Is my menopausal belly something to worry about?

We love it when we get questions from blog readers.  This one came in last week:

There’s a general recommendation that women keep their waist circumference to 35 inches or less, because of associations with metabolic syndrome, and insulin resistance. It seems at mid age this becomes more of a concern.  What’s Fit is a Feminist Issue’s perspective on this?

Kitty inspecting her waistline

Here’s how I read this question:   we’ve all heard that carrying more of your weight in your middle (“apple shaped”) is a bigger risk for heart disease, diabetes and other metabolic issues than carrying your weight in your hips, bum and thigh (“pear shaped”).  This belief has been around for a while — I’m old, and I remember learning this in high school.  So I think the questions are — Is there evidence behind this recommendation?   When we hit menopause, we tend to accumulate more fat in our middles — so are we at bigger risk for cardiovascular disease at menopause?  Is there a specific guideline?   Is there anything we can to do manage our fat distribution with an eye to preventing heart disease?

Turns out, this is a super not easy question to answer. 

I went down a few rabbit holes here, but I’ll try to break it down.

(But first, a quick note about gender terminology.  When I write about menstruation, menopause, vaginas, etc, I try to be conscious of recognizing that there are a lot of vagina and uterus-having people who don’t identify as female, and to de-gender my discussion as much as possible.  I’m finding this hard to do in looking at this research, because it’s strongly correlated to hormones that are categorized as male and female.  It’s also taken decades for science to begin to study gender differences around issues of cardiovascular disease at all, and I have yet to see one define what how they ascribe gender to their participants.  Given all of that, I’m going to sometimes use “women” and “female” here, because it’s what the research refers to, knowing that I am generally referring here to people assigned female at birth (AFAB), who are not taking testosterone and who are experiencing a naturally occurring menopause at mid-life).  

Why does where your body stores fat matter?

1.  The apple/pear thing is technically called Gynoid-Android fat distribution patterns. 

   

   Gynoid — or pear — is, as you would discern from the name, more typically associated with women, with the belly-prominent fat storage (Android/apple) more associated with men.
2. Gynoid fat distribution is controlled by female reproductive hormones, and android fat storage by testosterone.  
3. Gynoid and android fat patterns aren’t just about where they show up on the body but where they show up in relation to your organs.  Android fat storage can compress and restrict blood flow to your vital organs and can be a risk factor for both insulin resistance and heart disease.

How does menopause affect fat storage?

As a general rule, as AFAB people reach menopause, they tend to gain weight.  A large percentage of this weight tends to shift to an “android” pattern, because hormonal changes make it harder to store fat around their hips and butt.  In other words, even if you didn’t have much of a belly before menopause, there’s a high likelihood that you’ll develop one after.  On average, people accumulate abdominal fat after menopause twice as fast as before.

Does post-menopausal waist size correlate to cardiovascular and metabolic risk?

I waded through a sea of science to try to get an answer to this, and the bottom line seems to be:  maybe.  probably.  sure.  What is true is that women tend to develop cardiovascular disease on average 7 – 10 years later than men — but it’s the highest cause of death in women over the age of 65 years.  Estrogen seems to have a regulating effect on several metabolic factors, which lessens at menopause.  So menopause is associated with a greater risk for heart disease and metabolic syndromes.  And women with diabetes are at greater risk for heart disease than men with diabetes.

But it is not entirely clear whether this risk is generally due to aging and changing hormones, or fat distribution patterns.  

Do I have to worry that my middle aged belly is going to cause heart disease or diabetes?

I am not a doctor (except of patterns of words), but from what I can tell, the size of your tummy is a bit of a red herring — except that visible changes in your metabolism are a reminder that cardiovascular risk increases as we age, and women’s profile for that risk is different than men’s. 

Historically, women don’t tend to know their own risk of heart disease, and clinicians tend to under-recognize symptoms and risks in women.  So it’s important to be aware that risk rises at menopause and pay attention to things like blood pressure, blood sugar and cholesterol.  They’re imperfect but important indicators of changes in your body.

What about hormone replacement therapy?

HRT in post-menopausal woman does help protect against intra-abdominal fat accumulation — but there is no evidence at this point that it reduces menopausal cardiovascular risk.  So it might make you feel better in different ways, but it doesn’t change your risk. 

So what do I do?

As we preach often on this blog, weight is not the issue to focus on.  If you want to lower your risk for heart disease as you reach menopause, the biggest “bang for your buck” seems to be:

• Don’t smoke.  Ever. 
• Regular exercise is critical to sustain normal blood pressure, “good” cholesterol and keeping your heart muscles and blood vessels functioning.
• Eat food, mostly plants, not too much, as Michael Pollan puts it.  The “what foods are good?” debate is still raging, but the bottom line always seems to come down to less processed food, more veggies and legumes, lots of protein, balanced throughout the day so blood sugar doesn’t spike and crash.
• Pay attention to early symptoms of possible cardiovascular disease, such as shortness of breath, chest discomfort, facing or slow heartbeats, dizziness or lightheadedness, nausea and extreme fatigue.  Women’s symptoms tend to be more subtle than men’s, and aren’t always caught.  See a doctor and don’t downplay these symptoms if you’re experiencing them.

Until I did the reading for this post, I didn’t really know how much risk of heart disease changes at menopause.  What was news to you?

Fieldpoppy is Cate Creede, who lives and jumps around in Toronto.