What women can do to fight 'menopause belly'

Dr. Ekta Kapoor describes what she does in simple terms: "I take care of midlife women," she said.

Her approach is multifaceted. An endocrinologist at Mayo Clinic in Rochester, Kapoor also is an assistant professor of medicine at the Women's Health Clinic with special interest in menopause, obesity and menopausal hormone therapy. When she began her practice, she was sometimes frustrated by how little emphasis was placed on menopause, especially since, given increasing longevity, women can now spend more than a third of their lives in menopause. But while women's health in general and menopause in particular were once ignored and understudied, "That's changing now," she said. "And I'm so glad to be a part of it."

We talked to Kapoor about treating hot flashes, the return of hormone replacement therapy and the dreaded menopause belly.

Q: Menopause brings with it some less than appealing side effects. What are the worst?

A: The most common symptoms of menopause are night sweats and hot flashes, but women report that the most bothersome symptom is belly fat.

Q: Why is that?

A: Both men and women tend to gain weight as we age because we lose muscle mass and so don't burn as many calories. Even people who stay active don't burn as many calories as they did when they were younger. Menopause amplifies the issue for women.

Q: What role does menopause play?

A: It sends excess fat to the wrong spots, regardless of your body type or how active you are. That's a direct effect of the female hormone estrogen. Premenopause, women tend to carry weight lower in the body — our legs and thighs. That changes after menopause. The lack of estrogen in the body redirects the fat to the belly.

Q: That sounds like a double whammy.

A: Yes. Your body is, in effect, working against you.

Q: So menopause makes it harder to maintain your weight and shape?

A: Yes, it takes more work. It's just harder. You have to be more active and eat healthier than ever before.

Menopause also has symptoms that make it a struggle to be healthy. If a woman is having night sweats, not sleeping well or is feeling depressed, that makes it harder to exercise and eat well. You need to deal with those troublesome symptoms to maintain a healthy weight.

Q: What's the best way to deal with those symptoms?

A: Hormone therapy is coming back in favor. It's the most effective way to treat hot flashes, night sweats and poor sleep in women who don't have a history of breast cancer. It can also result in changes in the distribution of body fat by reducing fat around the belly.

Q: Does hormone therapy have risks?

A: It doesn't seem to increase the risk of heart disease when started before the age of 60 or within 10 years of menopause. But it can negatively impact heart health for women over 60. It can also increase the risk of clots in the legs.

Q: Hormone therapy isn't for everyone, then?

A: Correct.

Q: How can menopausal woman improve their health?

A: Not consume excess calories. I advise against carb-heavy diets. If your diet is generous in carbohydrates, you're likely to overshoot your calorie count. I'm not saying go carb-free, but to consume carbs in moderation.

Q: What about exercise?

A: Aerobic exercise will help shed body fat, and strength training, which can help build muscle mass, will help burn calories. I recommend about 200 minutes of exercise a week. Being active is important. Strength building and cardio exercise have real benefits.

But diet is most important. Stick to that caloric count.

Q: Do you recommend counting calories?

A: I do. The new mantra in health care is tracking behavior, making changes and tracking those changes. And there are all these great apps that make calorie counting easy — MyFitnessPal and Lose It! are two I recommend.

If you find counting calories too onerous, find a structured weight loss program and have them do it for you. There is a lot of help and information out there. You can talk to a dietitian at the grocery store or the gym.

Q: Does a woman's caloric requirement change after menopause?

A: Oh, yes. Your basal metabolic rate — that's the number of calories you burn while resting — slows as you age. As your muscle mass goes down, so does the number of calories you burn. So we need to eat less.

Q: Can you name one calorie killer?

A: Alcohol. It's just empty calories. But it's worse: The biggest risk in breast cancer is age. The second risk is alcohol consumption. I advise women to stay away from alcohol as well as other simple carbohydrates like white bread, white pasta and desserts high in sugar. Avoid sodas and juices. These are pretty easy steps to take.

Q: So will doing that get rid of menopause belly?

A: This stuff can be hard to fight. There's only so much we can do. If you're eating well and staying active, there are changes in the body that we have to accept. The bigger goal has to be maintaining your overall health.