There are many phases in a woman's life, menarche, menstruations, pregnancy, postpartum and menopause. Each phase comes with its own challenges, and changes the way of looking at life. However, narrowing to one, today we are focusing on weight gain after menopause. Gaining weight is a common concern for many women are approaching menopause. This period brings hormonal changes, shifts in activity levels and effects of aging. All of these contribute to weight gain. However, not everyone experiences weight gain during menopause, and individual experiences may vary greatly.

Menopause and Its Life Phases

Before diving into the specifics of weight gain, it’s helpful to understand the terminology associated with menopause:

• Premenopause refers to the period between puberty and the commencement of perimenopause.
• Perimenopause is the transitory period before menopause, characterized by fluctuating reproductive hormones.
• Menopause is defined as the absence of menstrual cycles for 12 consecutive months.
• Postmenopause is the period following menopause; typically used interchangeably with "menopause."

Hormonal Changes and Weight Gain

Hormones influence weight fluctuations after menopause, specifically how fat is distributed and how the body controls hunger.

Fat Content and Distribution

The hormonal fluctuations of perimenopause and menopause influence where fat is stored in the body:

Perimenopause: During this phase, estrogen levels fluctuate while progesterone levels decline steadily. In early perimenopause, higher estrogen levels can promote fat storage in the hips and thighs as subcutaneous fat, which generally carries fewer health risks.

Menopause: As estrogen levels drop significantly, fat storage shifts to the abdominal area as visceral fat.

This type of fat surrounds internal organs and is associated with health risks like:

• Insulin resistance
• Type 2 diabetes
• Heart disease
• Other metabolic issues

Appetite Regulation

Lower estrogen levels during perimenopause can have an impact on appetite management. A 2019 analysis found that decreased estrogen may diminish satiety signals, making you feel less full after meals. This might lead to increased calorie consumption and weight gain.

The Effect of Age on Weight

Weight gain during menopause is attributed to more than just hormonal changes. Several elements come into play throughout the aging process:

Increased fat content and decreased muscle mass: These changes affect the body's resting energy expenditure (REE), which means fewer calories are expended when at rest.

Lower activity levels: Fatigue, sleep difficulties, and menopause-related symptoms can all lead to a decrease in physical activity, further reducing REE and increasing weight.

Managing Weight Gain During Menopause

If you are concerned about weight gain during menopause, a variety of strategies can help you manage it effectively. It is usually recommended that you speak with a healthcare practitioner before developing a specific approach.

Dietary modifications

Focus on a well-balanced diet that includes less carbohydrates, more fiber, and less added sugar and salt.

Include nutrient-dense meals to boost overall health.

Physical exercise

Regular exercise helps to maintain muscle mass and reduce body fat. Strength training, aerobic, and flexibility exercises are quite beneficial.

If you have osteoporosis, see your doctor about safe activity options.

Rest and Stress Management

Prioritize sleep and relaxation to combat fatigue and stress, both of which can contribute to weight gain.

Mindfulness practices or yoga may help reduce stress levels.

The ovaries are a pair of pelvic organs in biological females associated with reproduction. Cancer of the ovaries is unfortunately increasing in incidence and usually presents late in the course of the disease. Ovarian cancer is often called the ‘silent killer’ because of the symptoms, which can be vague and easily mistaken for minor digestive issues. To date, we do not have a reliable tool to screen and detect ovarian cancer early.

Certain risk factors for ovarian cancer increase your chance of getting it in the future. An important point to keep in mind is that having a risk factor alone does not mean one will develop ovarian cancer in the future.

Conversely, some people who get ovarian cancer may not have any known risk factors. Some risk factors, like smoking, can be changed.

Others, like genetic mutations or family history, can’t be changed. Scientists have discovered several risk factors that increase a person’s chance of developing epithelial ovarian cancer.

These include:

Older age: Most ovarian cancers begin after menopause. If one experiences pelvic bleeding after menopause, it is important to see a doctor.

Genetics: Ovarian cancer does run in families. The most common inherited gene mutations are BRCA1 and BRCA2. We now have very reliable tests to detect these genetic mutations and tailor-made specific treatments which are effective.

Hormones: Hormones play a complex role in the development of ovarian cancer. In general, the total number of times a woman ovulates during her lifetime is related to her risk of ovarian cancer. More ovulations can mean a higher risk. Thus, early menses (before 12 years of age) or late menopause (after 52 years of age), and use of hormone replacement after menopause do increase your risk. Pregnancy and breastfeeding are considered protective.

Lifestyle: Certain factors such as lifestyle choices are within our control. While we cannot change our DNA or our reproductive history, certain lifestyle choices like smoking, drinking, and lack of exercise may influence our biological environment.

Weight Management: Research suggests a link between obesity and an increased risk of several cancers, including ovarian cancer. Adipose (fat) tissue produces estrogens, which can fuel certain cellular changes. Maintain a healthy weight to reduce your risk.

Sedentary Habits: Many studies suggest that regular exercise such as walking, yoga, and weight training can reduce your risk of ovarian cancer.

Smoking: While primarily linked to lung cancer, smoking is strongly associated with mucinous ovarian cancer, a specific subtype of the disease.

Dietary Patterns: While there is no singular “superfood” that can help prevent cancer, consuming a diet rich in vegetables, lots of lean proteins like fish, chicken, eggs, tofu, etc, and whole grains can help support a healthy immune system.

Every year, World Ovarian Cancer Day is observed on May 8. This is an initiative to raise awareness globally for educating the public about symptoms, risk factors, and the need for early detection of ovarian cancer. This year’s theme was No Woman Left Behind, which aims to ensure that all women have access to means of early detection, quality care, support, and to spread awareness so that no symptoms are ignored.

