A common midlife mystery women face during the menopause transition is, “I’m gaining weight, but I follow the same routines I always have and can’t figure out what’s changed. Is this perimenopause, my metabolism, or something else altogether?”
It’s impossible to answer that question without exploring individual lifestyle factors and health history, but during this period of hormonal shifts, physical and emotional stressors, life’s daily demands, and the natural effects of aging, it’s normal to notice some changes to how your body looks, feels, and functions.
The metabolism, or how our body converts nutrients from food into energy to keep physiological processes working properly, is a complex, sensitive system. It’s determined by our genes, age, hormones, body composition, and factors such as what we eat, how much we move during the day, certain medications, and how we sleep. Directly and indirectly, the quality of your sleep (and how much of it you get) can affect how your metabolism functions, and thus how your body burns calories and holds on to weight.
If you’re experiencing weight concerns during menopause that aren’t responding to diet and exercise in the way you’d expect, one thing to consider is the role sleep plays in metabolic function. Understanding this relationship can help make sense of what’s going on with your metabolism during midlife, which is often a time when regular, restorative sleep becomes more elusive, and we face new sources of stress.
We know it feels like you can’t catch a break from hormone swings during perimenopause, given all the effects of fluctuating and declining estrogen, progesterone, and testosterone. The truth is, all hormones fluctuate to some extent based on internal and external cues”it’s how your body runs essential processes like digestion, circulation, tissue repair, and more. So, while changing hormone levels aren’t necessarily abnormal or a bad thing, the ratios between them need to stay balanced so that they can cue your body to do what it needs to do. Interference from things like stress, dietary changes, and sleep deprivation can throw hormone levels out of balance and affect systems like your metabolism.
Some of the hormones involved in metabolism that are particularly sensitive to disrupted sleep are:
Cortisol as You may know cortisol as the “stress hormone,” and recognize it as the subject of many social media videos lately. And no wonder, since it does an awful lot in our bodies and having imbalanced levels can cause noticeable symptoms. While cortisol does play a big role in your body’s stress response, it has other functions too, like rising and falling throughout the day to cue your body to wake up and get drowsy during the sleep-wake cycle. As for its involvement in metabolism, cortisol works alongside other hormones, like insulin, to regulate blood sugar.
Most of the time, cortisol’s fluctuations are normal, natural, and necessary. However, sources of stress, like poor or insufficient sleep, can cause cortisol levels to stay elevated instead of following the ideal ebb and flow of their daily rhythms. Over time, this can interfere with how efficiently your metabolism works and result in:
Insulin as Insulin is a hormone that helps the body metabolize fat, protein, and carbohydrates. One of its main roles is to help different tissues absorb glucose from the bloodstream so it can be converted into energy”in other words, insulin’s a major player in regulating blood sugar.
Sleep loss, especially when it’s chronic, reduces the body’s sensitivity to insulin, meaning cells in the muscles, liver, and body fat become less responsive to its signals. When that happens, glucose can build up in the bloodstream instead of being absorbed by our cells and turned into energy. Over time, this can lead to insulin resistance and contribute to metabolic disorders like Type 2 diabetes or metabolic syndrome in people who may already be at risk.
Ghrelin and Leptin as These two hormones regulate hunger and satiety (a sense of fullness and satisfaction after eating) and have important roles in managing the body’s energy intake (eating and drinking) vs expenditure (burning calories). Ghrelin, made mostly in your stomach but also secreted by the brain, small intestine, and pancreas, is often called the “hunger hormone” because it stimulates the appetite.
Leptin, otherwise known as the “satiety hormone,” is produced by fat cells when your body recognizes that it has enough energy reserves. It suppresses hunger by telling your brain you’ve had enough of the right nutrients to replenish your energy.
Together, these hormones help your body prioritize which nutrient sources to use for fuel and sense when energy stores are low so you can fill them back up with a meal.
Like other hormones, ghrelin and leptin respond to inputs like physical activity, dietary habits, circadian rhythms, levels of other hormones, stress, and”you guessed it”sleep. Lack of sleep or poor-quality sleep can cause ghrelin levels to spike and leptin levels to drop; this can lead to increased cravings for calorie-dense foods for quick hits of energy and difficulty sensing fullness, making it easier to eat past satisfaction and consume more than your body needs.
A good night’s sleep is more than just the amount of time you spend in bed”the sleep stages matter.
If we’re healthy and sleeping well (that is, not dealing with sleep disorders or interruptions during the night) we can expect to cycle through rapid-eye movement (REM) sleep and multiple stages of non-REM sleep several times a night. During these stages, our brain wave activity changes and follows different patterns; these cycles determine when we dream, organize memories and process information, or carry out cellular healing to restore tissues to optimal function and repair them after injury and inflammation.
