Many are familiar with the symptoms of menopause - the hot flashes, night sweats, mood swings and insomnia. But what may be the most bothersome symptom of all is the dreaded weight gain and apparent "pause" in metabolism.

After age 30, metabolism starts to slow down, leading to weight gain.

In addition, by age 30 one can potentially lose a half of a pound of muscle per year. By age 50, a woman may lose up to one pound of muscle per year. This loss leads to a halted metabolism and a potential weight gain of 1.5 pounds per year starting at age 50, according to a review in the Mayo Clinic Proceedings.

Weight gain has many potential ramifications: hypertension, hyperlipidemia, diabetes, heart disease and stroke. Certain cancers, particularly breast cancer and colon cancer, are also associated with weight gain

There are several risk factors for weight gain, including hormonal factors, such as low estrogen levels and hypothyroidism. Exogenous factors include the typical culprits: stress, sleep deprivation, and certain medications.

After menopause, your ovaries stop producing estrogen, and the only place where it can be generated is in abdominal fat cells

So body naturally gravitates towards storing fat in that area, in an effort to get estrogen We now know that abdominal fat is associated with multiple medical conditions, including diabetes secondary to insulin resistance and heart disease

Other hormones that decrease during menopause include progesterone, and the reduction of progesterone leads to water retention and bloating. Testosterone also decreases, leading to the loss of muscle mass, decrease in metabolism and causing insulin resistance.

So what can one do about weight gain in menopause?

Energy expenditure decreases in menopause even if activity level and food intake stays the same, which means that fewer calories are required to maintain the same weight. A diet of low fats with five servings of fruit and vegetables and six servings of whole grains has been shown to lead to weight loss in one study of 17,000 menopausal women.

Research shows that People who slashed their calories to between 750 and 1,100 for five days a month for three months lost significantly more abdominal fat — and improved blood pressure according to a study completed by the University of Southern California.

There are a variety of diets available for weight loss: low carbohydrates, ketogenic diet, paleo diet, and the intermittent fasting diet among others. Regardless of which diet one chooses, to meet a weight loss goal in menopause, calorie reduction is needed.

Exercise also plays a key role in weight loss, with recommendations for at least 150 minutes of moderate cardiovascular exercise per week or 75 minutes of intense cardiovascular exercise per week. For vigorous exercise, high intensity interval training, circuit training or speed play (high intensity followed by lower intensity workouts, done continuously) can help one achieve a weight loss goal.

In addition, normal activity throughout the day and avoiding a sedentary lifestyle daily is just as important as the dedicated exercise per week, as this contributes to a daily energy expenditure Another important aspect of exercise is weight training. As discussed earlier, there is a reduction in muscle mass, and weight training can combat muscle loss and burn fat. Other factors that can contribute to weight gain include sleep deprivation. Sleeping less than 6 hours per night is associated with weight gain and an increase in appetite, particularly for high calorie foods.

Stress also contributes to hormonal imbalances, which leads to insulin resistance and ultimately weight gain.

If conservative measures fail to help with weight loss, medications may be an option for individuals with a BMI of greater than 30 kg/m2 with associated complications such as hypertension and diabetes.

Bariatric surgery may be deemed an option for individuals with a BMI of greater than 40 kg/m2 with associated complications.

Ultimately, weight gain in menopause is multifactorial. Addressing environmental factors along with evaluating and identifying medical causes for weight gain can greatly improve one's chances at losing and maintaining a healthy weight during menopause and beyond.