So many of my clients have a similar complaint: it’s hard for them to lose weight now more than ever.
While there is a multitude of factors that can contribute to weight gain, especially during menopausal years, there’s one of the culprits that is often disregarded: stress.
How stress can contribute to weight gain
Cortisol is a stress hormone produced in the adrenal glands and it’s normally released in response to waking up in the morning, exercising, and acute stress.
Acute stress is normal. The problem is when stress is chronic (long-term).
When chronically elevated, cortisol can have negative effects on weight, immune function, and increase the risk of chronic diseases.
The role of cortisol
Cortisol and adrenaline (also known as epinephrine) are best known for their role in the “fight-or-flight” response and temporary increase in energy production, at the expense of processes that are not required for immediate survival (digestion, metabolism, hormonal functions).
The following is an example of a modern-day situation of acute stress:
1. A woman is faced with a stressor (ex: she finds out that her teenage kid is failing most of his classes at school)
2. A complex hormonal reaction happens, and the adrenal glands secrete cortisol
3. Cortisol and adrenaline prepare the body for a fight-or-flight response (by increasing heart rate, increasing breathing, while pumping glucose (energy) to be readily available in case of need.
In the ideal world, the problem would be immediately resolved and hormone levels would go back to normal.
But we know that’s not what happens next because the problem may take time to be resolved or it may turn into another stressor.
The fact is that most of us won’t be able to resolve stressful situations and/or life stressors won’t go away in the short term. Stress may last for days, weeks, and even months.
So, there’s a high probability that our bodies are pumping out cortisol almost constantly, which can be very detrimental to our health.
And… this is chronic stress.
Now, on top of that, if you’re a perimenopausal woman, you’re also dealing with fluctuating estrogen and progesterone, which also may affect cortisol levels.
What happens to the body with chronic cortisol production
Blood Sugar Imbalance and Diabetes
Under stressful conditions, cortisol provides the body with glucose as energy that can help an individual deal with a stressor or a threat (like a caveman facing a lion).
However, elevated cortisol over a long period of time consistently produces glucose, leading to increased blood sugar levels, which can increase the risk for type 2 diabetes.
Over time, the pancreas struggles to keep up with the high demand for insulin, glucose levels in the blood remain high, the cells cannot get the sugar they need, and the cycle continues.
Weight Gain and Obesity
Repeated elevation of cortisol can lead to weight gain.
There are 3 ways this may happen:
1. Cortisol and fat cells
Cortisol can mobilize triglycerides from storage and relocate them to visceral fat cells (those under the muscle, deep in the abdomen).
Cortisol also increases the development of new fat cells. This happens because there’s an enzyme that converts cortisone to cortisol in the adipose (fat) tissue. The more need for cortisol, the more fat cells are generated, more enzyme is produced and more cortisone is converted into cortisol.
Also, visceral fat cells have more cortisol receptors than subcutaneous fat. So, for obese people, this means even higher production of cortisol (again, the more fat we have the more cortisol we produce).
2. Higher levels of glucose stored as fat
A second way in which cortisol may be involved in weight gain goes back to the blood sugar-insulin problem described earlier. Consistently high blood glucose levels along with insulin suppression result in cells and tissues that are starved of energy. The body then tries to regulate this by sending hunger signals to the brain.
Increased hunger is a result.
This can lead to overeating. And, to make matters worse, unused glucose (energy) is eventually stored as body fat.
3. Dysregulated hunger and satiety cues
Another connection is cortisol’s effect on appetite and cravings for high-calorie foods. Studies have demonstrated a direct association between cortisol levels and calorie intake in women.3
Cortisol may directly influence appetite and cravings by binding to the hypothalamus receptors in the brain and by disrupting hormones related to satiety and hunger.
This can stimulate an individual to eat food that is high in fat and/or sugar.
In perimenopausal women, the low levels of estrogen can decrease serotonin production (the feel-good hormone) that, by itself, also stimulates the desire to eat high-carb foods. So, adding stress to this equation, these cravings can be even more frequent and powerful.
Other health issues of chronic stress
I will not discuss the mechanisms for each of these, but it’s important to know that chronic stress (with chronic production of cortisol is known to cause the following:
Immune System Suppression
Increased Chronic Inflammation
Gastrointestinal Problems (IBS, colitis, ulcers)
High Blood Pressure
Fatigue or lack of energy*
Anxiety or depression*
Irritability or mood swings*
Insomnia or sleep disturbances*
Poor memory or difficulty retaining information*
Muscle and joint pain or weakness
* Common symptoms during perimenopause
The importance of Stress Management
Although stressful situations will happen and are beyond our control, we can still take care of our bodies and minds while going through difficult times.
