Empowering Women’s Metabolic Health: Perimenopause and Beyond

In our previous post on Weight Loss Drugs and Natural Alternatives, we discussed the pros and cons of weight loss drugs for women with metabolic health issues. We also discussed our goal beyond weight loss: to help women identify what caused their metabolic breakdown in the first place, and then use lifestyle and nutrition approaches to fix it.

The first step in fixing your metabolism is to understand, assess, and track your metabolic health markers. But let’s back up for a moment and discuss what the terms ‘metabolic health’ and ‘metabolic breakdown’ mean, especially as they pertain to women.

Understanding Women’s Metabolic Health: From Balance to Breakdown

When your metabolism is healthy, it means your blood sugar is balanced throughout the day, and your cholesterol, blood pressure, and weight are at healthy levels. Metabolic health is determined by genetics, environmental factors (including lifestyle choices), and age. We are all susceptible to a gradual decline in metabolic health as we age.

The first clue that points to metabolic decline is often abdominal weight gain. But it could also be that you suddenly have high cholesterol or high blood pressure, and your doctor wants you to go on medication. Or you may notice that the fasting glucose on your bloodwork is drifting upward near the cutoff of 100 mg/dL. You see, there’s a connection here between these things. They are all a part of a condition called ‘metabolic syndrome.’

Metabolic syndrome is a breakdown in metabolic health that starts with insulin resistance, an impairment in your ability to manage blood sugar and calories effectively. This causes high insulin levels in your blood, which in turn drives high blood pressure, elevated blood sugar, excess abdominal fat, and abnormal cholesterol or triglycerides. If you have only one of these things, it’s a sign of metabolic syndrome, and if you have several of them, you have full-blown metabolic syndrome.

If you do fall on the spectrum of insulin resistance and metabolic syndrome, you’re not alone! Metabolic syndrome is on a steady rise, impacting more women every year and becoming a major health concern–especially during perimenopause. The good news is that when caught early, metabolic syndrome can be reversed.

Navigating the Complexity of Metabolic Health in Perimenopause

Women in perimenopause (late-30s to mid-50s) often wonder what the heck is going on with their rising weight, blood pressure, or cholesterol. They ask if it’s hormonal, and they’re right to ask this. The sex hormone changes during this transition contribute to weight gain, shifts in fat distribution, and insulin resistance. If you’re in this age range and experiencing these issues, hormones do play a role, but the primary culprit is insulin. It’s the elevated insulin that drives this metabolic breakdown. In fact, just by being in perimenopause, your risk for metabolic syndrome significantly increases, particularly during the 6 years before your final menstrual period and the 6 years after.

Current statistics shows 32% to 58% after menopause have full-blown metabolic syndrome. This is at least one in three women! Taking proactive steps to maintain a healthy metabolism is crucial during perimenopause to effectively mitigate these risks. The best place to start is with a proper assessment of your current metabolic health, so let’s understand what this entails.

Beyond BMI: Accurate Measures of Metabolic Syndrome

Metabolic health isn’t solely determined by body size or weight. Relying on BMI alone is outdated. Despite common belief, small women with low BMIs can have organ (visceral) fat and a faulty metabolism, and large women with high BMIs can be fit and muscular with a healthy metabolism. Therefore, it’s important to set aside BMI and weight as the sole indicators of metabolic health.

The internationally accepted diagnostic standards define metabolic syndrome as having three of these five criteria:

  1. Waist circumference equal to or above 35 inches for women in the U.S. and 31 inches for other countries.
  2. Blood pressure over 130/85 mmHg.
  3. Fasting glucose over 100 mg/dl.
  4. Triglycerides over 150 mg/dl.
  5. HDL (high-density lipoprotein cholesterol) below 50 mg/dl.

However, if you already meet three out of five of these criteria, it indicates your metabolic syndrome has significantly progressed. It’s no longer in an early stage; these ranges took months or years to develop, and at this point, it’s more challenging to reverse. Catching this trend early is like catching a small leak in a roof—it allows time to repair before it becomes a major issue. In functional medicine, we promote early detection and personalized interventions to reverse these trends before they escalate.

