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A while ago, a listener wrote to me asking a question that was decidedly beyond my area of expertise. It was a question about menopause. Seeing as I am neither a doctor nor a woman, I decided I needed to call in an expert to tackle this one.

The question was:

"I have just started the menopause and would really like to keep trim and lean and keep my muscle tone up. Is this realistic, or is middle-aged spread inevitable,  and I should just accept that I will have a rounder, softer, body than I used to? I have noticed there are very few women my age in the gym lifting weights."

I met my podcast guest, Dr. Tamsin Lewis, when she was racing (and winning) Ironman triathlons. She has since become an expert in the field of aging and hormones, making her the perfect guest for this topic.

A three-pronged strategy for the fit menopausal woman

In our conversation, we broke down the most important and actionable tips into to three buckets: 

  1. Nutritional strategy: Reducing simple carbs and increasing protein intake.
  2. Supplementary strategy: Discussing with a trusted physician the possibility of introducing bioidentical hormone replacement.
  3. Lifestyle strategy: Increasing the amount of resistance or strength training (specifically in the larger muscle groups), choosing physical activities that are enjoyable and contribute to your happiness and lower stress, sleeping well, and focusing on a restorative practice (yoga, pilates, and breath work). 

Here is a transcript of my conversation with Dr. Tamsin Lewis. The text is verbatim, so it’s much easier to listen to than to read. So, as always, I encourage you to listen to the audio so you don’t miss out on any of the subtleties. 

Exercise for Menopause

Brock: I’m going to harken back to a question that I received specifically from one of the listeners. I guess a good place to start would be to answer her first question because I think we can answer that quite quickly. Is she right? Is this middle-age spread inevitable?

Dr. Tam: I don’t think anything in life is inevitable, is it? Apart from death and taxes. Who was it that said that? I think it’s certainly more common, and it’s certainly [something] that people come to me to help explore in terms of if there’s any answers for why I’m suddenly gaining weight. I haven’t changed what I’m eating. I’m mostly doing the same exercise. But certainly, once you approach that menopausal transition, the shift in the hormones absolutely makes you more prone to storing weight. So there are two things there. You can either adjust the way you exercise, or you should adjust the way you exercise, and we’ll come back to that. And also you can alter this hormonal milieu as they call it by three strategic dietary approaches, and also potentially using in a safe and medically guided manner, hormones, bioidentical hormones. So effectively replacing what your body is running out of, or is imbalanced in. Talking more about the perimenopausal state, which can certainly be from anything from mid-thirties onwards, where you become this ratio of estrogen and progesterone changes.

Dr. Tam: Estrogen tends to make you store fat. It tends to make you more prone to being, this is when you have excess estrogen, it tends to make you feel bloated. It can make you store fat specifically in the female-dominant shape so around the hips and the waist and the breasts. So I mean, I could explore the chemistry all day, but I guess we need to look at the answers here. And I think for the menopause when the timing is important. So classically, medically, menopause is defined as the absence of menstrual cycles for a period of one year. But the perimenopause is that years before, perhaps even up to 10 years, classically around five years, of hormonal changes. And that’s as I’ve said, usually characterized by this fluctuation of estrogen levels, either in an estrogen-dominant picture or in a low estrogen and progesterone picture. So once you reach the menopause, if you’ve been characterized medically or by yourself as not having any menstrual cycles for approximately one year, then you could probably make the decision, which means you will have categorically very little estrogen circulating, estrogen and progesterone.

Dr. Tam: Now that can lead to a situation in the body, which changes up its preference for fat storage. And it also changes the function of cortisol. So theoretically, I know we’re going into a lot of detail here, but your body does become more prone to storing weight around the middle. I’ve mentioned a few things here. I’ve mentioned the role of estrogen in its being dominant and in its problems with high estrogen. So in the menopause, there’ll be very low estrogen. You’ve gone through the ovarian senescence, as we call it, which is where the ovaries stop producing estrogen. So estrogen levels would be low. Estrogen is such an important hormone, but it needs to be at the right level. In the menopausal, levels are going to be too low. So we need a certain amount of estrogen to drive a healthy fat metabolism. And also it’s protected to the brain, to the cardiovascular system, and to bones. So I guess if we just back up a little bit and to answer the question here, is it inevitable that your body shape changes?

Dr. Tam: In most cases it is inevitable. There are things you can do to make that inevitability less pronounced. So for example, she mentioned that very few people as she sees in the older ladies lifting weights, and there are two reasons behind that, one, I feel, and you can disagree or agree here that one needs to feel strong in order to lift weights to start with it. It’s like it precludes you, I go to the gym or I feel a bit too weak to do that, and therefore I’ll avoid it. So there needs to be a graded approach to weights. Also, I don’t like the word lifting, but weights.

Brock: Yeah, it sounds like bodybuilding or something. But resistance training, how about that?

Dr. Tam: Resistance training. So I think there’s got to be a balance between some intensity, some weight training, or resistance training. So anything that puts the muscles under strain, and encourages a strengthening response so that the cardiovascular endurance in stroke intensity and then the resistance. And then also restorative exercise, which is often neglected, and that’s more of the yoga, Pilates, breath work, etcetera. I think there needs to be a balance of all three. Now, I’m trying to get this into a system whereby your listeners can understand, because it’s complex.

Brock: It is. It’s very complex.

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