For women in the peri- and postmenopausal stages of life (often starting in their 50’s), internal physiological changes make optimizing their health and weight management more challenging. During perimenopause—the time before menopause when hormone levels fluctuate greatly—women gain an average of 2 to 4.5 pounds.  This is because sex hormone levels like estradiol and progesterone drop drastically during your perimenopause years, further promoting internal pathways that favor gaining fat, losing muscle, and worsening blood sugar and cholesterol levels—indicators of cardiometabolic health.
The Wall Street Journal recently highlighted this midlife weight gain and health concerns linked to menopause, even in the absence of changes to a woman’s lifestyle habits. At InsideTracker, we were delighted to see the topic of menopause gain mainstream attention.
- Around menopause, women experience cardiometabolic changes that may include weight gain and altered blood sugar and cholesterol levels
- These changes are both linked to the hormonal changes of menopause as well as aging in general
- InsideTracker’s Ultimate plan and personal health analysis measures these critical hormones and cardiometabolic markers to help guide women through this transition including estradiol, progesterone, TSH, cholesterol, blood glucose and hemoglobin A1c
“Honestly, nobody talks about menopause, so I’d love any opportunity to demystify and normalize this time,” said Dr. Renee Deehan, Vice President of Science and Artificial Intelligence at InsideTracker. “This article sheds light on a very frustrating physical change that most women go through. Much of the messaging women hear is to work harder to shed the extra pounds. Yes, lifestyle choices can positively impact weight and body composition at any stage of life. But for women in menopause, it’s often harder to see positive results, as it sometimes seems that their biology is working against them every step of the way.”
InsideTracker’s personalized health analysis and science based wellness guide is designed to help women navigate menopause by explaining the transition and then connecting the biological changes to symptoms women may be experiencing. Women in this life stage may see information and recommendations and a personalized action plan from InsideTracker that targets body mass index (BMI), sex hormone levels (estradiol and progesterone), cholesterol, and hot flashes. Age, menopause status and hormone use (like birth control or menopause hormone therapy) all impact your blood results, which InsideTracker takes into account during our analysis.
So let’s dig deeper into the science behind why some of these unfavorable body changes occur, and how women can take a personalized approach to optimize their health.
Declines in estrogen spur metabolic changes in your body
Estrogen is a female sex hormone with health-protective properties. Fluctuating levels of estradiol (a potent form of estrogen) in perimenopause, coupled by a drastic drop in postmenopause, causes rippling internal effects.
Researchers of a large 2019 study found that fat mass significantly increased between pre-and postmenopausal stages in women, including for BMI, total weight, body fat percentage, waist circumference, and visceral fat—the deep internal fat that surrounds organs. 
The most recent data from the National Health Statistics Reports notes that the average BMI for adult women living in the United States is 29.6.
This study also found that fat stored in the body shifted from the legs to the abdomen between perimenopause and postmenoapuse. This is called android fat distribution because it tends to be more prevalent in males. Estrogen is the hormone known for giving women a more pear-shaped figure, and the combination of low estradiol levels and higher amounts of androgens (like testosterone) circulating in the blood promote an android or apple-shaped figure during postmenopause. 
Menopause and declining estrogen levels are also linked to decreases in lean body mass—especially muscle mass. Muscles burn more calories than fat. So whether you're active or at rest, having less muscle mass means you’re naturally burning fewer calories throughout the day. Even if your body weight stays the same, but you lose muscle and gain fat, your current eating and exercise habits may begin to promote weight gain rather than weight maintenance. 
There is some evidence that MHT—a medication that contains female hormones like estradiol—may be protective against excess weight gain and body composition. However, more research is needed to understand this relationship. 
One metabolic health marker the Wall Street Journal bypassed is thyroid-stimulating hormone or TSH. TSH is released from the pituitary gland in the brain and acts on the thyroid, which is a regulator of metabolism. Postmenopausal women may be more susceptible to elevated TSH levels, which indicate reduced thyroid function or possibly hypothyroidism. Research shows that estrogen may have a protective effect on thyroid health, so the decline of estrogens like estradiol during menopause may impair the thyroid’s ability to produce hormones, resulting in higher blood levels of TSH. Elevated TSH levels are associated with worsened menopause symptoms, type 2 diabetes and heart concerns. [5-7]
The most recent data from the National Health Statistics Reports notes that the average, age-adjusted waist circumference for women living in the United States was 98 cm.