The stage called deep sleep, also known as slow-wave sleep, helps us wake up feeling well-rested and is critical for cellular recovery. And properly functioning cells are essential for a properly functioning metabolism!
Lack of deep sleep, either because of trouble getting to that stage or from not spending enough time in it, can interfere with:
It’s typical to get less deep sleep as we age, but the menopause transition can make it even harder to get the amount we need. This period of life is full of things that keep us awake, be they hot flashes and night sweats caused by declining estrogen; night awakenings due to hormone shifts; circadian rhythm disruptions; sleep disorders; stress and anxiety; or interruptions from kids, partners, or pets.
Gennev’s Chief Medical Officer Dr. Rebecca Dunsmoor-Su points out that prolonged lack of deep sleep can reduce the basal metabolic rate (how many calories we burn at rest), keep cortisol levels higher than they ought to be, and generate some insulin resistance, all of which can contribute to changes in what kind of body fat we accumulate and where we store it, particularly during menopause when the body is adjusting to a whole host of new conditions.
Time for a judgement-free truth: The best-laid plans can often go awry when chronic sleep loss is involved. Poor sleep and fatigue affect energy levels, coordination abilities, emotions and mood regulation, memory and cognitive abilities, and appetite, so is it any surprise that we might not feel up to our ideal routines if we’re frequently not sleeping well?
Of course not! Tired minds and bodies want to save energy, not spend it, so it’s normal to choose less taxing activities when we’re not well-rested. Menopause can compound this, introducing levels of fatigue that can catch many women off guard and interfere with their quality of life.
The resulting cycle might sound like a familiar one: long stretches of poor sleep leave you perpetually exhausted while juggling a never-ending to-do list. For many, that makes it harder to consistently do things that support metabolic function and optimal sleep patterns, like prioritizing exercise or eating foods that provide plenty of complex carbs, protein, and healthy fats. That’s not a personal shortcoming, by the way”life asks a lot of us all, and today’s culture doesn’t always make it easy to nail sleep, nutrition, and physical activity the way we’re told we should.
In the long run, this cycle of fatigue from sleep loss, little exercise, and a diet that might offer quick calories without enough nourishment can take a toll on metabolic health as the body tries to keep all systems working efficiently. Without adequate fuel and recovery, it must make some adjustments to compensate, like holding on to body fat and lowering the basal metabolic rate to conserve energy (thus burning fewer calories), and has a harder time keeping hormones balanced and blood sugar stable. If these conditions continue for too long, it may increase the risk of more serious metabolic disorders and chronic disease associated with poor sleep.
Sleep and metabolism are incredibly complicated topics, and both aging and menopause can make them even more so. It can be difficult to say exactly what the culprit is for some of these complaints, but if you’re troubled by changes to your sleep, your body composition, or your energy levels, you don’t have to struggle through them alone.
Consider making an appointment with a menopause-trained Gennev physician or Registered Dietitian Nutritionist who can help you understand your metabolism, make sense of your symptoms, and find relief through personalized care plans.
If you or your doctor suspect you may have a sleep disorder due to symptoms that don’t respond to medications, hormones, behavioral or habit changes, you may want to be evaluated for sleep apnea. It’s a common sleep disorder that affects women more frequently after menopause and can be linked to other health conditions. You can’t diagnose yourself, but convenient at-home sleep studies are available through companies like Complete Sleep. If you do have sleep apnea, Complete Sleep also offers custom mouth guards, covered by insurance, for an easy-to-use treatment option that can support better, more restful sleep.
Pelvic pain can be a frustrating issue at any time in life, but the pain and frustration can escalate during perimenopause. In one survey, abdominal pain, which encompasses pelvic pain, was one of the three most troubling menopause symptoms adversely impacting women’s quality of life. The pain can be so bad that it’s responsible for 11 percent of all emergency room visits each year. Yet many women grin and bear it.
“A lot of women think it’s a natural part of aging and that nothing can be done,” says Dr. Yashika Dooley, an OB/GYN who specializes in Urogynecology, Female Pelvic Medicine and Reconstructive Surgery. “There are lots of women who don’t have pelvic pain. Just because you’re in your 50s, 60s, or 70s, it doesn’t mean you have to give up your favorite activities or the life you want to live. This is a prime time of your life. You should be traveling, hanging out with your significant other, not suffering.”
Unlike some menopause symptoms that you can try to self-treat, pelvic pain is best managed in collaboration with your doctor or healthcare provider. You may be experiencing pelvic pain for many reasons, and treatment varies depending on the cause. Your doctor can quickly treat some causes like urinary tract infections, constipation, and sexually transmitted diseases. Depending on what’s causing your pain though, some remedies could make it worse. For example, Kegels are a popular recommendation for problems down there, but they can worsen some conditions. Working with your doctor or healthcare provider will enable you to get the most effective treatment more quickly for pelvic pain.
