9 Menopause Myths That Are Harming Your Health

The following is chapter 2 from my book,Mastering Menopause.

There are plenty of myths about menopause. Some of them, you might actually believe. Lucky for you that youre reading this book, because in this chapter, well bust 9 of the most common myths about menopause, and answer a couple of frequently asked questions.

Before we jump in, lets just give some definitions of common terms:

• Premenopause: all the years from birth until you stop having periods.
• Perimenopause: the transition to menopause. This is when hormone levels drop, periods become more irregular, until you stop having periods. This could be as long as 10 years.
• Menopause: one year since your last period.
• Postmenopause: all the years after menopause.

With those definitions out of the way, lets start mythbusting. In no particular order:

Myth #1: All Women Gain Weight During and After Menopause

Very often, is were in a certain undesirable position, we think that others are as well. We think our situation is universal. After all, misery loves company.

But not all women gain weight during menopause.

In one study, 591 premenopausal women were recruited who were expected to be menopausal or postmenopausal over the next 5 years.

After 5 years, of the 591 women, 109 women (18%) actually lost 3% of their body weight. 255 women (43%) maintained their weight. And 227 women (39%) gained weight.

In another study of 497 women, 29% of them maintained their weight during and after menopause. 12% of them lost weight and 59% gained weight.

The overall message is that the number of women who gain weight during and after menopause varies study by study, but not all women gain weight during and after menopause. Some do and some dont. What is it that differentiates those who do, and those who dont? Ill cover that in myth #7. Keep reading

 

Myth #2: Weight Gain in Menopause is Bad

Were often told that weight gain is bad, as a blanket statement. But thats not true for a lot of people who gain weight. People who were underweight to begin with, and gain weight, experience a healthy weight gain. Likewise, women who had an ideal BMI (body mass index thats your weight in kg, divided by your height in meters squared. Stated another way, thats kg/m²) before menopause actually experience improvements in health and vitality when they go from a normal BMI (which is 18.5-24.9) to slightly overweight (a BMI of 25.0-29.9). This doesnt apply to women who were overweight and became obese (BMI >30).

Wait, what? Why is a personal trainer is saying that weight gain is healthy post menopause? Surely, he must mean from muscle? No, I dont. Actual body fat gain during and after menopause is a good thing. But dont take my word for it. Heres some research:

In one study of 6030 people, lean menopausal women (who had a BMI of under 25) who gained weight actually had a 65% reduction in their risk of all-cause mortality (risk of dying for any reason heart disease, cancer, dementia, etc.). How much weight, you ask? As much as 22 lbs. (10 kg). The same study showed that on the other hand, when premenopausal women gain weight, their risk of all-cause mortality rises by 5%.

One systematic review showed that weight loss in postmenopausal women did not reduce the risk of heart disease. In other words, some postmenopausal women who exercised and improved their nutrition lost weight, and others didnt. Regardless of whether weight was lost, there was a reduction in the risk of heart disease. So its not the weight loss that improved it, but rather, improved exercise and nutrition even if it didnt lead to weight loss.

To summarize the research, weight gain in premenopausal women who were of normal weight to begin with is not good. But weight gain in postmenopausal women who were of normal weight and became slightly overweight is good. Weight gain in postmenopausal women who were of normal weight or even overweight and became obese is not good either.

Aint that interesting?

Are you wondering why weight gain (and again, were talking about fat gain, not muscle) has such a positive effect on disease risk in postmenopausal women?

Estrogen. Besides age, one of the reasons that younger women have lower rates of heart disease compared to older women is that they have higher estrogen levels.

Before menopause, the 3 organs that make estrogen are the ovaries, adrenal glands and body fat. After menopause, the ovaries dont do the job anymore, so most of the estrogen is made by the adrenal glands and body fat. So women who do gain body fat also have more estrogen (and we used to think that body fat was just passive tissue. We now that that it isnt. Body fat is a hormone-secreting organ in its own right. And its responsible in the production of more than just estrogen, but thats a discussion for another time), and all the benefits that come with more estrogen, like:

• Better skin quality
• Better mood
• Better sleep
• Better focus
• Less brain fog,

and the biggie: a 65% lower risk of all-cause mortality. The term all-cause mortality means the risk of dying for any reason (heart disease, cancer, dementia, etc.).

