There’s a particular kind of frustration that arrives somewhere in your late thirties or early forties. The same eating pattern that worked for a decade no longer holds. The exercise that used to shift two kilograms in a fortnight does very little. Standard advice may not always account for the physiological factors that can influence weight, because you are eating less and moving more, and the scale is not moving.
If that sounds familiar, there may be additional factors worth exploring with a clinician.
How metabolic regulation shifts in your 30s and 40s
Research indicates that key reproductive markers play a role in metabolic regulation beyond their reproductive function (Mauvais-Jarvis et al., 2013). Across the cycle and across a woman’s life, key reproductive markers may influence:
- Insulin sensitivity: how easily your cells respond to insulin and pull glucose out of the bloodstream
- Fat distribution: where your body may preferentially store energy (hips and thighs vs central abdomen)
- Lean muscle maintenance: how readily you hold onto muscle mass, particularly after the age of 35
- Resting metabolic rate: the energy your body burns just keeping you alive
- Appetite signalling: leptin and ghrelin may both interact with reproductive marker levels
When reproductive markers begin to fluctuate (perimenopause), and then decline (menopause), these factors can shift (Lovejoy et al., 2008). Insulin sensitivity may drop. Fat storage patterns can change. Muscle mass may become harder to maintain. Resting metabolism can fall. Hunger cues may get noisier.
These are physiological factors worth understanding alongside lifestyle.
Why a clinical assessment may help
Some weight management approaches are built on a calorie-deficit model that may not account for physiological variation across the menstrual cycle or life stages. A metabolic health assessment can look at these factors. Such approaches may assume:
- Your physiology is stable across the month
- Your insulin sensitivity is intact
- Your thyroid is functioning normally
- Your sleep architecture is normal
- You’re not under chronic stress
For a 28-year-old woman with a regular cycle, those may be reasonable assumptions. For a 43-year-old in perimenopause with low ferritin, possible insulin resistance and years of broken sleep, those assumptions may not hold, and a different approach that accounts for these factors may be worth considering.
What’s worth investigating first
Before joining another weight management program, the things worth discussing with a clinician are:
Thyroid function. TSH, free T3, free T4, and thyroid antibodies. Subclinical hypothyroidism may be relatively common in women in their 40s and can sometimes be missed when only TSH is tested.
Metabolic markers. Fasting insulin, fasting glucose, HbA1c, and a full lipid panel. In some individuals, insulin resistance can sit beneath the surface for years, potentially contributing to central weight gain and energy changes, before glucose starts to look abnormal.
Reproductive markers. Reproductive and metabolic markers including SHBG, interpreted in the context of where you are in your cycle and life stage. A perimenopausal pathology profile changes what a useful intervention looks like.
Iron and ferritin. Low ferritin (the storage form of iron) may contribute to fatigue and reduced exercise capacity, which can then be attributed to other causes.
Vitamin D and B12. Both may be commonly low in Australian women, and both can affect energy, mood and metabolic function.
Cortisol pattern. Chronic stress and broken sleep may raise cortisol, which can contribute to visceral fat storage independent of diet.
What a consultation can actually look like
Where deemed medically appropriate, and only after assessment, a clinician may discuss options. These may include advice, lifestyle support, referral, further investigation, monitoring or, in some cases, treatment. Some women need no treatment at all. For others, meaningful progress can come from addressing nutrient deficiencies and sleep before changing anything about diet. For many, it may be a combination.
A clinical workup, with relevant pathology where indicated, conducted by a clinician experienced in women’s health, may help identify which of these factors could be at play, and what options are available.
This article is for general information only and should not replace individual clinical advice. Individual results vary based on your individual circumstances. Assessment findings do not guarantee a particular outcome.
Telehealth is not suitable for all health concerns. Your practitioner may recommend in-person assessment, urgent care, GP review, specialist referral, further investigation or no treatment depending on your circumstances.
If you’d like to discuss these factors with a clinician, explore our services.
References
- Mauvais-Jarvis, F., Clegg, D.J., & Hevener, A.L. (2013). The role of reproductive markers in energy balance and glucose homeostasis. Endocrine Reviews, 34(3), 309-338. doi:10.1210/er.2012-1055
- Lovejoy, J.C., et al. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity, 32(6), 949-958. doi:10.1038/ijo.2008.62
- Davis, S.R., et al. (2012). Understanding weight gain at menopause. Climacteric, 15(5), 419-429. doi:10.3109/13697137.2012.707385