There are various strategies that, when combined, and when done consistently, have a great impact on our stress response, and therefore, can help keep cortisol levels at bay.
Some strategies include: balanced nutrition, getting more and better quality sleep, breathwork, yoga, low-impact exercises, addressing emotional issues, and self-care actions.
A few things should be avoided in terms of nutrition when we are stressed AND we are going through perimenopause or menopause:
• An extreme caloric restriction – Low caloric intake or food and nutrient deficiency will put the body under more stress, so restrictive diets or poor nutrition will make matters worse
• Alcohol in excess – increases inflammation and burdens many systems in the body to process toxins. Definitely not recommended to cope with stress by drinking alcohol
• Be mindful of caffeine intake. Too much caffeine can increase cortisol.
· Avoid highly processed, high sugary, high-fat foods that can increase inflammation
Now, what should be included:
• Lots of fruits and vegetables to help fight inflammation
• High-fiber foods like whole grains, fruits and vegetables
• Include enough protein, carbs and fats in each meal
• Include minimally processed or whole foods such as seeds, nuts, beans, grains, olive oil, fruits, vegetables, animal protein, and low-fat dairy
It’s important to add here that therapeutic nutritional recommendations need to be customized for each individual’s condition, preferences, and goals and these are just general guidelines
Getting quality sleep
This is an important topic in menopausal women’s health. Most women are not getting enough quality sleep during these years because of changes in hormones, night sweats, or having a hard time winding down.
Cortisol can inhibit or delay melatonin production, which induces sleep. So try not to go to bed worrying.
Some apps offer sleep stories and meditations that can be done before bedtime. Reading a book or journaling can also help.
Breathing and Body Connection
Deep breathing, meditation, and yoga, are all activities that can help the mind and the body to calm down. Research has found that deep breathing can lower the levels of cortisol. So this is definitely not a “woo-woo” kind of strategy. It works.
Low-impact exercises or rest between hard workouts
Walking outdoors is great for stress relief. Some people find higher impact exercises such as running to be of relief as well, so whatever works for you. Higher intensity exercise release cortisol, so it's important to rest or do light recovery movements in between workouts. However, lighter exercises can be beneficial for stress, especially outdoor activities or fun movements such as dancing.
I talk about self-care all the time. It means different things to different people. For me, massages are not it. But a walk on the beach by myself definitely is. So find your reward, your favorite ways to care for yourself. Doing these often can be very helpful for your mind and can also relax your body.
If you’re going through a stressful situation that may linger for a while, I advise the help of mental health professional. Emotional health is as important as physical health and worth the effort.
Why is it harder to lose and manage weight during perimenopause and beyond? Because there is a complex web of factors and circumstances that can occur during this period: women tend to have more responsibilities and stressful lives, there may be hormonal imbalances, we are at a “sandwich generation” of older kids and elderly parents that demand our attention.
But we also have had many years of experience to know that life is not a sea of roses, and we can equip ourselves with knowledge and even seek professional support when we need to.
We realize that sometimes we CANNOT take care of everything and everyone at the cost of taking care of OURSELVES.
We become aware of our own well-being because if we don’t take care of ourselves, everyone else around us will suffer too.
So managing stress is as important as all the other things you do to take care of yourself. Don’t overlook it or your well-being will be compromised.
Epel ES, McEwen B, Seeman T, et al. Stress and body shape: Stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med. 2000;62(5):623-632.
Epel E, Lapidus R, McEwen B, Brownell K. Stress may add bite to appetite in women: A laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology. 2001;26(1):37-49.
Weinstein R. The Stress Effect. New York: Avery-Penguin Group; 2004.
Sher L. Type D personality: The heart, stress, and cortisol. QJM. 2005;98(5):323-329.
Cortisol — Its Role in Stress, Inflammation, and Indications for Diet Therapy By Dina AronsonToday’s Dietitian Vol. 11 No. 11 P. 38
compared to subcutaneous fat (8). This may also increase cortisol’s fat accumulating and fat cell size enlarging effect.
Mariemi, J. E., Kronholm, S. Aunola, et al. Visceral fat and psychosocial stress in identical twins discordant for obesity. Journal of Internal Medicine 251: 35-43, 2002.
Rosmond, R., M.F. Dallman, & P. Bjorntorp. Stress-related cortisol secretion in men: relationships with abdominal obesity and endocrine, metabolic, and hemodynamic abnormalities. Journal of Clinical Endocrinology and Metabolism83: 1853-1859, 1998.