How much more estrogen do overweight women have compared to lean women? According to one study, about 50% more.

But what about menopausal symptoms? You might be thinking Maybe the length of life is longer, but the quality of life is lower. Do women who gain body fat have more menopausal symptoms? If a woman is overweight, her menopausal symptoms arent any higher than a lean woman. But if a woman is obese, yes, she has worse menopausal symptoms.

In one study of 749 postmenopausal women, they were divided into 3 categories, based on their BMI:

• Group 1 had a BMI under 25 (considered lean)
• Group 2 had a BMI of 25-29.9 (considered overweight)
• Group 3 had a BMI of 30 or higher (considered obese)

 

Here are the highlights:

• The frequency and severity of symptoms (all menopausal symptoms not just hot flashes) were almost identical between the lean and overweight women.
• The obese women had 17% more hot flashes compared to the overweight women, and their hot flashes were more severe.
• There was a 14% increase in muscle and joint problems between the overweight and obese women.
• There was a 29% increase in depression between the overweight and obese women.
• There was a 29% increase in sleep problems between the overweight and obese women.
• Twice as many obese women had bladder problems compared to overweight women.

In essence, the results of numerous studies on fat gain during and after menopause can be summarized as follows: Being overweight is advantageous, while being obese is not.

Does that mean that if youre a lean postmenopausal woman, you should deliberately try to add body fat? Sounds like fun, doesnt it? But no, I wouldnt advise that. So dont get a membership to your local buffet.

As youll learn in the following myths, body fat is gained involuntarily. Likely because the body wants a certain level of estrogen. If youre a lean woman, and youre experiencing minimal to no menopausal symptoms, you dont need to gain body fat. But if youre a lean woman, and you are experiencing menopausal symptoms, try implementing the advice in the rest of this book. If after 3 months, you dont see an improvement, it might actually be time to gain body fat. Although I have no research to back this up, a handful of times, Ive told female clients to deliberately gain body fat.

When do I do it? When they meet these criteria:

• Theyre experiencing estrogen-deficiency symptoms.
• Their body fat is very low (for a woman, below around 15%).

 

Lastly, before moving on to the next myth, I can feel the savvy, well-informed reader criticizing BMI as a method of assessing body fat. The typical argument against BMI is that it just takes weight and height into account. But if someone is very muscular, itll classify them as overweight/obese, even though theyre lean.

I get that. But to counter that point, first of all, on a population basis, BMI works just fine. Most of the population doesnt exercise. Second of all, the portion of the population that does exercise isnt doing so with the express intent of gaining maximum muscle. They want to gain a bit of muscle and lose a bit of fat. Theyre not trying to be Arnold Schwarzenegger. A gain of 4-6 pounds of muscle wont make a difference to BMI. Only a tiny percent of the population (probably under 1% of postmenopausal women) is so muscular where BMI is not a good gauge.

Again, on a population basis, BMI gets the job done. But even then, not in every population. BMI works well in the Caucasian population. But what if youre not Caucasian? Here are some general rules (study):

• East Asian Women (Chinese, Japanese, Korean, etc.) have a higher body fat at the same BMI. For them, obesity doesnt start at a BMI of 30, but rather, 27.
• For East Indian Women, its the same as East Asian Women, but even more exaggerated. For them, obesity starts at a BMI of 26.
• As for Black people, the relationship between BMI and body fat is complicated. On average, Black people gain more body fat with age, compared to Caucasians, Asians and East Indians. There are also significant differences between African Americans, Jamaicans and Africans. But in almost all Black people body fat percentage is lower at the same BMI compared to Caucasians. So as a rough estimate (this one is my opinion only), for them, obesity starts at a BMI of 31.

While BMI is good on a population basis, when studying large numbers of people, on an individual basis, I prefer to use body fat. It solves the problems with BMI. Whats the best way to measure body fat? Thats another debate in an of itself. I wrote an entire report on the different methods of body fat testing (like the body fat scale, handheld device, underwater dunking, DEXA scans, calipers, etc.), along with their pros and cons. Ive made that report available to you for free at www.Mastering-Menopause.com.