Pelvic pain is a complex problem because it has many causes and presents differently from one woman to the next. “The pain can range from a sharp, stabbing pain to a dull ache,” says Dr. Dooley. “It can be in the lower abdomen, going into the groin. It can be a deep, throbbing pain that’s felt more in the vagina. Some women feel it in their rectal area and have pain with bowel movements or while sitting on the toilet. Everybody describes it a little differently.” According to the North American Menopause Society, pelvic pain can be in the pelvis, front of the abdomen, lower back, or even the buttocks, and it can be hard to distinguish from other medical conditions.
Chronic pelvic pain affects about 15 to 20 percent of women ages 18 to 50. While pelvic pain or conditions that cause it doesn’t tend to increase with age, women in perimenopause and postmenopausal women aren’t immune to it. Some problems that cause abdominal pain, like diverticulitis, are more common as you age. Even worse, pelvic pain during this stage of life is often more debilitating. “In menopause, you may experience pain as being more severe,” says Dr. Dooley. “Because hormones are changing and tissues and muscles aren’t as pliable, the level of pain you may experience can be so much worse.” For example, women who have had irritable bowel syndrome (IBS) report a worsening in the severity of their pain in menopause. Research shows that estrogen reduces pain severity. Hence, as estrogen levels decrease, your pain, whether due to a new or existing condition, may increase.
Acute conditions like infections or gastrointestinal issues can result in pelvic pain. And just like IBS, conditions you may have had for years, such as endometriosis or fibroids, can still cause pain, possibly even worse during menopause. Sometimes it’s due to cramping even if you’re not getting your period. A common cause, especially if you notice pain during intercourse, can be vaginal atrophy, which results in changes in the lining of your vagina due to a lack of estrogen.
Trauma, sometimes that you don’t even notice, or overuse can cause pelvic pain. One of Dr. Dooley’s patients developed pelvic pain after a bike trip. “She was sitting on a bike for two weeks, and when she got back, she had problems,” she says. “Your muscles can get into a spasm because you’re doing something they’re not used to doing.” A fall or an injury like a sprain that causes you to change your gait can also lead to spasms. Intercourse can also be a trigger.
Often, pelvic pain can be a combination of things, and the fastest way to unravel the mystery is with the help of your doctor. They’ll usually start by getting a complete history, asking you lots of questions about the pain and your lifestyle, and doing a physical exam. Based on all of that information, your doctor may also order diagnostic tests such as lab work, blood tests, an ultrasound, or other imaging tests such as an MRI or CT. Here’s what you can do to help.
Keep a pain diary. Be specific about when and where the pain occurs and any activities, situations, or foods that trigger it. This is valuable information that can help your doctor get to the root cause of your pain more quickly.
Stop doing what makes it hurt. Some women find that the pain worsens with specific activities, such as exercise or intercourse. “If you notice a trigger causing the pain, it’s best to stop doing that until you see your doctor,” says Dr. Dooley. “If you’re constantly irritating and retraumatizing it, the pain will get worse.”
Skip the Kegels. Kegels strengthen the pelvic floor muscles and can be an effective therapy for urinary incontinence. However, if muscle spasms are causing your pain, the last thing you want to do is contract those muscles. “If you have a spasm in your back or get a Charlie horse in your leg, you don’t go to the gym and work out,” says Dr. Dooley. “You massage or stretch it. You want to relax the muscles. You need to do the same in the vagina, but it’s hard to relax them on your own. That’s when a pelvic floor physical therapist can help.”
Curb stress and anxiety. We know it’s tough to escape the pressure, especially during this stage of life. But the effort may be worth it. Research shows that when you’re stressed out or anxious, pain increases, and when you relax, it decreases. Stress may influence some types of pain more than hormone levels do. The good news: There are many ways to relax. Some take just a few minutes, like deep breathing. Others”like dancing to your favorite tunes, petting your dog or cat, or walking in nature”can be enjoyable. There’s no right way to relax, so find what works for you and do it regularly.
Sometimes pelvic or abdominal pain requires immediate attention. If your pain is accompanied by unintentional weight loss, changes in your bowel habits, nausea or vomiting, blood in your urine or feces, abdominal swelling, or painful sex, talk to your doctor or healthcare provider as soon as possible. If you experience sudden, severe pain on the lower right side of your abdomen, it could be appendicitis and needs immediate attention. If there is any chance you could be pregnant (it can happen in perimenopause), pain could be a sign of an ectopic pregnancy and needs immediate attention. The pain associated with an ectopic pregnancy is sudden, severe, and on the lower right or left side of your abdomen.
Quality menopause care begins with a conversation between the provider and patient. Gennev’s board-certified OB/GYNs initiate care of their patients with a 30-minute consultation, dedicated to listening and learning about your menopause symptoms and experiences, as well as offering medical guidance. Book a virtual visit today.
The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.
“