You know, one of the things about getting older is that it can really sneak up on you. You wake up one morning and you notice a dozen gray hairs have suddenly sprouted on your head. Look in the mirror. You realize there's a few new lines on your face that you hadn't noticed before. When it comes to your sleep habits. You can't stay up as late as you used to. And then there are new aches and pains. Maybe a few extra pounds. And you think: my body just isn't what it used to be. Women in particular might notice that new weight creeping on, especially around the midsection as they approach menopause. In fact, research shows that women gain about a pound and a half every year during their 50s and 60s.

I went to sleep and I woke up the next day, and I promise you, I've gained 20 pounds.

Doctor Monica Christmas hears this from her patients all the time. She is the director of the Menopause Program at the University of Chicago Medicine, where she's also an associate professor of obstetrics and gynecology. And this pattern of menopausal weight gain wasn't just something she observed in her professional life.

I looked around at my own family members, or maybe other people that I knew that were in that age range, and it did seem like, wow, they did seem to gain a lot of weight in a short period of time.

Throughout her career, she has now seen thousands of patients who have complained about weight gain around menopause. And as Doctor Christmas sees it, her job is to first and foremost listen. After all, her initial interest in menopause was sparked in part by her own mother, who had a particularly challenging experience.

She had every possible symptom that you could possibly have, and not one person was really listening to her.

'And now, as an OB-GYN for nearly two decades, Doctor Christmas believes in validating her patients experiences and also letting them know about the medical treatments and lifestyle adjustments that could measurably improve their quality of life. That's all especially important because when it comes to menopause, there is still a lot we don't know. And part of the reason is that historically, medical research has largely focused on men. So there is still a major gap in terms of understanding women's health. Now, what we can say is that menopause is a natural process. It is not a disease, even though some people may treat it like one. And it's also important to understand that everyone's experience with menopause, like everyone's body, is different. Last season, neuroscientist doctor Lisa mosconi explained that women's brains undergo big changes in the years around menopause. They basically get remodeled and rewired in preparation for the next stage of life.

Women's brains go through phases, and these phases are really cured by biology and especially by your hormones.

Similarly, we know women's bodies also change during this time and hormones can play a role there as well. So on today's episode, we're going to dig into menopause and what many women believe is the seemingly inevitable weight gain that often accompanies this specific time of life. The question is, what exactly is the connection between menopause and weight? Can menopause cause weight gain? And can your weight impact the ways you experience menopause? Also, is there anything that can be done to specifically avoid that midlife weight gain? I'm Doctor Sanjay Gupta, CNN's chief medical correspondent, and this is Chasing Life.

For starters, you know, as we really dug into the topic of menopause, I wanted to highlight something that Doctor Christmas mentioned in our conversation, and that is that it's impossible to talk about menopause and what happens in the years around it without talking about aging.

Menopause is inextricably tied to the aging process.

As it turns out, aging has a lot to do with the weight that's often gained right around the time of menopause.

Aging in general is associated with weight gain, more so because of lifestyle changes. Being more sedentary, not as active as we once were. The weight gain doesn't happen with everybody. People that are really active, that are meticulous about exercise, that are intentional about what they fuel their bodies with. It's probably a minimal change. It's those of us that have fallen off that we aren't. Maybe we were in a sport or played tennis, or did yoga, did all the things, and then we had kids or the job responsibilities went up and we started slowly realizing I didn't make time for those types of things. You know, people will say, but this is what I've always done. I always just did Pilates twice a week. My diet's been this way. Why change now? And the reality of it is, is that our metabolism slows as we get older.

It's interesting because, as you point out, you get to this certain age, men and women alike, and maybe you are more sedentary. There's other things that have changed. What used to work for you in terms of your your exercise routines or even your diet may not work as well because your metabolism has slowed. But for women, I mean, it's complicated, but for women, it appears to be a double whammy because you have these hormonal changes happening as well. Is there a way to contextualize the significance of those hormonal changes with regard to weight gain during menopause? Like how how big a deal is the hormonal changes versus just life changes?

