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Five ways to fight insulin-resistant menopausal weight gain

Whether it’s yourself or your mother, sister, or girlfriend, you likely know a woman who has entered menopause or perimenopause who also cannot lose weight. Stubborn pounds grow around her midsection, seemingly resistant to changes in diet and exercise routine. 

For many women, this frustrating weight gain is yet another unpleasant symptom of menopause, which can include changes in mood, difficulty sleeping, night sweats, vaginal dryness, skin changes (including acne), and more.

So why does this happen? And what can be done? Tryon Women’s Center’s gynecology and sexual health expert Jennie Jarvis Hauschka, MD, FACOG, offers insight on insulin-resistant weight gain during menopause.

What is insulin? How does it impact weight gain?

Most people associate insulin processing issues with diabetes, but insulin plays a role in every person’s metabolism. 

“Insulin is a hormone made by the pancreas that tells our cells to open and let glucose in,” explains Dr. Hauschka. “When someone becomes insulin resistant, that same amount of insulin allows less glucose into cells. Because the body doesn’t turn that glucose into energy to burn, blood sugar becomes elevated, triggering the pancreas to make even more insulin.” 

Elevated blood sugar that cannot enter the muscle cells to be burned is converted to fat and stored. This is why insulin resistance makes it hard for people to lose weight.

Why does this happen during menopause?

Insulin resistance can occur in both men and women, but menopausal women and those diagnosed with polycystic ovarian syndrome (PCOS) are at higher risk. Estrogen improves insulin sensitivity, leaving women more vulnerable as they lose estrogen due to menopause or the hormonal imbalance that comes with PCOS.

“While I often see insulin-resistant weight gain in menopausal women, we can also see the first signs of elevated glucose levels in a primary care blood panel,” says Dr. Hauschka. “This is a perfect example of why women need to see both a gynecologist and primary care physician, so both clinicians can work together to provide the continuous care that patients deserve.”

What can be done?

Being overweight or eating a diet high in flour and sugar increases the likelihood of insulin resistance, but it can happen to anyone. 

“Patients come to me very frustrated,” empathizes Dr. Hauschka. “They have balanced, clean diets; they eat less and move more, but feel nothing they do for weight loss really works.” 

Appetite suppressants and medications like the diabetes drug metformin can be used to treat insulin resistance. (While buzzworthy Wegovy also works, it is not covered by insurance to treat insulin resistance that is not accompanied by a body mass index over 30, or conditions like diabetes and high blood pressure.)

Here are Dr. Haushcka’s top five things that can help:

  1. Intermittent fasting
    If you avoid eating or drinking things that will have an effect on insulin for at least 16 hours, the prolonged low insulin state allows more burning of fat stores, after carbohydrate energy is gone.
  2. Avoid flour and sugar
    Opt for fruit, veggies, nuts, quinoa, brown rice, and avoid processed foods. Learn to read labels to find out if there is hidden sugar in the foods you commonly eat.
  3. Plan ahead
    Know what you will eat 24 hours in advance and stick to that plan. Avoid snacking.
  4. Keep a food diary
    Make a simple list of what you eat and try to identify what triggers you to overeat. Get used to feeling an urge to eat something and let it pass.
  5. Exercise
    Aim for 150 minutes of moderate exercise weekly. While in the weight loss phase of your plan, it is better to not do intense exercise, as this can make you more hungry.

If you experience insulin-resistant weight gain, it does not mean you are diabetic. However it can be a sign of prediabetes, which can lead to type 2 diabetes. If you are concerned, talk to your primary care clinician, or mention it the next time you’re at the Tryon Women’s Center.