As a 40-something woman, I'm living with the changes a woman's body goes through prior to menopause. As a trainer, I also work with many women in the same phase of life. They work at making many of the same changes typical of our clients—they want to eat more healthfully and get the most from their exercise programs. They focus on decreasing their stress levels and getting more rest. And yet many of these same clients have great difficulty losing body fat. Yes, thanks to their efforts, they get stronger and feel better. They celebrate their small successes along the way, as they begin to be able to do things they couldn't before—they just can't seem to get leaner.

If you work with this clientele, you’re undoubtedly familiar with this scenario. Not only is it discouraging for the client—it’s frustrating for you, the trainer, as well. You may automatically assume that your client is not being truthful with what she is eating and with the other changes she is trying to make. Maybe you’ve even come down hard on a client and inadvertently made her feel shameful about her habits. 

As much as I've always hated blaming hormones on mood and other physical changes, increasing evidence suggests they may be at the root of—or at least a contributing factor to—many health challenges. It is important to note, however, that the purpose of this article is NOT to make it possible for you to diagnose a hormonal imbalance in your clients. Rather, this information is provided to give you a better understanding of obstacles to fat loss, as well as limitations within your practice and when it may be time to refer a client to her healthcare practitioner. 

Estrogen and Progesterone

Together, estrogen and progesterone are the primary female sex hormones. They counteract and balance out each other's effects.

“Estrogen gives women hips and breasts, buffers mood and keeps you on task by regulating serotonin,” explains Sara Gottfried, M.D., New York Times bestselling author of The Hormone Reset Diet (2015) and The Hormone Cure (2014). “Estrogen is responsible for the first half of your menstrual cycle.” 

Progesterone boasts its own attributions. “Progesterone is important for your overall sense of equilibrium or wellbeing,” continues Gottfried. “It's the hormone that allows you to soothe yourself. It raises body temperature and helps your thyroid perform efficiently. It's also a natural diuretic.” 

Ideally, says Gottfried, a woman has a rhythm between these two hormones, “which should function like well-matched dance partners.” 

Sometimes, however, one or the other hormone wants to be leading the dance, causing an imbalance between them—along with a host of issues. 

“Estrogen dominance is when you have too much estrogen compared with progesterone,” comments Gottfried. “Having a little bit too much estrogen in the body causes a number of symptoms—including weight-loss resistance—and makes losing weight very challenging, if not impossible.”

Carolyn Dean, M.D., N.D., medical advisory board member for the Nutritional Magnesium Association and author of Hormone Balance: A Woman's Guide to Resotring Health and Vitality (Adams Media, 2005), further explains, “Estrogen dominance is not defined by a particular amount of estrogen but by having too much estrogen relative to progesterone.”

Many things can cause estrogen dominance, says Dean, including a diet low in natural fiber, excessive alcohol use and chronic stress. 

“In one study, blood and urine estrogen levels increased up to 31.9 percent in women who consumed as little as two drinks a day,” says Dean. “Also, cortisol, the stress hormone, and progesterone compete for common receptors in the cells. Cortisol impairs progesterone activity, setting the stage for estrogen dominance.”

Dean notes that estrogen dominance is common during the perimenopausal years, “which in some women can begin around the age of thirty. It also affects all the tissues of the body.” 

A few common signs and symptoms of estrogen dominance include:

  • Irregular periods
  • Heavy periods
  • Bloating and fluid retention
  • Breast swelling and tenderness
  • Fibrocystic breasts
  • Headaches
  • Mood swings
  • Weight gain in abdomen and hips
  • Hair loss
  • Thyroid abnormalities—cold hands and feet, sluggish metabolism, fatigue
  • Foggy thinking and memory loss
  • Insomnia
  • Fat-loss resistance
  • Depression

“When your hormones are in balance, neither too high nor too low, you look and feel your best,” says Gottfried. “But when they are imbalanced, you feel miserable.”

How does a woman know her hormones are out of whack? 

“You won't really know if your hormones are to blame for your symptoms until you get some basic blood work done,” Gottfried says. “Record your symptoms and check in with your physician. Most traditional doctors only recognize the merits of blood testing, yet the latest testing techniques to determine hormone levels include saliva and dried urine testing.” 

If a client is going to her healthcare practitioner for testing, suggest she request that both estrogen and progesterone are tested. 

“Estrogen can be all over the map—low, normal or high—but if there is little to no progesterone to balance its effects in the body, any amount of estrogen can create estrogen dominance,” explains Dean. “Thus, the blood levels of estrogen can be within normal limits and the doctor will tell you that your blood tests are normal, but if they don't compare your estrogen levels with your progesterone levels, you might not find out that everything may not be all right."

Additional Hormones to Consider

Estrogen and progesterone aren't the only hormones that affect fat loss and gain. Thyroid hormones, insulin, cortisol and leptin are others (but certainly not the only ones).