'You know, that's the hard part about when we talk about menopause. And I'm put air quotes here because you - it's hard to disentangle it from the aging process. And so you know, I can't say oh 80% of it is hormones and 20% of it is sedentary. It's probably 50/50, right. Or maybe more actually. It's actually I'm going to change. I'm gonna roll back my answer. I said 50/50, but I'm going to actually go out on a limb and say it's probably more like 80/20, because when people do employ those healthy lifestyle practices, things get reversed or they get better. So if it was all just related to hormones then there would be no hope, and that's actually not the case.

When you said 80/20, 80%, you say more likely due to things in your control, 20% more due to hormonal stuff.

Yeah. Well somebody else may argue me down, and I will say, I'm not saying that from a research standpoint right now. But just an anecdotal experience of having taking care of people traversing through the menopause transition over the last 20 years. I think that there's a good 80% of it that's within our control. Now, the other 20% is genetics, right? The body type of your family members is real, too. So I think when we're talking to people, it's unrealistic. If everybody in your family, has a different body stature and you are wanting a body type, that's really not going to be realistic for you. So that's where I'm putting that, that 20% of things that are out of our control.

So even though aging and lifestyle might be the primary culprits when it comes to weight gain around this time in a woman's life, the fact is there are these hormonal shifts which are pretty significant.

What menopause is, is our ovaries have stopped making, estrogen and progesterone too, you know, so once that process happens, there are some metabolic changes that slows our metabolism. I think that's probably the easiest way to think about it. And it's with those changes and how we burn fat, and also that our muscle tone starts to decrease. And that's where that that would accelerate the weight gain, especially around that pivotal time frame around the last of the Perimenopausal years, like where our periods haven't stopped yet, but they've started to, to change. And then those first couple of years after our periods have actually stopped. There's some still some, hormonal fluctuations going on behind the scenes. And that's why it's those initial few years around the final menstrual period where we notice more of a marked change in the weight.

And where we typically notice that new weight on the body is not likely a surprise.

It doesn't work to our benefit. Much of it deposits in the midsection. I can't think of a worse place for it to go.

'The fat that gathers around your midsection, known as visceral fat. It's the dangerous kind. This isn't the fat that you can sort of pinch on your belly. It's the fat that is deeper inside your abdominal cavity. It's the fat that surrounds your organs. It is fat that is metabolically active. That means that it's secreting hormones, that it's releasing pro-inflammatory molecules, and as a result, that increases the risk of things like diabetes and heart disease and blood pressure and stroke. But here's the thing: we do have more control over this than we think.

It's most pronounced or most marked around those initial few years around the final menstrual period. So that's a good thing, one that it doesn't just keep going up, up, up forever. It's kind of this time frame where we see it marked the most. And so that's when we might be able to be most influential and say, hey, you know what? This is the average age or median age of menopause is about 52 the range that 90% of women fall into is between the ages of 45 and 55. So I guess a better way to say that is, by 55, 90% of women will have met the natural definition of menopause, which is not having a period for a full year because their ovaries stop making those hormones. And if we can say, hey, is in this time frame when I start to see patients in their mid 30s where I'm already starting to maybe see that the weight is going up a little bit, not enough that it really bother them. Not enough that they have to buy a new wardrobe, but it is noticeable. That's a perfect opportunity to even ask them about it because most people have recognized it. Most are not absolutely happy about it, but they feel like, hey, my doctor didn't say anything, so I guess it must be okay. Or I'm a little embarrassed about it, or it's not something at this 5 pounds in the context of what is going on with all my other health issues probably isn't as important to waste that person's time with. But if we bring it up as the health care professional to say, I notice every time you've come in, we've gone up a little bit. It's been 10 pounds over the last, you know, X amount of years. It hasn't seem like that much because it's been slow. But you're also about to hit that early 40s transition where we start to see perimenopausal changes happening. You know, this is a good time for us to really intervene. Are you exercising? How much do you exercise? Usually I won't say, tell me about your diet. I'll say. What did you eat for breakfast this morning? You know what was dinner last night? Are you a snacker? What time do you usually eat? And those are the conversations that get people thinking there's no judgment with it. It's not talking about a specific diet or something that they have to follow that sounds like a punishment, but it's saying, how do we make your overall lifestyle better so that you can be healthy so that we are helping propel you to the greatness that you're trying to achieve every day? I think that puts a more positive spin on it than you need to lose 15 pounds.