Nonetheless, what are the body fat guidelines that I use with clients? I like to see menopausal and postmenopausal women in the 18-28% body fat range. Above 28%, and we try to reduce it. Below 18%, and we try to either maintain if theyre feeling fine or raise their body fat if theyre experiencing estrogen-deficiency symptoms.

Now, I get it. When you picked up this book, maybe your biggest reason was to lose weight, and here you are, getting advice like weight loss may not be advisable. Lots of my clients have beautiful dresses, jeans, and tops that they really like, but are now feeling snug, or they just cant fit into them.

So its a bit of a psychological battle between what youre used to, and whats healthy at this point in your life.

 

Myth #3: My Metabolism Slowed Down

The women who gain weight during and after menopause often attribute it to their metabolism slowing down. It makes sense. Its logical, but its not correct.

Its undeniable that weight is gained. But the reason for that weight gain is largely (but not entirely) misattributed.

Theres a concept called Total Daily Energy Expenditure (or TDEE for short). There are 4 components to TDEE:

• Basal Metabolic Rate (BMR): this is how many calories you burn just to stay alive. How much energy it takes to keep your brain working, your blood flowing, your liver/kidney filtering, etc.
• Thermic Effect of Food (TEF): you dont absorb 100% of the calories that you eat. You absorb about 90% (although this varies slightly based on the composition of your diet). So you use 10% of the calories you eat for digestion, absorption and elimination (i.e., pooping/peeing).
• Exercise
• Non-Exercise Physical Activity (NEPA). This is movement that isnt purposeful exercise, that still burns calories. For instance, gardening is not a deliberate attempt to improve strength or endurance, but it burns calories. Housework is not a deliberate attempt to improve your fitness, but it burns calories. Some people also just fidget. They sit there and bounce their ankle. Or they twirl their hair, or they click the pen. All these little things can add up to hundreds of calories per day.

A drop in any one of these can cause weight gain. It also explains why you might be eating the same number of calories as before, but still gaining weight. The calories in part of the equation didnt change, but the calories out did.

Lets say that before menopause, your weight was stable, and hypothetically, you were eating 2500 calories a day. Since your weight was stable, you were also burning 2500 calories per day. Now that youve hit menopause, youre still eating 2500 calories per day, but youre now burning maybe 2300 calories per day. So what used to be maintenance calories is now a surplus of calories.

So where did this drop in caloric expenditure come from? Is it from metabolism or other sources? By and large, its the other components of TDEE.

One very large study looked at the metabolism of people as young as 8 days old, and as old as 95 years old. They found that strictly speaking about metabolism, there is no difference between the age of 20 and 60. Zero. Is weight gained during this time? For some people, yes, for others, no. But if weight is gained, its not due to a drop in metabolism. Its largely due to changes in activity levels and/or nutrition. Maybe when you were 20, you would play pickup soccer a few times a week, and youre not doing that anymore when youre 60.

After 60, metabolism does slow down by up to 0.7% per year, which isnt a lot. So any weight gained beyond 0.7% per year is not due to metabolism slowing down.

One study revealed that, during menopause, weight gain primarily occurs due to a substantial decrease in NEPA rather than a decline in BMR. So youre basically moving around less involuntarily. Youre less fidgety. In the words of the researchers, weight gain during menopause is predominantly due to a reduction in spontaneous activity. These little things can add up to hundreds of calories per day.

Fortunately, your metabolism doesnt slow down until approximately the age of 60, and even then, it slows down a little. But for the small declines in metabolism, whats the reason? The two biggest factors are simply body temperature, and muscle mass. As long as your body temperature is normal (36.5-36.8 Celsius or 97.7-98.2 Fahrenheit), theres not much to do there.

As for muscle mass thats largely within your control. One study concluded that the primary reason that metabolism slows down after menopause (and even then, not by much) is the loss of muscle. Another study found the same thing.

The solution to a decline in muscle mass is fairly simple (but not necessarily easy): strength training and adequate protein. Real strength training. Not body pump classes. Thats cardio with weights. Not that its bad for you, but its not strength training. How do you do strength training properly? Stay tuned until chapter 6, where well outline how to exercise properly during and after menopause. And in chapter 3, well discuss protein.

