Starvation mode with too much exercise?
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I'm sorry but that just doesn't seem to fit with the numbers.
Let's take me as an example. If I was sedentary, BMR around 1750 my calorie expenditure should be around 2100 calories per day according to calculators.
Now if we take that 15% number for a fact that would be 1785 instead, or a reduction of 315 calories below what it should be. 10% of that reduction now are changes in BMR as stated. So 31.5 calories, let's say 32. My BMR is now 1722. The rest are changes to my NREE which is part of the calories between BMR and TDEE. So of the 350 calories I burn from moving around on any given day, I have lost 283, or 80% of them which doesn't make sense no matter how you look at it.
Either my calculation is wrong, the guy is wrong, or both of us misunderstood some significant part of this whole thing.
All I know is that scientists in more than one study say that a 10% reduction in weight results in about a 20% increase in skeletal muscle efficiency and about a 10%-15% reduction in overall metabolism.
So if you previously needed 2100 calories to maintain, if you lost 10% of your weight you would need 10%-15% less calories than someone of the same weight who had not lost weight.
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There are confounding factors I can't clear from just the summary though - it would be nice to get the whole paper.
The entire paper is here:
http://ajpregu.physiology.org/content/285/1/R183
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It looks more like 22 pounds to me. 284 to 262.maillemaker wrote: »So the answer is you've gained weight? Do you think you would have had more success if you tried to figure out how to lose weight as opposed to looking for the reasons why you are destined to not lose weight?
Are we looking at the same graph?
I have lost weight.
From looking at that up and down chart in the frame of 4/20-4/27 your weight is lower than the very last point of on the chart or right around the same, no? It makes it more difficult to know numbers by looking at lines. Looks like in the last 3 months total you're looking at maybe 6 lbs lost, correct? You know it could be better than that.
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From looking at that up and down chart in the frame of 4/20-4/27 your weight is lower than the very last point of on the chart or right around the same, no? It makes it more difficult to know numbers by looking at lines. Looks like in the last 3 months total you're looking at maybe 6 lbs lost, correct? You know it could be better than that.
I re-started dieting on 2/18. I started weighing on 2/28 with my new scale. I was 272.1 pounds on 2/28. I am currently 261.4, for a loss of 10.7 pounds over 13 weeks, or approximately .82 pounds per week.
The best I have ever achieved was 1.2 pounds per week.
I have MFP set at a 2-pound-per-week loss, and it has me at 1570 calories per day. I don't always hit it.
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It looks more like 22 pounds to me. 284 to 262.
I am down 28 pounds from my maximum of 291 pounds on 8/24/2014.
However, I am now about where I was this time last year (MFP charts on PC only goes back one year).
Last year I lost 30 pounds and gained it all back. Since August I have lost it again.0 -
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More calories burned than consumed results in weight loss, no matter what. You could have 100 calories everyday and work-out, and even though it's not recommended, you will still lose weight.0
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Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
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maillemaker wrote: »I'm sorry but that just doesn't seem to fit with the numbers.
Let's take me as an example. If I was sedentary, BMR around 1750 my calorie expenditure should be around 2100 calories per day according to calculators.
Now if we take that 15% number for a fact that would be 1785 instead, or a reduction of 315 calories below what it should be. 10% of that reduction now are changes in BMR as stated. So 31.5 calories, let's say 32. My BMR is now 1722. The rest are changes to my NREE which is part of the calories between BMR and TDEE. So of the 350 calories I burn from moving around on any given day, I have lost 283, or 80% of them which doesn't make sense no matter how you look at it.
Either my calculation is wrong, the guy is wrong, or both of us misunderstood some significant part of this whole thing.
All I know is that scientists in more than one study say that a 10% reduction in weight results in about a 20% increase in skeletal muscle efficiency and about a 10%-15% reduction in overall metabolism.
So if you previously needed 2100 calories to maintain, if you lost 10% of your weight you would need 10%-15% less calories than someone of the same weight who had not lost weight.
Well, I did lose 10% of my original weight. 20% even. Can't say that my TDEE went down.0 -
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10% to me personally is pretty insignificant. I have had this discussion with others, some say it's significant, I disagree. 10% calories of a man's TDEE roughly 2,500-3,000 calories is 250-300 calories. People go over 300 and below 300 calories on their diary often. It doesn't mean much.
It doesn't sound significant, until you don't pay attention to it and eat those 250-300 calories that you think you ought to be able to eat based on your weight and discover that you're consuming a 10% surplus. Just a 3% surplus over a few years can result in several pounds of weight gain.