'Yeah, and conceding this point that there's all sorts of things we need to do with regard to the things that are in our control. I am still curious, this idea that for the 20% that's, you know, we're making this number up, obviously it's not an exact number, but this roughly 20% that is due to the hormonal changes associated with menopause. Does that eventually stop? And I again, I realize it's not simple, but does the weight gain around menopause that's related to the hormones specifically stop. Do those other symptoms hot flashes and irritability -- do they eventually stop? Is that part of just our natural human sort of aging process as well?

Yeah they do. For the vast majority of people, you know, and I'll start you said the hot flashes and night sweats. I'll start with those. So the hot flashes, the night sweats for the vast majority of people probably linger on about four and a half years after the final menstrual period. For some people, though, like myself, Black women, we often have symptoms for a much longer duration. It could be upwards of ten years or more. But for most people, like I said, it's about four and a half years after the final menstrual period. Now those symptoms start a little bit before the menstrual periods end. So when we talk about what's the duration, it could be about seven years. Usually they're the most bothersome, the most intense, around the initial few years around the final menstrual period. And then they start to subside on their own without treatment. What we don't understand, though, is why some people have really debilitating hot flashes and night sweats and other people don't. That really does not have anything to do necessarily with how big or small they are, or what they eat or what they don't eat. It's very variable and probably has some genetic predisposition. Sometimes I'll ask, did your mom have really bad hot flashes? And people say, oh my gosh, it was terrible, you know, versus the person that says, no, I don't even remember. And I'm asking my mom now what she experienced, you know, and she doesn't remember it. And her sisters didn't either. So in terms of the mood swings, though, those actually tend to be the most intense, as I said, right around those hormonal fluctuation time points, those late perimenopause transition years and the early first couple of years after the menstrual period stops. And those then get better on their own too. So many of these things is what I was trying to get at, is mostly around this transition point. And then once our bodies get acclimated to not having that hormone anymore, things seem to subside and we adjust. Now, the time frame that it takes probably varies from person to person. Like I said, some people have very few symptoms and it doesn't bother them at all. They're they're looking at the other people like, what's wrong with you? And then there are those of us that that have pretty debilitating symptoms that absolutely need treatment.

Now, as Doctor Christmas mentioned, whether you gain weight or even how much you gain will vary from person to person. But as a general rule, the weight gain can go on for around 7 to 10 years. Now again, this may seem obvious, but I think it bears repeating that no two people are going to be exactly alike when it comes to their health. And the same is true when it comes to women and menopause. There's a lot of factors at play everything from your genetics to your lifestyle, and there is so much variability then when it comes to the experience of menopause. So after the break, we're going to talk about how the symptoms of menopause can affect your ability to lose weight. Also, whether hormone replacement therapy can help here. And what else can menopausal women do to avoid weight gain?

And we're back with Chasing Life. As we've heard, the connection between menopause and weight gain is complicated. While weight gain often occurs during menopause, menopause doesn't exactly or necessarily caused the weight gain. Doctor Christmas says it's a mixture of things aging, genetics, lifestyle and the effects of fluctuating hormones. And she also says we definitely shouldn't ignore how the very real symptoms of menopause can also have consequences for your weight. For example, mood changes which can play heavily into your desire to eat well or exercise.

If we are feeling more down or depressed or anxious, that impacts how we feel about movement. But we both know that if you exercise, your mood is elevated. All of those natural endorphins that antidepressants mimic are released naturally when we exercise. The other stands true, too. We start to experience hot flashes and night sweats. And if you're having debilitating night sweats that are disrupting your sleep, you're waking up 2 or 3 times at night, soaking wet and having a difficult time going back to sleep. You're exhausted. You're going to feel fatigued. That isn't primed for exercise either. And if you're sleep deprived, there's tons of research that shows that people that are sleep deprived don't make good food choices either. We crave, you know, more of the things that we're telling people to limit or avoid. So all of those things really start to come to a head. They come together. So it's not really just one thing in this perimenopause or early menopause transition that are impacting weight. It's probably a little bit of all of these things right?