 

Myth #4: My Thyroid Caused the Weight Gain

Were often told that the thyroid is the master metabolic gland. Since it largely controls body temperature, its largely responsible for the metabolic rate as well. So its logical to conclude that since the metabolism slowed down (which we know is questionable, and the extent of the decrease is very small), the thyroid must be slowing down.

This one is only a half-myth, as youll see. The story of what happens to thyroid with age is quite fascinating.

One systematic review found that 2.4% of postmenopausal women have diagnosable thyroid disease. An additional 23.2% of postmenopausal women have subclinical thyroid disease (subclinical means that its not bad enough to be a diagnosable disease, but not good enough to be considered normal). Within that group of 23.2% with subclinical thyroid disease, 73.8% is hypothyroid, and 26.2% is hyperthyroid.

Heres where it gets a bit tricky: to diagnose thyroid issues, you have to use the right tests, and look at the right things. The most used test for thyroid function is TSH (thyroid stimulating hormone). While its a good test, its not complete. Tests that give you additional information about thyroid function are:

• Total T4
• Free T4
• Total T3
• Free T3
• Reverse T3
• Thyroid binding globulin (TBG)
• Anti-TPO antibodies
• Anti-TGB antibodies

Although this isn’t a book on thyroid physiology (though you can find a comprehensive video explaining these tests at www.Mastering-Menopause.com), the key takeaway is that relying solely on TSH doesn’t provide a complete picture of thyroid function. Why? Because one study showed that in postmenopausal women, there arent any changes in TSH, but there are drops in T4 and T3 (called the active thyroid hormones). In that study, the researchers recruited 50 healthy women between ages 20-44, and 50 healthy women between ages 45-77. Although both groups were healthy, the T4 levels of the older women were 37% lower than those of the younger women. The T3 levels of the older women were 16% lower than those of the younger women.

The real question from all of this is what does that mean? Should these drops in thyroid levels be addressed, or left alone?

One study proposed that the slight decline in thyroid hormones might actually be a good thing. With a lower metabolic rate, you use less energy, which contributes to longevity.

But when do these declines in thyroid levels become excessive? When is it Too much of a good thing? If someone has had declines in their thyroid levels from before menopause to after menopause, and is not experiencing hypothyroid symptoms, chances are that no treatment may be necessary. But if their thyroid levels have dropped, and they are experiencing hypothyroid symptoms, it may be time to speak to their doctor about getting some treatment.

Or if all of this is too confusing, speak to your doctor anyway.

 

Myth #5: Im Inflamed

Due to charlatan health gurus using scare tactics about inflammation, more and more people are afraid that they’re inflamed. In fact, without testing, lots of people are claiming that theyre inflamed. Its almost trendy to be inflamed. But how does menopause affect inflammation?

To really answer that, we have to look at the common tests for inflammation:

 

• CRP (C-Reactive Protein)
• TNF-alpha (Tumor Necrosis Factor alpha)
• IL-6 (Interleukin-6)
• Fibrinogen

By the way, if you want a list of the 49 blood tests that I give to my clients to ask their doctors to run, its available to you for free at www.Mastering-Menopause.com.

While this isnt a book on diagnostics, I just want to lay the groundwork for how inflammation is measured.

One study compared the levels of CRP, IL-6 and TNF-alpha between 45 premenopausal women and 44 postmenopausal women. They found that CRP and IL-6 are no higher in the postmenopausal women compared to the premenopausal women, but TNF-alpha was indeed higher.

Another study also found that fibrinogen is no different between premenopausal and postmenopausal women.

But lets backtrack a little bit, and ask a seemingly basic question: what is inflammation? The simple answer is that inflammation is a repair process. The body is trying to repair damaged tissue.

So whats damaged? What is the body trying to repair? Largely its the muscle that is lost with aging and declining estrogen levels. How do we know this? Because in one study, every inflammatory marker that was elevated decreased with both cardio and strength training. One large systematic review of 1510 postmenopausal women found the same thing: exercise is anti-inflammatory in postmenopausal women.

Stay tuned until chapter 6 to learn how to exercise properly in your postmenopausal years.

 

Myth #6: I Should Gain Muscle to Lose Fat

This is another myth that spread during the early days of the internet. The myth went like this: Muscle burns calories even when youre sleeping. So if you increase your muscle, youll speed up your metabolism, and lose fat.