On my 1570 calorie-a-day allotment, 300 calories to me is a feast. That's double what I normally eat for breakfast and lunch.
Anyway, the point is, when you lose weight, you will not only have to learn to eat less food for your new weight, you'll have to eat 300 or so calories a day less than that.Well, I did lose 10% of my original weight. 20% even. Can't say that my TDEE went down.
Did you exercise while doing it?0 -
Yep, weight lifting. Hate cardio.0
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Yep, weight lifting. Hate cardio.
The study indicates that heavy exercise may mitigate the metabolism slow-down.
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I personally wouldn't define going to gym for an hour 3 times a week as heavy exercise. I even use the sedentary calories for my cut.0
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So, "Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass."maillemaker wrote: »Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
10% to me personally is pretty insignificant. I have had this discussion with others, some say it's significant, I disagree. 10% calories of a man's TDEE roughly 2,500-3,000 calories is 250-300 calories. People go over 300 and below 300 calories on their diary often. It doesn't mean much.
But that's 10% with a 10% weight reduction. Does that then equate to, (for example) 40% reduction in metabolism for a 40% weight reduction?0 -
I personally wouldn't define going to gym for an hour 3 times a week as heavy exercise. I even use the sedentary calories for my cut.
Well, the study did not study the metabolic effects of weight loss on people who were exercising. They just saw (as I read it) that increased power output seemed to mitigate the increase in GME.
"Maintenance of a body weight 10% below Wtinitial was associated with significant increases in skeletal muscle GME to generate 10 and 25 W, but not 50 W, of power. The percent increase in GME at Wt-10% compared with Wtinitial steadily diminished as exercise intensity increased. Mean (SD) %change in efficiency at Wt-10% compared with Wtinitial were +26.5 (26.7)% (P < 0.001) to generate 10 W of power, +23.2 (25.8)% (P = 0.027) to generate 25 W of power, and +9.0 (19.4)% (P = 0.062.) to generate 50 W of power (see Table 2). Maintenance of a body weight 10% above Wtinitial was associated with significant decreases in skeletal muscle GME to generate 10 but not 50 W of power. Mean (SD) %change in efficiency at Wt+10% compared with Wtinitial were -17.8 (20.5)% (P = 0.043) to generate 10 W of power and -3.2 (12.1)% (NS) to generate 50 W of power (see Table 2). No significant effects of gender or initial somatotype on changes in skeletal muscle work efficiency were noted."
GME = Gross Mechanical Efficiency.
I'm not sure I fully understand the above however.
But the initial study I cited suggests that exercise might mitigate the efficiency increase. I think they aren't stating it definitively because that is not what they studied. They were studying the straight-up effects of weight loss on metabolism.0 -
3 months resistance training on 800 calories a day diet showed no decrease in LBM. That's funny, an increase of RMR increased in resistance group.
http://www.ncbi.nlm.nih.gov/pubmed/10204826
Great study find. That seems to indicate that resistance training might counter the metabolic slowdown caused by weight loss.
This makes sense. If your body is not having to work and you cut calories, it's just going to slow down to try and preserve its fat stores. But if it has to work, it can't do that to the muscles.0 -
There are 2 parts to this metabolic slow down, 1. just getting smaller. This doesn't matter, because this is calories are directly proproportional to your size. Meaning a guy who is eating 3000 calories to maintain weight, he would feel exactly the same if he lost weight and ate 2000 calories ot maintain his new weight. Weight = Calories. Your weight goes up, you need more calories, the weight goes down you need less calories.
Agree 100%.The only relevent issue is hormones that lead to metabolic suppression. Most of these are due to lack of food intake, so your metabolic rate drops. Once you hit maintained they will come back up to normal. And your issue is you're probably starving yourself, if you're eating 1750 that's too extreme.
Disagree partially. The metabolic rate drop does seem to be related to lowered levels of Leptin. But the lowered levels of Leptin are a result of lowered levels of body fat. Body fat produces Leptin. Your body detects the lowered Leptin levels and responds in a defensive manner in an attempt to restore the fat stores.
It's not due to your lack of food intake (other than that is what is causing the loss of fat).
I really, really, really hope that when I am on maintenance the problem goes way. But the study indicates that the effect persists for years. So I am doubtful that the effect goes away at all. It is possible that getting fat does permanent damage to your health in that you have now set a "high water mark" for Leptin that your body will want to re-achieve forever.I few mistakes i made through my weight loss, which I "recently" discovered after a fwe years. If you're using a HRM to track calories, don't use it for resistance training. It's also simply best to have a constant intake of calories, don't be eating back exercise calories, this leads to more possible errors. These errors is what you want to get rid of. Just to be clear if you're eating 1750 calories and eating back your exercise calories. I would stop that, and shoot for something more constant, like 2000 calories a day.