A Functional Medicine Approach to Proactive Screening

We focus on early detection of metabolic syndrome in women by identifying elevated markers before they become problematic. Catching insulin resistance early allows time to reverse it before it progresses into full-blown metabolic syndrome.

This is why we always screen our female patients aged 35+ for metabolic health markers. And for those under 35 experiencing menstrual irregularities, weight concerns, or with a family history of type 2 diabetes or obesity, we also assess these markers. Our basic panel includes the following markers and optimal ranges:

MarkerIdeal Value
Total cholesterolBelow 200
LDL cholesterolBelow 100 mg/dL – but depends on the details about the LDL
HDL cholesterolAbove 60 mg/dL
Total cholesterol:HDL ratioBelow 3.0
TriglyceridesUnder 80 mg/dL 
Fasting insulin2–5 IU/dL
Hemoglobin A1C:5.0–5.3%
Fasting glucose75–85 mg/dL
Glucose two hours after a mealUnder 140 mg/d
C-Reactive ProteinUnder 1.0 mg/L

We also pay attention to symptoms that give us clues that metabolism issues may be at play, including fatigue, brain fog, poor sleep, irregular cycles, heavy periods, weight gain, sugar cravings, and intensified perimenopause symptoms. These symptoms may be due to other causes, but they are also signs of dysregulated blood sugar and insulin.

But why is metabolic syndrome such a big deal? Why do we care about it beyond weight? It’s crucial to pause and address these questions and acknowledge the serious future health risks involved beyond the annoying weight gain.

Unveiling the Hidden Dangers of Metabolic Syndrome: Beyond Weight Gain

You know that insulin resistance drives weight gain, which often garners the most attention for women. However, the broader implications are significant (and remember this affects 1/3 to 2/3 of us). Metabolic syndrome can lead to type 2 diabetes and a range of serious health conditions:

  • Alzheimer’s disease, often referred to as “Type 3 Diabetes
  • Osteoporosis
  • All types of cancer as shown in this 2024 study
  • Polycystic ovarian syndrome (PCOS)
  • Fatty liver disease
  • Sarcopenia, the loss of muscle tissue
  • Cardiovascular disease
  • Chronic inflammation

Notably, cardiovascular disease stands as the leading cause of death for women. Early detection and intervention can effectively reverse metabolic syndrome, halting its progression and potentially preventing the primary cause of mortality. If this is your goal, you’ve come to the right place! Functional medicine provides a clear, step-by-step approach to reversing metabolic syndrome.

Six Personalized Steps to Reclaim a Healthy Metabolism

In our previous post, we outlined the steps we use to empower women to reclaim their metabolic health, and in this post, we discussed the first step, assessment, in more detail. Here are the full six steps:

  1. Assess and track important metabolic health markers–know where you stand and watch your markers improve over time.
  2. Identify and treat the physiological root causes of metabolic decline, including insulin resistance, gut microbiome imbalances, and mitochondrial dysfunction.
  3. Study and control your blood sugar with tools like a continuous glucose monitor (CGM) or a finger prick test, and discover which meals and snacks are the right metabolic match.
  4. Address and improve lifestyle factors such as appropriate exercise, quality sleep, and effective tools to manage stress and emotions.
  5. Learn and understand how to nourish your body to build lean muscle mass and manage weight effectively, with a focus on the right macronutrient types and amounts.
  6. Utilize and personalize a daily supplement protocol to replenish nutrient deficiencies and boost your metabolism.

These steps take time and are best accomplished with a lot of support and education. We provide this through individual medical appointments, lab testing, our health and nutrition coaches, and group programs. We hold your hand and walk you through the journey to restore your metabolic health and flexibility for the long term.

If you’re ready to take the next step in your health journey, we’re here to support you. Let’s work together to achieve your health and wellness goals.

Dr. Laura Paris is an IFM-certified functional medicine practitioner and doctor of acupuncture and Chinese medicine. She helps women rebalance hormones and cycles, reclaim metabolic health, reverse autoimmunity and inflammation, and restore gut health.

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