Weight gain

Putting on weight in the years around menopause, mostly around the stomach and upper body. The NHS website says this is common in perimenopause and menopause.

Doctors sometimes call fat around the middle central adiposity. The Pakistan Menopause Society lists concern about weight among the early symptoms of perimenopause, and central fat among the longer-term effects (Table 1).

Clothes that fit last Eid no longer close. A waist that has thickened even where your weight on the scale has barely moved. Feeling heavier and slower, and more tired after the same day's work. For many women it is the comments, more than the weight, that sting.

The British Menopause Society explains it this way. As estrogen falls, more fat is stored around the organs, deep in the abdomen. At the same time muscle mass drops, and the rate the body burns energy slows. So the same food, eaten the same way, can lead to weight gain.

And HRT? NHS inform, the Scottish health service's site, notes that there is no evidence HRT makes women put on weight, and that weight gain during the menopause often happens whether or not a woman takes HRT. The Menopause Society, the North American menopause body, goes a little further in its 2022 statement: HRT may help limit the build-up of fat around the middle and the weight gain of the menopause transition, but the effect is small. It rates that evidence as limited.

Why it matters more for South Asian women

The British Menopause Society notes that South Asian women have a higher rate of heart risk factors during the menopause transition: insulin resistance, diabetes, fat around the middle and high blood pressure. The Pakistan Menopause Society lists central fat and insulin resistance among the longer-term effects of menopause that doctors should watch for (Table 1). Weight around the middle is not only about how clothes fit.

• The British Menopause Society says there is high-quality evidence for eating fewer calories together with more exercise, including strength exercise. It calls strength exercise close to essential for women at this stage who want to change their weight or shape. Strength training covers how to start.
• It warns against diets that cut out whole food groups, and says carbohydrates should stay, choosing slower-releasing ones. Its own examples include chapati and basmati rice.
• It suggests judging progress by your measurements and how your clothes fit, not the scales alone.
• The Pakistan Menopause Society names sweetened drinks and colas as drivers of central weight in Pakistani diets, and encourages saag, methi, moong dal, chana and makkai ki roti (Table 5). On white rice and white bread, Women's Health Concern says they can be part of a healthy diet and need not be avoided, though more of your starchy food should be wholegrain.

The library's long read on nutrition and weight management go further.

There is no medicine for menopause weight gain in these guidelines. The British Menopause Society calls good nutrition and an active life the cornerstone of a healthy menopause, whether or not HRT is part of a woman's treatment. If weight is linked to another condition, such as diabetes or a thyroid problem, that is for your doctor to find and treat.

The Pakistan Menopause Society asks doctors to use the menopause visit for prevention: checking blood pressure, body mass index, blood sugar and cholesterol, and asking about weight gain and fat around the middle (Tables 1 and 2). If you are putting on weight around your middle and there is diabetes or heart disease in your family, that check is worth asking for.

The British Menopause Society also tells doctors to ask before starting a conversation about diet. You are allowed to say now is not the right time.

Food at home is family, hospitality and love, and the cook is often the last person anyone thinks to ask. Changing what goes on the table can mean changing it for everyone, and that is a conversation, not a rule. The Pakistan Menopause Society names shared healthy habits as one way a husband and family can help (section 4.2.6).

When the remarks come at weddings and dawats, it can help to have one line ready: this is the menopause, and I am looking after it.