I'm eating 1570 a day (at least, that is my MFP-designated target goal). I don't exercise often though. I am trying to swim every night now that the pool is open but it's still damn cold.
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maillemaker wrote: »Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
Going by that, every single person here who has lost at least 10% of their body weight would now have to be reducing their calorie intake 10%-15% more than what the calculators say in order to get the same result. Maybe I'm a special snowflake, but that certainly hasn't happened to me.0 -
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I googled Gross Mechanical Efficiency and it seems to me that doesn't factor in that reduced weight makes the movement inherently easier for the person doing it, i.e. someone pedaling pedals to generate 10/25/50 watts who weighs more is going to burn more calories doing it already because their legs are heavier than someone who weighs less.
http://www.livestrong.com/article/549465-what-is-mechanical-efficiency-during-exercise/ (not the best source, I know. I was just looking for the definition.)Gross efficiency is the percentage ratio of external work achieved compared to the total energy expenditure.
If the study your quote comes from thought about that I can't say without the source. They should have though.0 -
maillemaker wrote: »3 months resistance training on 800 calories a day diet showed no decrease in LBM. That's funny, an increase of RMR increased in resistance group.
http://www.ncbi.nlm.nih.gov/pubmed/10204826
Great study find. That seems to indicate that resistance training might counter the metabolic slowdown caused by weight loss.
This makes sense. If your body is not having to work and you cut calories, it's just going to slow down to try and preserve its fat stores. But if it has to work, it can't do that to the muscles.
That is what that Oxford Journal study I posted in the beginning of the thread stated.0 -
Chrysalid2014 wrote: »
So, "Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass."maillemaker wrote: »Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
10% to me personally is pretty insignificant. I have had this discussion with others, some say it's significant, I disagree. 10% calories of a man's TDEE roughly 2,500-3,000 calories is 250-300 calories. People go over 300 and below 300 calories on their diary often. It doesn't mean much.
But that's 10% with a 10% weight reduction. Does that then equate to, (for example) 40% reduction in metabolism for a 40% weight reduction?
Was wondering the same, and frankly, don't feel like reading the studies.
All I know is I lost 80lbs (about 35%) of my body weight on 1800 calories. The day I got to maintenance, I ate 2500, and 3500 the next. Then ate 3000 for another 3 or 4 days and my weight dropped more. So I went to 3500. Have been eating between 3200-3700 ever since.
Nothing but cardio at that time.
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Is whining and making excuses a form of exercise?0
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Chrysalid2014 wrote: »
So, "Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass."maillemaker wrote: »Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
10% to me personally is pretty insignificant. I have had this discussion with others, some say it's significant, I disagree. 10% calories of a man's TDEE roughly 2,500-3,000 calories is 250-300 calories. People go over 300 and below 300 calories on their diary often. It doesn't mean much.
But that's 10% with a 10% weight reduction. Does that then equate to, (for example) 40% reduction in metabolism for a 40% weight reduction?
Lets check it out.
I input stats in to iifym.com calculator for TDEE. a 200lbs man TDEE is about 2645. He drops 10% of his weight, this will be 20lbs, so now he weighs 180.
HIs new TDEE is 2580. We take away 10% from this due to the metabolic decrease. HIs new metabolic rate is 2322.
So in the end his metabolic rate dropped 12%.
Thanks @Pu_239. So what I'm wondering is what happens if he then drops another 10% off his weight? Does the metabolic decrease happen only once (i.e. when he exceeds 10% weight loss) or does it decrease a further 10% (in addition to his reduced TDEE) every time he loses 10% of his weight?0 -
Nony_Mouse wrote: »maillemaker wrote: »Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
Going by that, every single person here who has lost at least 10% of their body weight would now have to be reducing their calorie intake 10%-15% more than what the calculators say in order to get the same result. Maybe I'm a special snowflake, but that certainly hasn't happened to me.
I have a migraine right now, so I'm not following the numbers in this too well, but... yeah... I sort of follow this... why aren't people on here complaining en masse about this effect if it's such a sure thing? I've lost 19% of my bodyweight. No need to reduce my calorie intake further than expected to get results.
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Chrysalid2014 wrote: »
So, "Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass."maillemaker wrote: »Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
10% to me personally is pretty insignificant. I have had this discussion with others, some say it's significant, I disagree. 10% calories of a man's TDEE roughly 2,500-3,000 calories is 250-300 calories. People go over 300 and below 300 calories on their diary often. It doesn't mean much.