Now doctors frequently do prescribe hormone replacement therapy to help with menopause symptoms like hot flashes. So you may be wondering what, if anything, can hormone therapy do for the extra weight women gain around the same time?

There's not a magic jelly bean. Is hormone therapy the answer? And there...it's not. Hormone therapy is not going to make you skinny. It doesn't make your wrinkles go away. You know, it does help you if you're having moderate to severe hot flashes and night sweats. And if those hot flashes and night sweats are keeping you up at night making you irritable, you're going to feel better and have more energy if you're sleeping and overall feeling better. And that may help you present yourself to the world a little bit better than if you were exhausted.

So what you're saying is that hormone replacement therapy itself is probably not going to help you lose weight, but it can reduce the symptoms overall, which may make you more inclined to lose weight. It could help you feel better. Eat more mindfully. Have more energy to exercise. Of course now, keep in mind, with around half the population likely to experience the symptoms of menopause, it can seem like there are countless products being offered to help. This includes things like herbal supplements, which, by the way, are not regulated by the FDA.

Many of the herbal supplements have actually not been shown in randomized controlled trials to be better than placebo. What happens is initially everybody says they feel better. And then after a couple of weeks, nobody does.

So while supplements may not help with things like hot flashes, mood swings and sleep disruptions, Doctor Christmas said that there may be prescription medications that can. And she also wants to make sure women know how to empower themselves in other ways.

And so I think that there is something, profound about when we think we're doing something good for ourselves, that so it goes back into this mind over matter thing that may have an influence on how we perceive menopausal symptoms. Because hypnosis and cognitive behavioral therapy have been shown to actually help to not only help mitigate hot flashes and night sweats, but cognitive behavioral therapy techniques also help with managing sleep disruption and also anxiety and depression as well. And again, it's it's really helping us reframe how we think about whatever that bothersome or noxious stimuli that's coming. And so exercise in itself has not been shown to reduce hot flashes and night sweats, but weight loss has. So I always tell people will, even though there's not a particular exercise that can help you minimize your hot flashes and night sweats, weight loss does. And you need to get to the exercise to get to the weight loss.

So when you put it all together, there are no hard and fast rules when it comes to weight and menopause, but it's important to understand menopause and weight can influence each other.

I mean, I don't know if you ever think this way, Doctor Christmas, but I often, like in medicine, they call it teleological, trying to understand, you know, you see the outcome, like trying to figure out what's driving that. Why would hormonal changes in women during menopause lead to more visceral fat, for example? Like when you're younger, you think everything is about reproduction. And if you like try and study the body and say, why is the body behaving this way? It's towards certain goals, which makes sense. Why does that happen to women so much more at that point?

Yeah. You know, I could be a really rich person if I figured all of that out. you know, estrogen in particular. I don't want to, you know, make progesterone seem like it's not as important, but it's the estrogen that seems, in particular that once our ovaries stop making and producing that, those metabolic processes that help us burn fat start to slow a little bit. I won't say it goes to a screeching halt, but it definitely slows.

Of course, one of the ways to rev up the body's metabolism is through exercise. And Doctor Christmas says there is one type of exercise that really can be a game changer for women.

What's really going to be most important, or give us the biggest bang for our effort is weight resistance exercise, because we really do want to see how we can maintain our muscle mass and our muscle tone. Not not just for the esthetics of it, but really for the practicality of, hey, that's what's going to help us not be as fragile help, keep our bones well supported and our joints supported, so that we have, you know, we're not losing height, too, as we get older. All of those other structural things that people don't always think about or we take for granted when we were younger. But those are the types of things too that, that we don't always think about when we're just so focused on weight. But hey, what else is important about maintaining muscle tone? And it's great that you do your cardiovascular exercise. But, you know, even the American Heart Association says there should be two days of weight resistance activity. Two, and I think that's the one that that falls off or people don't always think about. Are you going to do the cardiovascular or the or the weight resistance? And if we can't do both, pick the weight resistance, especially if you're menopausal woman.

