As our bodies move toward the biological milestone of menopause, nature prepares us over a period of years, just as she did when we were preadolescents and our bodies began to mature. The changes in appearance are different this time, though, and they can be unsettling if we don’t fully understand why they are happening.

Hormone and metabolic changes in this decade result in a different body shape: a waist that looks less pronounced, breasts that seem less firm, hips and thighs that are more rounded and generous than in the past. Women in their forties often think they are gaining weight and try to do battle against their changing shape by cutting their food intake. But as we’ll see, eating less doesn’t work as a defense mechanism against body changes, and it can in fact exaggerate them.

“When I was younger, my stomach would get puffy every month before my period,” Marcia told a discussion group. “But afterward the bloating always went away. Now it sticks out all the time. I look down, and it’s like a little tray. I could practically serve you a glass of wine on it.” Everyone in the group, a dozen women in their forties, laughed at Marcia’s exaggerated description.

I met privately with Marcia a few days later. Her weight has been a sensitive issue for her all her life, and at 46, she views her body’s shifts with growing alarm. “I swear I’m not eating any more than I usually do, yet it seems like in the last several months everything is expanding. I feel like I should go on one of those very-low-calorie diets. Maybe now that I’m this age, I just can’t eat anything,” she said, sounding intensely frustrated.

As Marcia and I talked more, I learned that in fact her weight hadn’t changed significantly over the last several months; no more than the usual fluctuations she had had all her life. Yet she was convinced that her hips and thighs were larger, her pants were no longer comfortable. “What’s going on?” she asked.

Marcia’s body was responding to changes not only in her hormone levels but in her metabolic rate. Researchers don’t fully understand why the rate at which we convert food to energy slows down as we age, but it may in fact be part of an intricate relationship between the hormones that govern a host of reproductive and metabolic functions.

“Your body is also changing the way it produces estrogen,” I explained to Marcia. “In our younger years, our ovaries are the primary manufacturing sites for two types of estrogen, estradiol and estrone. During perimenopause, as our ovaries produce less of both of these types of estrogen, Mother Nature assigns estrone synthesis to our fat cells. Eventually our ovaries stop producing estrogen completely.”

During our perimenopausal years, our fat cells assume this important function that our ovaries once performed. In fact, it is healthy for us to have enough fat cells to synthesize the estrone our bodies require. Later in life, our bodies tend to store fat cells in the abdomen, buttocks, thighs, and upper arms. So the rounded, softer look we acquire is actually the look of health and a sign of nature’s protection for our bodies.

“I wasn’t thinking about changing hormones,” Marcia said. “I just thought I was getting fat.” When she completed the clinic’s questionnaire about her overall health, I wasn’t surprised to see that she had relatively few perimenopausal symptoms, no hot flashes, no vaginal dryness, no depression or loss of libido. In fact, the only change she had observed up until now was that her menstrual cycle was shorter and her periods were lighter.

It’s not unusual for women like Marcia, who have softer and rounder figures, to exhibit fewer perimenopausal symptoms. It’s as if their additional fat cells are a type of insurance, the estrone they synthesize probably helps to continue the nourishing estrogenic effect even as ovarian function declines. This isn’t to suggest that excess weight is healthy. Being seriously overweight elevates the risk of heart disease and other illnesses. Yet Marcia’s toying with the idea of a strict diet is at least as unhealthy as gaining extra pounds.

We talked more about Marcia’s dismay and her perception that she is “getting fat.” She, like many women in their forties, was in her teens or early twenties when the glorification of the seriously underweight body began in earnest with the Twiggy look. Marcia laughed when I brought up Twiggy. “Oh yes, I had the white lipstick, the see-through plastic rain hat, and everything. Never the body, though.”

I mention Twiggy as a historical marker, today, in some ways, she looks positively plump compared with the cadaverous models we now see in magazines, on television, and on billboards, so far has the extremism about thinness gone. I don’t meet many women in their forties who aspire to the underfed and gaunt look of these models, but the external pressure to be slim is still very real. It was, in fact, our baby boom generation that gave rise to the current idea that woman must be thin. While women our age are now taking a lead in dismantling this notion, there are still very strong media messages that slim is elegant, rich, and disciplined while other body shapes are sloppy and lacking in class or even intelligence.

We have the opportunity to turn this perception around. We can replace the goal of an idealized body shape with the conviction that our bodies are changing in the way nature intended, and that our goal is to be fit, strong, and toned rather than slim. I started to suggest that Marcia think more in terms of strength than “fat,” but I had barely finished my sentence before she cut me off: “But the waist of my pants is pinching me. That feels fat, not strong, I’m sorry.”

“I was getting to that,” I continued. “You mentioned that you are considering a very-low-calorie diet. That’s a choice you could make, but it wouldn’t be the best one for your body and certainly not for your psyche. You probably would take some weight off”, but here’s what you risk giving up in exchange: your energy and your equilibrium. I’d put money on it that after a few weeks of eating very little, you’d be back here in my office, telling me that you’re very tired, that you’re bursting into tears for no reason, that you and your husband are at each other’s throats because you feel so irritable.

“You have a strong body, Marcia,” I continued. “It’s working the way nature intended it to. Let’s see what we can do to make it even stronger.” Marcia said she exercised only occasionally, once in a while she and her husband would walk from their home to the center of their small community. “Can you start doing that two or three times a week?” I asked her. “You’ll tone your body, the walk is good for your husband too, and it gives you some extra time together. More regular exercise will also boost your metabolism.”

In fact, regular short workouts actually do more to keep our metabolic rate up than less frequent, longer exercise periods. It took Marcia and her husband twenty-five minutes to walk from their house to the center of town. “Doing that three times a week, four when you can, would give you more of a payoff than working out for an hour at the gym once or twice a week,” I said.

I also advised Marcia to eat not less but more, with special emphasis on foods with phytosterol effects. “If you send your body messages that you’re going to be giving it less food, it’s going to respond by holding on to what it has even longer, and the little you do eat won’t be metabolized efficiently,” I said.

After only a few weeks of walking regularly and eating more small meals during the day, Marcia found that she felt stronger and more energetic. She decided to find other ways to exercise besides walking that would also be enjoyable and help her to keep fit, so she asked her husband for a different birthday gift: eight sessions with a personal trainer over a month’s time. “My boss always talks about her personal trainer, and I used to tune it out as mere boasting. But then I thought about it some more. She’s in her sixties, she looks great, and she’s totally vigorous,” Marcia said. “Maybe the trainer isn’t the only reason, but I decided I wanted to give it a try.”

The time with the personal trainer was well spent, Marcia told me: “She showed me how to exercise certain muscle groups so my abdomen and arms can be stronger. The sessions were fun, and I saw a lot of progress in only a month.”

If the extra attention and specialized training that Marcia enjoyed sound appealing, you can consider working with a personal fitness expert yourself. As with any professional who is going to play a role in your health, investigate the person’s background, training, and references carefully before you agree to work with them.