Menopause and Sleeve Gastrectomy – The 411

Menopause is not a fun topic, but throw a sleeve gastrectomy in the mix and we’re taking things to a whole new level! So let’s dig in a take a look at what we know about menopause and sleeve gastrectomy and how menopause can impact your sleeve and your weight loss results in the long term.

What happens to your body during menopause?

Menopause changes our bodies regardless of whether you’ve had surgery or not. Obviously with menopause comes changes in terms of your hormones levels, mood, and some of the less pleasant symptoms like hot flushes and weight gain or body composition changes. However weight gain during menopause is not so simple… Here’s why!

During menopause women experience a reduction in oestrogen. This reduction in oestrogen means that the ratio of oestrogen to testosterone changes which changes how you store body fat. Often it’s not necessarily that you are gaining weight but sometimes it’s where you store weight that changes. You might naturally begin storing more weight around your hips and your stomach (take a look at the men in your life and where they store fat!).

Along with this change in hormones, as we get older we lose muscle mass (called sarcopenia). This reduction in muscles mass means we burn less energy at rest, and our metabolism is reduced. In addition, we are often less active then we were when we were younger and (triple whammy) after a sleeve when you lose a huge amount of weight, you aren’t only losing fat, you are losing muscle too!

So to sum it up…. The surgery itself as well as ageing reduces muscle mass. Combine that with the hormonal changes that occur menopause. Add on top the fact that as we age we’re commonly less physically active. What does that equal? Often weight gain! 

**I will put a huge caveat on this by saying that some people experience no weight gain whatsoever after menopause, and can even feel more energetic due to the changing oestrogen/testosterone balance, increasing physical activity levels and reducing weight! (I know I know – there is never a straight one-size fits all approach…)

Should you have a sleeve before or after menopause?

There’s very little research on what happens in terms of results in terms of whether you have a sleeve gastrectomy pre-menopause or post-menopause. There have been some studies to suggest that there’s not really a signficant difference if we look at the average weight loss. Meaning, even if you are older and you have the surgery after menopause it doesn’t seem to impact the weight loss that is available (1). However, one study did find that when post-menopausal women undergo bariatric surgery, only those with a starting BMI >50kg/m2 achieved the expected weight loss of 50% excess body weight (2) so it is worth discussing with your surgeon if you are post menopausal and considering surgery.

What I would like to see more research into is what happens to those who have sleeve gastrectomy prior to menopause and then go through it and how that impacts weight loss, but sorry – there’s not much out there at the moment.

What can we do to mitigate the impact menopause has on weight loss post op? 

The biggest thing you can do to minimise the impact menopause has on weight loss in the long term is to cement your healthy related habits. I like to bring it back to the four pillars of successful long term weight loss:

• What you eat. Make sure you’re eating food that is good quality and you’re eating a good variety of healthy foods so that you are getting the nutrients you need.
• How you eat. Focusing on being more mindful when it comes to your food and try to eat intuitively most of the time. This means reducing the times you eat when you’re not actually hungry or don’t feel like it.
• Movement. Here’s where strength training comes in to maintain or even increase your muscle mass to give your metabolism its best chance. Remember, the more muscle you have, the more energy you burn even when you are sitting around doing nothing. Move it or lose it as they say! If you need some ideas on where to start, check out this post.
• Self care. Make sure you are looking after yourself. Check in with your GP; they can help to manage the hormonal changes that happen during and after menopause. If you are unsure, see a bariatric GP so that you know you can have regular blood tests done, you can talk about what treatments might be available for you and what recommendations they might have from a pharmacological point of view. Track your mood, give yourself some time out, try to reduce stress and make sure you are getting enough sleep. This is extremely important as excess stress and sleep deprivation result in excess fat accumulation particularly around the abdominal area which can slow weight loss after surgery as well.

The bottom line?

As more research comes out around the premenopausal and postmenopausal population I will definitely feed it back to you. In the meantime, it’s really important to get the basics down and to ask for help if you’re not sure. Talk to your GP, your dietitian, your psychologist and your surgeon and don’t forget to get going with some strength training so that you can build muscle mass and manage the changes that are occurring from a hormonal point of view.

1. Zhang, C., Martinek, L., Marks, Y., Teixeira, J. (2016). Outcomes of sleeve gastrectomy in the pre- and post-menopausal popualtion. SAGES. https://www.sages.org/meetings/annual-meeting/abstracts-archive/outcomes-of-sleeve-gastrectomy-in-the-pre-and-post-menopausal-population/
2. Kusema, E., Bostock, C., Billmeier, S.E, Hill, M.V., Quigley, M., Adrales, G.L. (2016). Comparative weight loss after bariatric surgery among pre- and postmenopausal women. Journal of the American College of Surgeons: 222(4): e67. https://doi.org/10.1016/j.jamcollsurg.2016.08.176