And it's worth mentioning that Doctor Christmas recommends resistance training for most women, including someone like my mom who's in her late 70s, and for someone like my wife, who's in her 50s, it's that important. At 51, Doctor Christmas says she is taking her own advice. She's also quick to point out there is a variety of options that work well for women's bodies as they get older.

Whatever it is that you do, pick something that you like, you know? I know that there's no way that I'm going to be doing HIIT class, or I don't like anybody blowing a whistle at me. I can't get up at 5:00 in the morning unless I need to do surgery. Not going to. I'm a nighttime exerciser. I like Pilates because it makes me feel like a kid on the jungle gym again. Yoga helps calm my kooky mind when I've got all these racing thoughts about the things that I forgot to do that day. And walking is peaceful to me. And walking, by the way, is weight bearing. Every time your feet hit the pavement. That's a weight bearing exercise. People that love tennis or aerobics class, step aerobics, whatever it is, whatever it is that you will do and keeps you moving physically is going to be the thing that that you should do until you can't do it anymore. And hopefully that's, you know, over 100 for all of us.

Do what you can and do what you like. I love that, and I think maybe we should all be adopting that kind of mentality for ourselves, regardless of our gender or age.

What do people most commonly get wrong in menopause? What's the misconception?

50% of the population is going to go through it. It doesn't matter how rich you are, how poor you are, what race ethnicity you are, where you live in the world, if you live long enough, you are going to go through menopause. It is a natural process. And so especially or as it relates to weight, is that how we think about the aging process is going to be really instrumental in how we how we fare.

You know, one of the things I really appreciated about my conversation with Doctor Christmas was the way that she views menopause. It's something that she has been thinking about for years.

You know, think about when you have a prepubescent young person right before they start to get their menstrual cycle. They may not remember it, but the adults in their life will say, oh my goodness, you were all over the place, or you were really emotional or you, you know, you slept all the time or whatever those things were. And then they started to get their periods and then they were in that reproductive phase of life and things were different. You know, we give a lot of grace to our young people. We teach them about it. We talk about, you know, it in health class in school. I think we prepare them much better, at least than in the past when you had to figure it out on the playground. But with menopause, it's kind of like we're on the playground sometimes where women are just trying to get information where they can. But when we are in this other end of the reproductive spectrum, we're not always as kind or gentle with ourselves in accepting that there are some hormonal things going on with my body that are natural. But they are impacting me in a way that's impacting my my quality of life and not a positive way. And how do I get help? How do we manage it? How do I think about it in a more positive way? Because that's a big part of it, too. If it's woe is me, this is awful. I'm getting older. It's I'm hot now. I'm irritable. You know? I feel different. Then that's what you manifest for yourself. If we think about it in a different way of just, this is what it is. Let me think about the things that I can change. And can I exercise more? You know, can I eat a little bit better? How do I think about the aging process in a more positive manner? Really, really does impact how we feel.

'I know that sometimes it doesn't feel like it, but it is a gift to grow older. Yes, some of what happens during aging can be uncomfortable, unpleasant even. For women and menopause and the weight gain that often happens around that time, that's not typically welcomed. But as Doctor Christmas said, menopause is not a disease. Remember that -- it's not a disease. It's a normal part of life. And there are things you can do that are within your control, such as maintaining your weight and keeping an active lifestyle well before menopause, making sure that weight resistance exercises are part of your routine, and finding types of movements that you genuinely like, maybe even bring you joy. Next week on Chasing Life. Is obesity really a disease?

People worship the calorie, people count the calorie. And then by doing that, you don't focus on actually improving the quality of your diets. And that is an issue, I think.

Chasing Life is a production of CNN audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai, and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Kane is our medical writer, and Tommy Barzarian is our engineer. Dan Dzula is our technical director, and the executive producer of CNN Audio is Steve Licktieg, with support from Jamus Andrest, Jon Dianora, Haley Thomas, Alex Manasseri, Robert Mathers, Leini Steinhardt, Nichole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker, Amanda Sealy, and Nadia Kounang of CNN Health and Katie Hinman.