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Podcast episode 28: Your body during menopause with dr. Isabel De Smet
What really happens to the female body during menopause? In this episode, Dr. Isabel De Smet, gynecologist at AZ Sint-Jan Bruges, speaks openly about the physical effects of hormonal decline after menopause. We talk about the taboos that are still rarely discussed: vaginal dryness, joint pain, loss of libido, and night sweats.
Why do these symptoms so often go under the radar, even with doctors? And what can you do to support your body? An honest, science-based episode about what estrogen does for your body and what happens when it’s no longer there.
About Dr. De Smet
Dr. Isabel De Smet has 19 years of experience as a gynecologist. Initially, she focused mainly on fertility and obstetrics, but over the years, she developed a growing interest in the issues women face during menopause.
“After 19 years, your regular patients have also gotten a bit older,” she says. “People who came to me at the start of my career were around 30 back then, but now they’ve turned 49. That’s how my focus shifted toward functional gynecology and the problems of menopausal women.”
The first signs of menopause
According to Dr. Isabel De Smet, the first menopausal signs often start appearing in women in their early forties. While younger women typically experience few complaints and are mostly satisfied with their contraception - they can’t get pregnant, are in a relationship, and everything runs smoothly - this picture changes as the years go by.
When the kids are around ten to twelve years old and family life is in full swing, many women start noticing small changes. Things just don’t run quite as good. Energy levels aren’t the same, and the dynamics in their relationship with their partner shift. This is often the beginning of perimenopause.
Common symptoms of menopause
As menopause approaches, symptoms become stronger and more noticeable. In her practice, Dr. De Smet often sees recurring themes:
- Reduced libido: This is usually not brought up spontaneously, but it affects many women.
- Hot flashes or flushes: This is the symptom most women mention first.
- Weight gain: This is also commonly reported. Many women don’t fully understand where the extra pounds come from and feel powerless to do anything about it.
The role of metabolism
An important factor is your changing metabolism. Dr. De Smet explains that the body undergoes hormonal adjustments due to declining estrogen levels. The metabolism does indeed slow down, leading to weight gain, especially if diet and lifestyle are not adjusted. Eating less during menopause is definitely wise, as the body simply requires less energy. However, this doesn’t mean you should eliminate entire food groups.
“At Insentials, we see during consultations that many women suddenly stop eating meat or fish - and along with that, important proteins,” says Amandine. Yet in this stage of life, adequate protein intake is crucial.
Proteins help counteract the loss of muscle mass. During menopause, muscle mass decreases and the body becomes less firm. This is caused by hormones and results in weaker arms, buttocks, and abdominal muscles. Even the pelvic floor muscles lose strength, which can lead to problems such as incontinence.
How to get rid of belly fat?
During menopause, the body’s fat distribution changes - you tend to develop the typical apple shape and gain a belly. According to Dr. De Smet, you can take steps to manage that menopausal belly. The stronger your abdominal muscles, the more you can prevent belly fat from accumulating.
But most women don’t exercise enough. They simply don’t feel like it.
“That’s how they get caught in a vicious cycle,” says Amandine, “because once you’ve gained a belly and extra weight, it’s obviously even harder to start running.” So losing weight first is key, but that’s not easy with a slowed metabolism.
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How can you lose weight during menopause?
Dr. De Smet's patients who complain about difficulty losing weight and having a belly are routinely told that their metabolism has slowed. If you continue eating the same way, you will gain weight.
If you know your metabolism has slowed and you want to maintain your weight, there are two options: either you boost your metabolism through exercise - and that's not just an hour of walking, but activities that actually burn fat.
The other option is you drastically reduce your calorie intake. For most women, that’s very challenging.
Is medication for weight loss a good idea?
Many women say they don’t have time to work out. They’re too busy with their children, their partner, and their job. During consultations, Amandine notices that many women turn to medication to lose weight, which puts them at risk for even more muscle loss.
Dr. De Smet: “I very often get asked to prescribe this kind of medication, but I will never do it. I’m not a fan.” In cases of severe obesity, an endocrinologist may prescribe something if necessary. “But the big problem with these products is that if you lose weight and then eventually return to your old lifestyle, you gain the pounds back immediately. So that’s not the right approach.”
Dr. De Smet has been seeing some patients since they were thirty, year after year. That’s when the weight gain becomes noticeable. “If you only see a patient once a year, you notice an incredible difference starting at around forty.”
Joint pain and the role of collagen
Joint problems are very common during menopause. They are linked to estrogen, the female hormone produced during your cycle. “Estrogen is the oil for your joints,” explains Dr. De Smet. With the drop in estrogen during menopause, it’s no surprise that 90% of women experience joint issues. Interestingly, women who exercise regularly and keep their joints active tend to have fewer problems.
Amandine mentions collagen or broccoli extract as a way to sensitize estrogen receptors. Dr. De Smet confirms: “Collagen is good for skin, hair, and joints.”
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Do easy pregnancies also mean an easier menopause?
Amandine asks Dr. De Smet whether women who had easy pregnancies also have an easier time during menopause, and vice versa: do difficult pregnancies also mean a tougher menopause?
“That’s impossible to predict,” Dr. De Smet responds. However, she does note that thinner women tend to experience fewer menopause symptoms. “Thinner women have fewer hot flashes.” Amandine isn’t surprised. “If I eat too much or too much fatty food, I get hot flashes in the evening too.”
Heavier people tend to sweat more and generally experience more symptoms, Dr. De Smet observes.
Sleep during menopause
Amandine asks about sleep during menopause. The answer is clear: “Most women sleep very poorly. Everything is interconnected: the drop in estrogen also affects sleep and makes it harder to fall asleep.”
Poor sleep during menopause is often linked to hot flashes. “Many women who don’t use hormone replacement therapy experience hot flashes that wake them several times a night, drenched in sweat - off with the blanket, back on again because they get cold, and so on…”
The biggest menopause taboo: vaginal dryness
In addition to weight gain, joint pain, poor sleep, and hot flashes, women going through menopause also face vaginal dryness and loss of libido. This remains a taboo, says Dr. De Smet. Everyone talks easily about joint pain, but patients only bring up vaginal dryness if I ask about it.
For women who walk or cycle a lot, vaginal dryness can be very annoying - it causes irritation and makes workout clothes uncomfortable, but it is primarily an obstacle for their sex life. Some women even remain very sexually active past 75 and look for solutions.
The causes of night sweats
Menopause is not always the (only) cause of night sweats. Other factors can play a role, such as stress. Many women ruminate at night, which can trigger sweating. Other possible causes include a fatty liver and weight gain.
Avoiding extra pounds
A well-functioning metabolism is essential for keeping your weight under control during menopause.
When your metabolism is efficient, you burn more calories even at rest and gain weight less easily. At the same time, being mindful of your diet is crucial in this phase. Eating more protein and strength training can boost your metabolism. Protein helps build muscle mass, and muscles burn a significant number of calories, even at rest.
Forever Hot: menopause event
Want to learn more about your body during menopause? Then join Forever Hot on October 20, 2025, the third menopause conference organized by Insentials. Dr. De Smet will be one of the speakers.
At Forever Hot, you’ll get the latest insights from top doctors, and we’ll finally break the silence around taboos. Sexuality, intimacy, skin, identity, nutrition, and hormone therapy - all in one program you won’t find anywhere else.
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