You’ve hit the gym with the same exact frequency for months. You’ve eaten the same cinnamon oatmeal for breakfast, spinach salad for lunch, and standard protein for dinner since summer (with the occasional happy hour added in—no change in frequency there). Yet somehow, maddeningly, the number on the scale continues to creep up.
Packing on even just a few pounds with no discernible cause is crazy frustrating (maybe you’re sleepwalking to the fridge at night?! Birth control fail?) but it can also be a sign something is askew in your bod, like out of whack hormones or other sneaky health conditions that are causing your metabolism to misfire.
What to do? Whether the scale's tipping over five pounds or 20, Melina Jampolis, M.D., an internist and physician nutrition specialist based in LA, recommends first ruling out the most obvious culprit: a caloric surplus. Because, let’s be honest, in most cases of unexplained weight gain, everything comes down to calories.
“Lots of people have ‘calorie amnesia’—they’re eating more calories than they tally up in their head, or it’s not that they’re exercising any less during the week but maybe they’re sitting more,” Jampolis says. That's why she recommends that, before visiting the doc, you keep a log of everything you eat as well as your exercise habits (including outside-the-gym activity) for at least a few days if not a week or two. Then, by taking it to your doctor with your weight-gain concerns, you can go from there.
Once any caloric problems have been excluded, your doc can get to the bottom of other lingering health issues that might be messing with your waistline. Here's how an M.D. might assess your symptoms:
1. YOU’RE EXHAUSTED… IT COULD BE HYPOTHYROIDISM
When a young woman walks into a doc’s office with unexplained weight gain, the thyroid is the first place most physicians will investigate, says Jampolis. And for good reason: a whopping one in eight women will develop a thyroid disorder in her life, according to the American Thyroid Association.
That butterfly-shaped gland in the neck is responsible for secreting a hormone that regulates the metabolism, and if you’ve got an under-active thyroid (called hypothyroidism) the metabolism may slow down, triggering weight gain.
Women with hypothyroidism may also suffer from low energy levels or fatigue, dry skin, hair loss, hoarseness, or constipation, says Jampolis. Notice any of them and you should book a chat with your doc who can check on your thyroid with a simple blood test if necessary.
2. YOUR PERIODS ARE ABNORMAL… IT COULD BE PCOS
Research shows that as many as one in five women have polycystic ovary syndrome (PCOS)—an endocrine disorder that throws off the balance of reproductive hormones estrogen and testosterone, and can trigger a number of unpleasant symptoms like wacky periods, facial hair growth, and migraines. PCOS can also muck up the way your body uses insulin (the hormone that helps turn sugars and starches into energy), which means (womp, womp) unexplained weight gain around the mid-section is common, says Jampolis.
If your menstrual cycles are off, a gyno will likely take a peek at your hormones to diagnose this one.
3. YOU’RE STRESSED AF… IT COULD BE DEPRESSION
The body’s a miraculous, well-oiled machine—but it’s got a few hiccups. Case in point: When we’re chronically stressed, we’re thrown into that fight-or-flight mode and get a surge of adrenaline (to help us run from danger) along with a heavy dose of the hormone cortisol, which is supposed to help us restore our energy reserves and store fat. Because, hello, we obviously just sprinted three miles from a tiger—we're starving. The problem? Lots of us get stressed sitting at our desk—a time we don’t exactly need to hang on to those extra calories, says Jampolis.
If you’ve persistently felt down in the dumps or anxious, have trouble sleeping, feel fatigued, or you’ve lost interest in the stuff that used to make you tick, talk with an M.D. or mental-health pro who can make suggestions for getting back on track, which (bonus) should help you drop those extra pounds.
4. YOU’RE RESTLESS AT NIGHT… IT COULD BE INSOMNIA
There’s nothing like a busted night of sleep to make a girl crave sugar and fat (anything to survive at work the next day, right?) That's because missed shuteye does a number on your hunger hormones and metabolism: Sleeping too little raises ghrelin, the hormone that signals it’s time to eat, while lowering our levels of leptin, the hormone that conveys the “I’m full” feeling, says Jampolis. The result: a totally unsatisfying chow-fest the next day.
Adding insult to injury, the bleary-eyed also tend to cling on to body fat—a study published in the Annals of Internal Medicine found that people who slept 5.5 hours a night lost half the weight that those who slept 8.5 hour did, even when eating the same number of calories.
5. YOU’RE CONSTANTLY BLOATED… IT COULD BE SIBO
We all know by now that the gut relies on good bacteria to function well (probiotics, anyone?), but there’s also bad bacteria chilling in your digestive tract. When that balance of good to bad gets thrown off, small intestinal bacterial overgrowth (SIBO, for short) can take place, triggering extra gas in your GI tract along with bloating, abdominal pain, diarrhea, and—yay—unexplained weight gain.
Like the many other mysteries of our crazy-smart and complex guts, docs aren’t entirely sure how SIBO may trigger those extra pounds, says Jampolis.
6. YOU’RE IN YOUR 40S… IT COULD BE PERIMENOPAUSE
The transition period to menopause (which can start in women as early as their mid-thirties, but usually starts in your forties) triggers hormones like estrogen to rise and fall unevenly, which can trigger weight gain in some women, says Jampolis. (Other signs of perimenopause include irregular periods, hot flashes, mood swings, and a change in your libido—symptoms your doc can usually suss out with her eyes closed.)
Compound perimenopause with the other inevitable body changes that happen with age (like a loss of muscle mass and increase in body fat), and it may feel like the scale’s tipping fast. Talk to your doctor to manage "the change" in stride.
7. YOU’RE POPPING A NEW PILL… IT COULD BE YOUR MEDS
It’s not just birth control—a laundry list of both prescription and over-the-counter meds can trigger sudden weight gain or water retention that shows up on the scale as extra poundage. “Antidepressants—most commonly the selective-serotonin reuptake inhibitors (SSRIs) such as Paxil, Lexapro and Prozac—may affect the appetite center in the brain,” says Rocío Salas-Whalen, M.D., an endocrinologist at the Medical Offices of Manhattan.
Meanwhile, beta-blockers (meds that reduce blood pressure) can slow your metabolism, and certain steroids (like prednisone—an anti-inflammatory that causes water retention and an increase appetite) can add on pounds. Even OTC antihistamines like Benadryl, which can disrupt an enzyme in the brain that helps regulate food consumption, can trigger noticeable weight gain, says Salas-Whalen.
A word to the wise: Don’t stop taking any pills cold-turkey—chat with your doctor, who may be able to find a more waist-friendly substitute.
8. YOU’RE NOTICING ABNORMAL FATTY DEPOSITS… IT COULD BE CUSHING'S DISEASE
A super-rare condition called Cushing’s disease (only 10 to 15 people per million are affected, but 70 percent of those diagnosed are women) causes excess cortisol production and can trigger excessive weight gain just around the abdominal area (legs and arms usually stay lean) and the back of the neck, says Reshmi Srinath, M.D., assistant professor of diabetes, endocrinology, and bone disease at the Icahn School of Medicine at Mount Sinai.
“Cushing’s typically presents with significantly low energy and complications like diabetes, high blood pressure, and high cholesterol. But the telltale sign is very large red stretch marks on their belly,” she says. If this sounds eerily familiar, talk to your doctor asap.
This article originally appeared on Women's Health US.