We should all do our bit but not spread fear or stigma. Since there is no universal screening tool for ovarian cancer, awareness of symptoms and associated risk factors is key. By recognizing the interplay between our genes, our hormonal history, and our daily habits, we can hope to move toward a future where ovarian cancer is detected earlier and treated more effectively.

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as Ozempic and Mounjaro, are best known for treating type 2 diabetes and obesity. However, a new study published in The BMJ suggests that people with diabetes using these blockbuster drugs may have an increased risk of hair loss (alopecia).

While the absolute risk is low, researchers from the University of Pennsylvania and the University of Southern California identified alopecia as a possible side effect of GLP-1 receptor agonists, particularly semaglutide and tirzepatide.

“GLP-1 receptor agonist use was associated with a higher risk of clinically recorded alopecia, particularly non-scarring alopecia, in patients with type 2 diabetes, compared with SGLT-2 and DPP-4 inhibitors,” the researchers wrote.

Non-scarring alopecia is a type of hair loss in which the hair follicles remain intact, making hair regrowth possible.

The researchers said the findings could help inform shared decision-making when considering GLP-1 receptor agonist therapy and highlight the need for further research into dermatological outcomes.

What Did The Study Find?

Researchers analyzed health data from 12,004 patients using GLP-1 receptor agonists and compared them with 15,221 patients using SGLT-2 inhibitors between January 2019 and September 2024. They also compared another 11,964 GLP-1 receptor agonist users with 11,233 DPP-4 inhibitor users.

The study found that adults using GLP-1 receptor agonists had:

• A 37% higher risk of alopecia than SGLT-2 inhibitor users (6.91 vs. 5.04 per 1,000 person-years).
• A 68% higher risk of alopecia than DPP-4 inhibitor users (6.53 vs. 3.89 per 1,000 person-years).

Further analyses showed the association was specific to non-scarring alopecia, with a 53% higher risk compared with SGLT-2 inhibitors and a 72% higher risk compared with DPP-4 inhibitors.

Why GLP-1 Drugs Are Linked to Hair Loss?

The researchers noted that rapid weight loss is a well-established trigger of hair shedding and may also lead to iron or zinc deficiencies, disrupting the hair growth cycle.

They added that hormonal changes may also play a role, although further studies are needed to understand the underlying mechanisms.

What Are the Study's Limitations?

The researchers acknowledged that they could not assess the severity, extent, duration, or reversibility of alopecia after treatment was stopped because of limited clinical information. They also could not rule out the influence of other unmeasured factors.

However, they said the study was based on high-quality data from a large, representative cohort, and the findings remained consistent across additional analyses.

“Our findings extend previous anecdotal safety signals and provide more systematic evidence to inform clinical awareness of this potential adverse effect,” the researchers concluded.

What To Do If You're Losing Hair on Ozempic, Mounjaro?

If you're experiencing excessive hair shedding while taking semaglutide, you may consider:

• Discussing with your physician whether your dosage should be adjusted or whether nutritional supplements may help.
• Increasing your protein intake to at least 100 grams per day.
• Taking hair-supporting nutrients such as biotin, vitamin D, iron, and zinc.
• Using topical treatments such as minoxidil to support hair regrowth.
• Avoiding severe calorie restriction and maintaining a nutritionally balanced diet.

Between climbing the career ladder, raising kids, and keeping everything else running smoothly, there's rarely a spare moment when women should stop and check in with their own bodies.

Yet these same demanding years are often when certain autoimmune and chronic conditions first start to surface. The early signs tend to be so mild and easy to explain away that most women simply put them down to stress, lack of sleep, or an overly full plate.

Some of the autoimmune conditions that commonly fly under the radar include:

· Lupus

· Rheumatoid arthritis

· Sjogren’s syndrome

· Systemic sclerosis

· Psoriatic arthritis

Family history matters more than most women realize. Autoimmune conditions often have a genetic component, and having a parent, sibling, or close relative with an autoimmune disorder meaningfully raises the likelihood of developing one yourself, even if the specific condition isn't identical. If this applies to a woman, the symptoms below deserve even closer attention and a lower threshold for seeking medical advice, rather than waiting to see if they resolve on their own.

So, when should women get it checked? If any of these symptoms stick around rather than passing after a good night's sleep, it's worth paying attention:

· Fatigue that doesn't go away no matter how much rest you get

· Joint pain or stiffness, especially in the morning

· Unexplained aches in your muscles

· Skin rashes or a new sensitivity to sunlight

· Sudden shifts in your weight or energy levels

It is advised not to dismiss them, particularly if they've been going on for a few weeks. Early detection changes everything. It is observed that the difference between a manageable condition and a complicated one often comes down to how soon it was caught.

Diagnose early, and treatment can be initiated before the disease has a chance to progress, allowing a patient to continue living life on her own terms, not one dictated by illness.

That said, the fundamentals of good health have never changed, and we continue to emphasize routine check-ups, a balanced diet, adequate sleep, regular physical activity, and sound stress management. But if there is one thing every woman should take seriously, it is to learn to listen to your own body.

You know it better than anyone else. If something feels different, do not dismiss it or wait it out; seek an opinion. Awareness combined with timely action is what ultimately allows a woman to lead a full, active life both professionally and personally, well into her later years.

(Dr. Chirag Rajkumar Kopp, Consultant - Rheumatology & Clinical Immunology, Ramaiah Memorial Hospital, Bengaluru)