Gottfried recommends a few basic nutritional changes for certain hormones imbalances. Don’t forget, however, that it is outside of a fitness professional’s scope of practice to diagnose hormonal imbalances.

For estrogen dominance: “I recommend eating a pound of vegetables per day, divided between meals,” she says. “The fiber from the vegetables will help excrete estrogen so it doesn’t keep circulating in the body. Aim for 35 to 45 grams of fiber per day (women), but slowly increase in 5-gram increments each day to get to the goal without as much gas or bloating.” 

For high leptin levels: “One way to reset leptin levels is to remove or reduce the amount of fructose in your diet.”

For insulin resistance: “To reset insulin levels, I recommend drinking filtered water with apple cider vinegar. A recent study found that consuming two tablespoons of apple cider vinegar before a high-carb meal significantly reduces blood glucose levels in people with insulin resistance.”

For high cortisol levels: “To reset cortisol, you need to hit the pause button on your caffeine intake. Slowly wean off the caffeine over three days and notice how your sleep and stress levels improve.”

“Thyroid hormones play a direct role in metabolism, with lower levels associated with a decreased metabolic rate and consequently fat gain,” says Ramon Julian M. Pesigan, M.D., primary care physician in sports medicine at Atlantic Sports Health in Morristown, N.J. 

“Another hormone that influences fat metabolism is leptin, which is synthesized primarily in adipocytes (fat cells) and stimulates satiety,” continues Pesigan. “More leptin is produced with a greater number of adipocytes. However, the body tends to become insensitive with higher levels and so more adipocytes do not necessarily translate into greater feelings of satiety.” 

Gottfried explains it further. “High leptin causes weight gain and excessive hunger. Leptin is nature’s appetite suppressant. When you’ve had enough to eat, leptin signals your brain to stop eating. When you are overweight, your fat cells produce excess leptin. When your brain gets bombarded with leptin signals from too many fat cells, it shuts down from being overwhelmed. Leptin levels keep rising, receptors stop functioning, your body doesn't get the leptin signal and you don't feel full. You keep eating the wrong foods in an addictive pattern and you keep gaining weight.”

Pesigan says insulin is similar to leptin in several ways. “Like leptin, high levels of insulin are associated with an anorexigenic effect (causing loss of appetite). Consistently high levels, however, can also lead to the development of insensitivity to it. Due to an inability of the body to correctly metabolize glucose, susceptible individuals then start to develop signs of type 2 diabetes.”

Cortisol is the main stress hormone—it is released in response to stress. “But most of us run around stressed all the time,” interjects Gottfried. “All those stress hormones wreak havoc over time and make you store fat, especially in your belly. High cortisol is also linked to depression, food addiction and sugar cravings, so that you overeat the wrong foods, like cookies and processed foods. 

“Cortisol is a stress hormone that greatly influences the metabolism of macronutrients,” says Pesigan. “It has been shown to induce muscle protein breakdown, as well as stimulate the appetite by inhibiting signals that are associated with satiety.”

“I think cortisol dysregulation is the elephant in the room when it comes to women who are doing everything right but can't lose the fat,” declares Gottfried. “Women are way more sensitive to stress and more vulnerable to altered stress response compared to men. Some women will have to give up coffee and alcohol and start a contemplative practice to calm down and get back to normal.” 

Can Exercise Be the Enemy?

In a time when higher-intensity exercise is the golden rule, it may not be the best choice for some women.

“High-intensity exercise can sometimes have the opposite effect on weight loss,” explains Lynne Kavulich, D.C., founder and clinical director of American Wellness Care in Hopewell Junction, N.Y. “When hormones are out of balance, weight gain can accelerate due to the stress placed on the adrenal glands. Overdoing exercise can make cortisol levels rise sharply during times of hormone imbalance, exacerbating weight gain. People who become exhausted after one to two hours after exercise have depleted their energy stores, which can create further hormonal imbalances.”

“While exercise is an essential part of managing health and balancing your hormones, it can also throw them further out of whack if not managed properly,” adds Gottfried. “Most exercises place stress on the body that causes cortisol to shoot up, such as endurance running. If you’ve got imbalanced cortisol and chronic stress, high-intensity exercise can be depleting and worsen adrenal fatigue. Most people with this situation feel worse or tired after exercise, not energized.” 

Gottfried recommends burst training for those who want to become more stress resilient and increase human growth hormone (HGH) in the body. However, if you're struggling with chronic stress, she says you may want to opt for adaptive exercise. "Physical activities such as yoga, Barre or Pilates can be a better choice for adrenal fatigue. Also consider adding meditation or guided visualization several times a week.” 

“By opting for relative rest, meaning a more moderate type of activity level as opposed to high-intensity exercise, these women stand a better chance of recovery with less of a psychological burden,” concludes Pesigan. “However, the management of hormonal imbalances is not as simple as just changing activity level. Oftentimes, these women need a multidisciplinary team of professionals to reach the root of the problem and address it.”