PSA: Weight gain associated with this age should NOT be assumed to be vaguely 'menopausal' and necessarily normal.
I see a lot of commenters on this sub and the 'over40' sub acting as if notable weight gain is normal and inevitable once peri or menopause happens. I've not personally had any change in weight despite not being on HRT and having several conditions that predispose me to gain weight. I have had a slight redistribution of my fat as estrogen dropped (I gain a little more on my midsection rather than butt/legs) but I think people are too quick to write off midlife weight gain as normal or vaguely 'hormonal' when it might be something else.
So I am repeating a comment I just made on another thread just in case it alerts someone to potential health issues.
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Some people do gain a bit of weight with menopause and that isn't necessarily indicative of a problem. But if you experience rapid weight gain with no change in activity or calories, that often indicates 1 of 4 possible health problems; so it is really important to not assume it's 'normal'.
- Thyroid disorder (super common)
- Insulin resistance* (super common, responsible for the escalating tsunami of diabetes in the US since the 1990s, shockingly undiagnosed b/c many docs are idiots about it). Often IR gets worse after menopause, as well.
- High cortisol (much less common; usually associated with adrenal disorders)
- High prolactin (less common, can be due to different things: certain meds, side effect of PCOS (which is driven by number 2 in most cases, so double whammy there), pituitary tumor (usually benign), kidney trouble, etc.
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Re: insulin resistance
IR can contribute to the following symptoms: PCOS or related symptoms (irregular periods or ovulation, androgenic symptoms); unusual weight gain/difficulty with loss; unusual hunger/food cravings/fatigue; skin changes like darker thicker patches or skin tags; unusually frequent infections esp. yeast, gum or urinary tract infections; intermittent blurry vision; headaches; frequent urination and/or thirst; high cholesterol; brain fog; hypoglycemic episodes that can feel like panic attacks…e.g., tremor/anxiety/muscle weakness/high heart rate/sweating/spots in vision, occasionally nausea, etc.; insomnia (esp. if hypoglycemia occurs at night).
Late stage cases of IR/prediabetes/diabetes usually will show up in abnormal fasting glucose or A1c blood tests, and that is all most doctors test. Most docs will also not even consider testing for IR unless you are notably overweight. BOTH OF THESE ARE MISTAKES!
Earlier stage cases of IR will not show up that way.
I'm thin as a rail, and have had IR for about 30 years; I've never once had abnormal fasting glucose or A1c... I need more specialized testing to flag my IR.
The most sensitive test that is widely available for flagging early stages of IR is the fasting oral glucose tolerance test with BOTH GLUCOSE AND INSULIN (the insulin part is called a Kraft test) measured, first while fasting, and then multiple times over 2 or 3 hours after drinking sugar water. This is the only test that consistently shows my IR.
Many doctors will not agree to run this test, so the next best test is to get a single blood draw of fasting glucose and fasting insulin together so you can calculate HOMA index. Even if glucose is normal, HOMA of 2 or more indicates IR; as does any fasting insulin >7 mcIU/mL (note, many labs consider the normal range of fasting insulin to be much higher than that, but those should not be trusted b/c the scientific literature shows strong correlation of developing prediabetes/diabetes within a few years of having fasting insulin >7).