“As you can see, data from InsideTracker users reinforces findings in the scientific literature,” says Dr. Deehan. “While the average BMI of InsideTracker users tend to be lower than the average US population, our dataset reveals small but significant differences in common measures of cardiometabolic health.”
Excess body fat, especially around the abdomen, is a risk factor for cardiometabolic outcomes
Cardiometabolic health refers to a combination of factors that affect heart health (cardio) and the utilization and storage of energy (metabolic). This includes an individual’s body composition, the amount of lean mass and fat mass, in addition to blood sugar (glucose) and cholesterol levels.
A 2020 statement from the American Heart Association summarized the science of the cardiometabolic changes of women around the menopause transition. Some of the key findings were: 
- Increased abdominal fat storage is associated with a higher risk of mortality, even for women that have a normal BMI (typically considered to be 18.5-24.9)
- Elevated cholesterol levels (including low-density lipoprotein cholesterol and apolipoprotein B) and metabolic changes are mainly driven by the menopause transition
- Increased blood sugar, insulin (the hormone that lowers blood sugar), and blood pressure in menopausal women may be more influenced by aging than by the menopause transition
- Cardiovascular disease is the leading cause of death in women, with risk notably increasing after menopause
“When we analyzed the data of female InsideTracker users, we saw the same trends in cholesterol markers that the current research outlines,” says Dr. Deehan. “Most of the literature out there is all doom and gloom, and there are upsides to the menopause transition. For many of us, this can be a wake-up call that it’s time to prioritize our health, recovery, and interests. And much of the cardiometabolic shifts that happen with aging and menopause can be mitigated with lifestyle changes.”
InsideTracker’s lifestyle approach to supporting cardiometabolic health in postmenopausal women
Habits like diet, physical activity, and sleep can all support cardiometabolic health for women in menopause
- Strength training can help preserve lean body mass, promote healthy metabolism, and support heart health
- Eating fiber-rich foods like oats and beans can help lower cholesterol levels
- Taking a sage extract supplement may improve sleep, as well as the frequency and severity of menopausal symptoms that typically occur at night 
A personalized health analysis using InsideTracker can shed light on what actions are most beneficial for you and your personal goals.
InsideTracker measures and evaluates blood markers associated with menopause and cardiometabolic health, including estradiol, progesterone, TSH, blood glucose, hemoglobin A1c, total cholesterol, LDL cholesterol, apolipoprotein B, triglycerides, and BMI. Analysis of these markers is compared to optimal zones, not just clinically normal ranges. Optimal zones account for characteristics like age, sex, activity level, and ethnicity. For example, the top end of the reference range for LDL cholesterol is 100 mg/dL. For a 35-year-old woman, the top range of her optimal zone would be 87 mg/dL, whereas a 55-year-old woman would see 100 as her top range.
For estradiol, progesterone, and TSH, optimal zones are influenced by menopausal status.
Many women during peri- and postmenopause also experience sleep disturbances. InsideTracker now tracks nightly sleep data from Apple Watch, Garmin smartwatch, Oura ring, and Fitbit.
Your InsideTracker Action Plan automatically ranks the recommendations according to which habits are likely to improve your biomarkers and help you reach your goal. InsideTracker currently has a total of 15 goals to choose from. Some of the most relevant ones for peri- and postmenopausal women may include, Metabolism, Heart health, Healthy aging, Sleep, and Lose fat.
“We hope with the addition of these insights that women feel empowered to take control of their health and equipped with science-backed knowledge to have informed conversations with their medical provider on topics like MHT use, thyroid health, and even mental health,” says Dr. Deehan.
“Regular testing of these blood biomarkers, not only during peri- and postmenopause, but also at least a decade before the transition, can establish a baseline for your health. This allows you to identify unfavorable trends before they become a problem by adjusting your habits and lifestyle accordingly.”
There are a lot of lifestyle habits that can support a woman's cardiometabolic health as one ages. What’s frustrating is, because of the biological changes that happen, sometimes the payoff of those changes comes much slower than you’d like.
“For women in their 40s or 50s who feel like they’re experiencing weight gain, possibly for the first time in their life, you’re certainly not alone,” says Dr. Deehan. “At InsideTracker, we’re here to help."
Check out this article to learn more about the menopause-specific updates of the platform, and click here to explore our menu of InsideTracker plans.
*InsideTracker does not provide recommendations on daily calorie intake or macronutrient breakdown.