Perimenopause and Menopause

Excerpted from
Body for Life for Women: A Woman's Plan for Physical and Mental Transformation
By Pamela Peeke, M.D., M.P.H

Welcome to Milestone 3! This is where I'm hanging out right now, and I'm happy to tell you that the view from here is just fine. You might think I'm crazy. What's so cool about more body far, a wider waist, and a metabolism that appears to be tanking? The good news is that you can get control of all this, and look and feel better than you ever have.

Typically in Milestone 3. your kids, if you have any, are older; your rime is more your own. Your stresses may include workplace woes, the boomerang child who's back in his or her old room until that elusive job appears, or new worries about age-related medical conditions of you or your loved ones. For the first time in your life, you're thinking about your own mortality. I'll never forget my first conversations with my good friend Katie Couric, who, while in her early forties, suffered through the tragic loss of both her young husband and her older sister. It's such a cruel blow to have to endure that grief and look into the mirror of your own life and worry about death.

And then there's the other big M-menopause. But first you have to get through perimenopause, which, as currently defined by the NIH, extends from the first onset of symptoms through the 12 months after the cessation of your menses. This phase can extend from the late thirties to the midfifties. Ouch. That's a lot of time to be shape-shifting in your hormonal hurricane, soaking in your bedsheets, waking up all night, hot-flashing, and enduring funky, unpredictable menstrual cycles.

I know through experience that you're really frustrated about midlife weight gain. Well, we'll get it off you, girlfriend. But let me tell you this: In this Milestone, it's definitely about removing for and looking great while living through a natural estrogen withdrawal. But it's also about optimizing every opportunity for perimenopausal self-care now, so that you can continue to live well in the future.

What's Happening In Your Body

After age 40, the average woman starts losing about 1/2 pound of muscle per year. Actually, through disuse, she can lose 5 to 10 pounds of muscle between ages 40 and 55. As I've already mentioned, when you lose muscle, your daily calorie burn dips, while the number of calories you eat either stays the same or increases. Either way, you end up with more body fat. Now, add that to declining female sex hormones, a sedentary lifestyle, and the presence of what I call "Toxic Stress," and you have the recipe for big-time weight gain during this period of life.

Where's the fat going? If you're 40 or over, you know. The upper body gets fluffier. Estrogen usually directs fat to the lower body, but as hormone levels begin to decline, it becomes easier to deposit extra fat on the upper body. You get the back roll, the flapping upper arms, the fat that pooches out over your bra (one of my patients refers to it as having two extra breasts). Speaking of bras, don't be surprised if you go up at least a cup size.

And you get the single most frustrating symptom of this Milestone-the expanding waistline. Suddenly belt is a four-letter word. Like men, women in Milestone 3 store excess belly fat in two compartments. The first is outside the abdominal muscle. I call it the "menopot" (manopot, for men!). The second is underneath the abdominal wall, around the organs, deep in the belly. Yep, Toxic Fat.

Some studies have found that postmenopausal women have up to 49 percent more intra-abdominal fat and 36 percent more upper-body fat than premenopausal women do. The grand majority of women will get a menopot. It's normal and to be expected as you course through perimenopause. Typically, the menopot is no more than about 5 pounds and is not associated with illness. We'll always have some menopot as we age. The key is to minimize it to its rock bottom and keep it like that.

But it isn't as easy as when we were premenopausal. Menopot fat is stubborn fat. Studies conducted at the University of Maryland showed that these Milestone 3 fat cells are less efficient at releasing their fat to be used as energy. This means that the menopot is probably a throwback to prehistoric rimes, when the matriarch of the clan needed extra body fat to survive famine so she could care for her children and grandchildren.

This shift of for from our behinds to the menopot saved our female butts back in prehistoric times. But it's the Toxic Fat we should really be worried about.

If excess fat starts to accumulate inside your abdomen, you've got problems. As I noted. Toxic Far raises a woman's risk for heart disease, diabetes, and cancer. What's more, as you lose estrogen and gain body fat, your levels of protective HDL cholesterol drop, while your levels of artery-clogging LDL cholesterol and triglycerides rise.

Though growing a small menopot is inevitable-I have mine!-a full-blown gut is not. So don't expect to completely eliminate your menopot. Just minimize it with good nutrition and regular physical activity. When researchers at the University of Pittsburgh Medical Center compared the body compositions of athletic perimenopausal women with those of women who were couch potatoes or who were only moderately active, they found that the athletes had the least trunk, arm, leg, and total body for. Plus, they weighed an average of 17 pounds less than the less active gals.