This is only partially true. The numbers thrown around on the internet until very recently were that each pound of muscle burns 40-50 calories per day. But anyone who actually did the math would see that it doesnt make sense. The body of an average postmenopausal woman (who doesnt do strength training) contains about 27% muscle. So if a woman weighs 150 pounds, she would have about 40 pounds of muscle. If each pound burned 40-50 calories per day, her metabolic rate from muscle alone would be 1600-2000 calories per day. Never mind all the calories burned by other organs (the brain and liver burn a lot of calories as well).

But metabolic rates for average postmenopausal women are around 900-1400 calories per day.

It is now estimated that each pound of muscle burns around 6-10 calories per day. But thats not the whole story. Body fat also burns calories. It burns around 2 calories per pound per day.

So for the gain muscle to burn fat theory to be meaningful, youd have to gain a lot of muscle. Like 15-20 pounds of muscle. And thats extremely difficult (and takes 2-3 years).

So gaining muscle to burn fat is not the most direct way to fat loss. There are many great reasons to gain muscle, like:

• Improved bone density.
• Better mobility, and overall function.
• Better blood sugar control.
• Lower blood pressure.
• Reduced inflammation.

But fat loss is not a good reason to gain muscle.

 

Myth #7: Fat Loss is 80% Nutrition and 20% Exercise

Youll often see this sound bite online if you want to lose fat, nutrition is responsible for 80% of the results, and exercise is responsible for 20% of the results.

Unfortunately, sound bites lose a lot of nuances. And this sound bite is certainly not true for postmenopausal women.

At this stage of your life, exercise is more like 40-50% of the fat loss puzzle. Remember from myth #3, that the biggest reason for fat gain during and after menopause is not a slowdown in metabolism, but a drop in involuntary activity? Well, the way you compensate for that is with an increase in voluntary activity exercise.

In one very large study, the researchers followed 34,079 women for 15 years. At the beginning of the study, their average age was 54 years old.

The women were divided into 3 categories based on their physical activity levels:

• Group 1 burned less than 7.5 calories/kg/week. In other words, a 154-pound woman is 70 kg. So this woman would have burned less than 525 calories per week.
• Group 2 burned between 7.5-21 calories/kg/week.
• Group 3 burned over 21 calories/kg/week.

 

To absolutely nobodys surprise, the group that exercised the most gained the least weight (between 0-2.3 kg or about 5 lbs.), while very few women lost weight. Again, this might be pointing to the fact that the postmenopausal body actually wants to gain body fat to maintain whatever estrogen levels can be maintained.

 

Myth #8: Theres an Optimal Estrogen or Hormone Level

One common question amongst postmenopausal women is whats the optimal estrogen/progesterone/testosterone level?

We wish it were a nice, simple answer, like a specific number. But unfortunately, its much more complicated than that. Heres why:

We use the word estrogen like its a single hormone, but its actually 3 different hormones:

• Estradiol: the dominant premenopausal estrogen. Largely made by the ovaries, although the adrenal glands and body fat make it as well.
• Estrone: the dominant postmenopausal estrogen. Largely made by body fat. And weaker than estradiol.
• Estriol: the dominant estrogen during pregnancy. Since thats not the topic of this book, well leave that one out of the conversation.

 

So one thing that makes it hard to determine an optimal hormone level is to determine which estrogen were talking about.

Furthermore, estrogen is a double-edged sword. On the one hand, it improves bone density, mood, muscle, skin, decreases hot flashes, etc., but on the other hand, high levels of estrogen are also implicated in different cancers, like breast, vaginal, ovarian, endometrial, etc. So whats the right level that gives you the benefits of estrogen, without the risks of estrogen? We wish it was a strict cutoff, but it isnt. Theres some overlap.

As if this wasnt complicated enough, the research is conflicting as well.

In one study, 209 postmenopausal women were given questionnaires about cognitive decline. The average estradiol levels in women with cognitive decline were 14.95 pg/ml (54.8 pmol/l). The average estradiol levels of women without cognitive decline were 21.67 pg/ml (79.6 pmol/l).

