Improve General Well-Being and Weight During Menopause

Improve General Well-Being and Weight During Menopause

By: Sobia Khan, M.D., EdD • Posted on December 14, 2022

Educational Series of Lifestyle and Functional Medicine Approach for Perimenopause

Is it true that our biological age can defeat the chronological aging with appropriate adjustments in nutrition, exercise, sleep and stress management? Yes!

The hypothalamic-pituitary axis, inflammatory pathways and immune responses influence each other and impact the function of important glands in our bodies such has ovaries, thyroid glands and adrenal glands.

Perimenopause is a time of transition and change prompts questions, and in some, prominent symptoms and deterioration of one’s sense of wellbeing. Therefore, in this educational series I will share information based on a Functional Medicine approach, natural remedies and resources on topics including:

  • Improving general well-being
  • Weight management at the time of perimenopause (most women's foremost concern)
  • Gut health and the GI microbiome
  • Memory and brain health
  • Musculoskeletal health and exercise, and it's anti-aging benefits
  • Fall prevention
  • Mental health and stress management
  • Maintaining and optimizing sexual health
  • Treatment of vasomotor symptoms (hot flashes, night sweats) that can affect sleep and your circadian rhythm

I hope you enjoy my first column in this series!


How Hormonal Changes Lead to Change in Waist Circumference?

It can be significant and dramatic when women, who are otherwise lean, begin to accumulate belly fat during perimenopause. The most striking thing for most women is that they cannot lose the weight with usual dietary changes and weight loss routines that worked in the past.

Some women are adamant that they do not want to change their lifestyle and expect their metabolism from their reproductive age to be awakened. Ideally, women should start improving their health at age 40 (for a healthy woman having regular menstrual cycles and without previous diagnosis of polycystic ovarian syndrome).

Studies have shown that the changes in female hormones impact fat storage patterns leading to more visceral and abdominal obesity. It's the kind of adipose tissue that holds on to environmental toxins and promotes secretion of pro-inflammatory cytokines, hormones and adipokines.

Central obesity initiates fat deposition fat in organ system of the body and increases the risk of:

  • Fatty liver disease
  • Breast cancer
  • Atherosclerosis
  • Prediabetes
  • Menstrual irregularities and endometrial hyperplasia

    Therefore, the significance of belly fat is beyond the mere cosmetic reasons.

    How to Avoid and Lose Belly Fat?

    The best way to approach weight loss is by targeting your efforts on the most easily modifiable hormones such as cortisol, melatonin and insulin. This can have a profound domino effect on a women’s sex hormones and sex hormone binding globulins.

    Food is Medicine

    1. Take into consideration the factors that impact the insulin level such as simple sugars and refined carbohydrates.
    2. Avoid spikes in plasma glucose - low glycemic fruits and vegetables in small portions are recommended for snacking after 5pm or after dinner.
    3. Eat foods rich in deep colors and antioxidants and promote detoxification by fasting overnight - 12-15 hours minimum.
    4. Eliminate alcohol as it steals your deep sleep and impacts metabolism for 24 hours with a 70% decline.
    5. Try time restricted feeding protocols - eating in sync with your natural circadian rhythm significantly helps with detoxification and visceral fat tends to melt away.
    6. Try to eliminate inflammatory or trigger foods, such as gluten and sugar to improve insulin resistance. Whole fruits and vegetables rich in color are good source of phytonutrients and antioxidants which promotes detoxification.
    7. Time and calorie restricted eating at time of perimenopause helps not only to lose weight but to sustain healthy weight and improve insulin sensitivity.

    Activity with Intensity

    1. It’s an oxymoron to mention exercise, but moving is the best strategy.
    2. Never start with an aggressive routine, try a walk out in nature. When you feel the sweat coming, your heart palpating and conversations getting interrupted with fast breathing, you have entered the aerobic phase - burning calories and shifting weight from belly to muscles. Congratulate yourself! Your mind and body crave for positive feedback to help you stay on the right path.
    3. Introduce high intensity interval trainings (HIIT) as it’s most proven to improve insulin sensitivity. Balance the sympathetic activities with more relaxing and unwinding parasympathetic moves such as yoga, tai chi and meditation. These types of exercises show a significant reduction in stress hormones, release of brain derived neurotrophic factor (BDNF) and improve insulin sensitivity. This impacts the sex hormones and improves hormonal and psychological symptoms.


    Get in sync with circadian rhythm. Circadian rhythm is the 24-hour internal clock in our brain that regulates cycles of alertness and sleepiness by responding to light changes in our environment.

    1. Allow the light of dawn and sunrise to stimulate the wakefulness from your eyes to your brain. Similarly, the light of sunset initiates unwinding and preparation for sleep.
    2. Avoid eating large meals and spicy foods before bed as they can trigger night sweats and hot flashes.
    3. Avoid drinking alcohol or caffeinated beverages too close to bed as they can lower your REM sleep quality.
    4. Avoid strenuous exercises and intense cardio closer to the time of sleep. Adrenaline rush and high cortisol levels can keep the mind wired and influence the sleep wake cycle.
    5. Avoid or use gadgets less frequently 2-3 hours prior to sleep time.

    Stay tuned for my next column for more tips on improving your health during the menopause transition.

    Be Strong, Be Healthy, Be in Charge!
    Sobia Khan, MD, EdD

    About Sobia Khan, MD, EdD

    Dr. Sobia Khan is board certified in internal medicine physician and holds a doctoral degree in Professional Leadership and Health Science Education by University of Houston, Texas.

    Prior to joining Cleveland Clinic as Menopause and Functional Medicine specialist she served as Director of Center of Women's Center for Comprehensive Care at Baylor College of Medicine for ten years.

    She is a certified Functional Medicine practitioner and now offering Women's Health Functional Medicine consultation at Center of Specialized Women's Health, Women's Health Institute, Cleveland Clinic.

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