The transition to menopause involves a series of hormonal and metabolic changes that can directly influence weight control and a woman’s relationship with food. If before it was easier to maintain weight or control your appetite, between the ages of 40 and 55 this scenario can change significantly. During this period, it is common for an increase in so-called emotional hunger to appear, a phenomenon known in science as reactivity to food stimuli.

“The problem is not always hunger. Many women, especially in the menopausal transition, develop greater reactivity to food stimuli, that is, the brain starts to respond more intensely to triggers such as stress, sleep deprivation, anxiety, images of food or even conditioned habits”, explains Dr. Ana Paula Fabricio, gynecologist with a postgraduate degree in Nutrology from the Brazilian Association of Nutrology (ABRAN).

Endocrinologist Dr. Deborah Beranger, with a postgraduate degree in Endocrinology and Metabology from Santa Casa de Misericórdia do Rio de Janeiro (SCMRJ), highlights that situations of stress, anxiety and emotional suffering they can alter brain reward mechanisms and influence eating behavior, increasing the search for hyperpalatable foods, generally rich in sugar, fat and sodium. “This pattern, when frequent, can contribute to weight gain and worsening of metabolic parameters, especially when associated with a sedentary lifestyle, sleep deprivation and poor dietary quality,” he says.

Hormonal and neurochemical changes influence hunger

According to Dr. Ana Paula Fabricio, it is not uncommon to hear patients saying that they have always had control over their diet and, suddenly, they start snacking more, feeling an intense desire for sweets or eating even when they are not physically hungry. “Often this is not related to a lack of discipline, but to hormonal and neurochemical changes typical of this phase”, he explains.

The doctor explains that, during climacteric and menopause, the progressive reduction in estrogen and progesterone levels causes changes that go far beyond fertility. “These changes directly affect neurotransmitters involved in mood, motivation, reward and appetite control, such as serotonin, dopamine and noradrenaline”, he says.

This set of changes can favor episodes of emotional hunger. “Estrogen, for example, plays an important role in insulin sensitivity, energy expenditure and also in the modulation of brain centers linked to satiety. With its decrease, some women may present greater insulin resistance, a worse satiety response and an increased search for fast-rewarding foods”, says Dr. Ana Paula Fabricio.

Menopause impacts food decisions

Emotional states influence reward circuits, satiety and food decision-making. According to the gynecologist, at this stage, the brain starts to interpret some foods almost as a relief strategy. “The problem is that this comfort usually lasts for a short time, creating repetitive cycles of guilt, anxiety and new consumption”, he highlights.

Furthermore, other symptoms of menopause can encourage more impulsive food choices. “In addition to metabolic changes, classic symptoms of menopause, such as hot flashes, insomnia, irritability, difficulty concentrating and the so-called ‘mental fog’, can also contribute to more impulsive food choices”, says Dr. Ana Paula Fabricio.

Sleep deprivation, for example, is associated with an increase in hormones related to appetite, such as ghrelin, and a reduction in satiety signals mediated by leptin, explains the gynecologist. “At the same time, the chronic increase in cortisol, common in women under persistent stress, favors greater accumulation of abdominal fat and a greater desire for highly palatable foods”, he highlights.

As a consequence, the relationship with food tends to become more challenging. “Patients often believe they have lost willpower, when in reality they are facing a combination of sleep deprivation, mental overload, hormonal fluctuations and hyperactivation of the stress system. All of this changes their relationship with food”, warns the doctor.

Personalized treatment helps you regain control over your eating habits

Recognizing reactivity to food stimuli is an important step in treatment. “Among the warning signs are: sudden and intense desire for sweets or pasta; episodes of ‘picking’ without realizing it; eating to relieve tension, sadness or exhaustion; feeling of guilt after eating; and difficulty stopping even after feeling satisfied”, explains Dr. Ana Paula Fabricio.

Therefore, the treatment of weight gain at this stage must consider different factors. “Addressing female weight gain, especially during menopause, requires an integrated view that consider hormonal healthsleep quality, body composition, stress management, physical activity and eating behavior. When we only address diet but ignore poor sleep, anxiety, insulin resistance or hormone deficiency, many women fall into repeated cycles of losing weight and gaining weight back. The female body during menopause needs a more intelligent and personalized strategy”, comments the gynecologist.

In this case, according to Dr. Deborah Beranger, the best option is multidisciplinary monitoring. “Treatment involves a multidisciplinary team, with a psychologist, doctors and nutritional support”, he states. Therefore, strategies that consider this set of changes tend to be more effective than focusing only on dietary restrictions. “More than counting calories, understanding what the brain, hormones and emotions are communicating can be the first step to regaining control over eating. But this must happen without turning each meal into a battle”, concludes Dr. Ana Paula Fabricio.

By Maria Claudia Amoroso