If you were to look at this single study, youd conclude A-ha! So the optimal level of estradiol after menopause is over 20 pg/ml (73.4 pmol/l). But its not quite that simple, because in the group that had cognitive decline, their average estradiol level was 14.95 pg/ml (54.8 pmol/l). But the variation was 10.24 pg/ml (37.6 pmol/l). It means that the range was as low as 4.71 pg/ml (17.3 pmol/l), and as high as 25.19 pg/ml (92.5 pmol/l). In the group that didnt have cognitive decline the average estradiol level was 21.67 pg/ml (79.6 pmol/l), but the range was 14.92 pg/ml (54.8 pmol/l). So as you can see, theres significant overlap in estradiol levels between women who had cognitive decline and those who didnt.

The same is true for other health outcomes, like heart health, osteoporosis, etc.

Case in point, in one study, 90 postmenopausal women were recruited, and divided into 2 groups:

• Had a heart attack in the last year.
• Didnt have a heart attack in the last year.

The results are a bit confusing, because its actually the group that didnt have a heart attack that had lower estrogen levels.

Heres the data:

	Heart Attack	No Heart Attack
Estrone	52 pg/ml (192.3 pmol/l)	29 pg/ml (107.3 pmol/l)
Estradiol	31 pg/ml (113.8 pmol/l)	13 pg/ml (47.7 pmol/l)

 

These are just two examples, but the literature is filled with conflicting and confusing data.

Because its so complicated, women will often go to their endocrinologist, gynecologists, and GPs for years, trying different ratios of estradiol/estrone/progesterone every few months to figure out whats the right mix.

After all, if it was simple, we would just measure a womans current hormone levels, and give her the amount of hormone that brought her up to ideal. But therein lies the problem: we dont know whats ideal, and likely, it varies woman-by-woman.

 

Myth #9: Theres a Magic, Hormone-Balancing Superfood, Supplement or Device

Lots of superfoods, supplements or devices are marketed as hormone-balancing. But there are 3 problems with that:

 

• You can see from the previous myth how complex hormone balancing really is.
• They dont specify which hormone(s) they balance.
• They have no evidence to back it up.

 

About the closest you can get to balancing all hormones is what I call the boring basics: exercise 4+ days per week, good nutrition (adequate calories, adequate protein, adequate fibre), stress management and good sleep. Although for some women, making these lifestyle changes, sometimes isnt enough to adequately balance their hormones, and they need additional help.

Why is Weight Gained Around the Middle?

This one is not a myth, but more of an FAQ (frequently asked question), so I thought Id put it in here.

Before menopause, most women tend to store their body fat in their buns and thighs. During and after menopause, the body fat shifts to the waist.

What caused this shift?

One of the things that regulates the location of your body fat is your hormones. A body fat distribution in the buns and thighs is indicative of estrogen dominance which is what should be happening before menopause.

After menopause, estrogen drops a lot, but testosterone only drops a bit. So now, theres a testosterone-to-estrogen ratio that favours testosterone more than before menopause.

The other reason behind the shifting body fat towards the middle is an increase in cortisol levels (study, study). Cortisol is also related to belly fat.

How do you get rid of belly fat? While you cant spot reduce (you cant reduce belly fat by doing abdominal exercises. Theyll strengthen your abs, but wont make them any leaner), if you lose fat overall, youll also lose belly fat. The other way to burn fat is through hormone balance and certain ratios of hormones/hormone profiles are related to certain fat distributions (for example, when a woman has more testosterone than estrogen, shell have more belly fat than thigh fat. But when a woman has more estrogen than testosterone, shell have more thigh fat than belly fat). However, if your primary fat storage place even before menopause was your belly, then it might just be genetics, and theres not much that can be done about it.

How Long do Menopausal Symptoms Last?

This is another FAQ that made sense to include in this chapter. One study found large differences in the duration of menopausal symptoms. About 80% of women feel symptoms for 4 years and 10% of women feel symptoms for as much as 12 years. Why the variation? It largely depends on when a woman started experiencing hot flashes. If a woman started experiencing hot flashes before menopause, shell have symptoms for an average of 11.8 years. But women who only started experiencing hot flashes after menopause will only feel symptoms for 3.4 years.

Of course, there are the cases of women who never experienced any symptoms whatsoever.

According to one study, ethnicity only changes the age of onset (some ethnicities experience an earlier menopause, and others a later menopause), but it appears that the duration of the menopausal symptoms is quite universal.