what’s going on.
Can you guess which group suffered the greatest burden of symptoms?
The women in perimenopause. What’s more, the researchers found that higher body fat percentage was indicative of more symptoms among this group too, explaining almost half of the variance in symptoms.
On the surface, it might seem like it’s reinforcing the same story—higher body fat percentage is linked to more menopause symptoms. But that’s not the full picture.
“It’s not about the fat.”
When I talked to Smith-Ryan about the study last summer, she told me that we shouldn’t just be talking about fat. “We need to talk about muscle,” she said.
Percentage body fat describes the relationships between fat and muscle. During the menopause transition, the distribution between muscle and fat changes because yes, women may be gaining fat. But, more importantly, they’re losing muscle since muscle declines with age and decreasing hormones. So even if they maintain the same amount of body fat, the fact that they’re losing muscle means that the percent body fat will still shift higher in relationship to muscle.
Smith-Ryan and her colleagues have seen this play out in the women they studied. In another analysis of this same cohort of women, they saw an increase in body fat coupled with a significant loss of muscle—both muscle size and quality—and a decrease in protein turnover, meaning that the muscle doesn’t use protein as well.
This matters because other studies suggest that even though higher body fat percentage may be linked to more symptoms, it’s not the actual percentage body fat that it’s important. Maintaining a steady body fat percentage seems to be the more important factor.
“Even women who enter perimenopause with a higher percent body fat, if that percentage remains stable across the menopause transition, it was indicative of lower symptoms,” Moore told me last year.
What can we do to mitigate menopause symptoms?
So here’s the part where Moore’s study is interesting.
Previous studies on the effect of exercise on menopause symptoms showed little or not effect, but those studies focused on low or moderate exercise. Here, they found that there vigorous physical activity was associated with fewer menopause-related symptoms. The data suggests that high intensity physical activity may moderate menopause symptoms by blunting these unfavorable body composition changes.
The thinking goes that by doing more intense exercise, it stimulates muscle in a way that offsets some of the muscle loss related to age. As a bonus, high intensity exercise has also been shown to target visceral fat. This is the fat deep inside your body and around your organs that’s associated with higher risk of cardiovascular and metabolic disease and that increases during menopause too.
While we still need more studies to both validate and understand the link between vigorous exercise and menopause symptoms, it is exciting because it points to a way to intervene that could potentially mitigate some the burden of menopause symptoms that so many women bear.
For me, I felt almost a sense of relief after learning more about this study. It takes the focus off of body fat—the thing that has been a lingering bogeyman in my head—and puts it on muscle. It makes me feel like there’s actually something I can do, something within my control, which is build muscle. And I know how to build muscle. I know how to strength train.
Links & Things
There are no links and things because I have fallen into a deep, deep rabbit hole of Royal family conspiracy theories about the whereabouts of Kate Middleton aka Princess of Wales aka the Duchess of Cambridge.
But if you were to read one thing about this whole situation, read this article from Nieman Lab with Ellie Hall, Buzzfeed News’ former royals reporter.
Thanks for being here. More soon.
Christine
Thank you for spotlighting this study and its conclusions—it's so important! However I'm wondering about your conclusion, focusing on strength training, which is indeed crucial. But I was reading the prior paragraphs, with its focus on high-intensity exercise, to be a call to do higher-intensity cardio in addition to strength work. Isn't the takeaway to do high intensity exercise (getting one's heart rate up for an extended period) *and* heavy lifting for muscles and bones, not just one or the other? Or did the study mainly focus on strengthening?
Re fat gain and what the scale says—I'll share the following not to brag but to share an unexpected menopause outcome. We all have a normal set weight, right? To me, this is the weight that is most typical, that our body gravitates toward, although daily weight can vary by many pounds based on hydration, inflammation, and other factors. When I was perimenopausal, my typical normal weight would swing a lot based on whether I was PMSing and whether I was inflamed and retaining water from extra-strenuous exercise such as running an ultra. Now, nearly two years fully post-menopause and taking a low-dose estrogen patch (.025mg) and progesterone pill (100mg), those weight swings have mostly gone away or minimized, and my set weight is about 5 pounds less than at any time during adulthood! And I haven't really changed anything, except reduced alcohol (which may be a main factor). I certainly still eat hearty and do not monitor calorie intake. I hope this weight reduction is not due to loss of muscle; I do strength training to preserve muscle mass. I really haven't changed much with my lifelong exercise habits. It's as if my body got past the storm of perimenopause and settled into a more efficient, less inflamed state. This may be TMI but I put it out there because I wonder if it has to do with an upside to menopause hormone therapy or what?
I (Heather) appreciate this so much, and am realizing how much I have to learn as I gradually enter that zone of perimenopause (or am I there?!). The findings related to the steadiness of body fat percentage mirror what we see in weight cycling research too. It's not so much that a higher body weight is so strongly correlated with negative health outcomes; it's much more to do with health promoting "behaviors" (e.g. exercise, diet variety, not smoking, etc.) and weight stability vs cycling up and down. And with the recently signed executive order for women's health research, hopefully we see a lot more of this to come!