But that's 10% with a 10% weight reduction. Does that then equate to, (for example) 40% reduction in metabolism for a 40% weight reduction?
Was wondering the same, and frankly, don't feel like reading the studies.
All I know is I lost 80lbs (about 35%) of my body weight on 1800 calories. The day I got to maintenance, I ate 2500, and 3500 the next. Then ate 3000 for another 3 or 4 days and my weight dropped more. So I went to 3500. Have been eating between 3200-3700 ever since.
Nothing but cardio at that time.
And you're 40-something right? I was thinking earlier that Steven's results might be because he's younger, but your story is different.
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maillemaker wrote: »There are 2 parts to this metabolic slow down, 1. just getting smaller. This doesn't matter, because this is calories are directly proproportional to your size. Meaning a guy who is eating 3000 calories to maintain weight, he would feel exactly the same if he lost weight and ate 2000 calories ot maintain his new weight. Weight = Calories. Your weight goes up, you need more calories, the weight goes down you need less calories.
Agree 100%.The only relevent issue is hormones that lead to metabolic suppression. Most of these are due to lack of food intake, so your metabolic rate drops. Once you hit maintained they will come back up to normal. And your issue is you're probably starving yourself, if you're eating 1750 that's too extreme.
Disagree partially. The metabolic rate drop does seem to be related to lowered levels of Leptin. But the lowered levels of Leptin are a result of lowered levels of body fat. Body fat produces Leptin. Your body detects the lowered Leptin levels and responds in a defensive manner in an attempt to restore the fat stores.
It's not due to your lack of food intake (other than that is what is causing the loss of fat).
I really, really, really hope that when I am on maintenance the problem goes way. But the study indicates that the effect persists for years. So I am doubtful that the effect goes away at all. It is possible that getting fat does permanent damage to your health in that you have now set a "high water mark" for Leptin that your body will want to re-achieve forever.I few mistakes i made through my weight loss, which I "recently" discovered after a fwe years. If you're using a HRM to track calories, don't use it for resistance training. It's also simply best to have a constant intake of calories, don't be eating back exercise calories, this leads to more possible errors. These errors is what you want to get rid of. Just to be clear if you're eating 1750 calories and eating back your exercise calories. I would stop that, and shoot for something more constant, like 2000 calories a day.
I'm eating 1570 a day (at least, that is my MFP-designated target goal). I don't exercise often though. I am trying to swim every night now that the pool is open but it's still damn cold.
Just get in the pool and MOVE. You'll warm up soon enough. Our swim club pool is freezing, but moving right away takes care of that. I've been water jogging this past week since it opened.
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Chrysalid2014 wrote: »Chrysalid2014 wrote: »
So, "Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass."maillemaker wrote: »Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
10% to me personally is pretty insignificant. I have had this discussion with others, some say it's significant, I disagree. 10% calories of a man's TDEE roughly 2,500-3,000 calories is 250-300 calories. People go over 300 and below 300 calories on their diary often. It doesn't mean much.
But that's 10% with a 10% weight reduction. Does that then equate to, (for example) 40% reduction in metabolism for a 40% weight reduction?
Lets check it out.
I input stats in to iifym.com calculator for TDEE. a 200lbs man TDEE is about 2645. He drops 10% of his weight, this will be 20lbs, so now he weighs 180.
HIs new TDEE is 2580. We take away 10% from this due to the metabolic decrease. HIs new metabolic rate is 2322.
So in the end his metabolic rate dropped 12%.
Thanks @Pu_239. So what I'm wondering is what happens if he then drops another 10% off his weight? Does the metabolic decrease happen only once (i.e. when he exceeds 10% weight loss) or does it decrease a further 10% (in addition to his reduced TDEE) every time he loses 10% of his weight?
should only occur once. Hence the max drop in metabolic rate is 10-15%. In the Minnesota starvation study, those guys went down a lot in weight, and if i remember correctly the max drop was 10-15%.
Oh, okay, well that's not so bad then... and cheaper on groceries too!0 -
Do I give you migraines?mamapeach910 wrote: »Nony_Mouse wrote: »maillemaker wrote: »Okay so you've lost .8 per week, even though it could be better that's still progress. Now wouldn't you energy be better spent researching what you can do this time to not gain the weight back or how you can give others advice on what to do the succeed instead of constantly telling people why they will fail? It's kind of like you are setting yourself up for justification as to why you won't have long term or even semi long term success.
I am not "telling people why they will fail."
This is a discussion about the metabolic consequences of weight loss and exercise.
I am providing scientific citations about the metabolic consequences of weight loss.
Weight loss of 10% results in about a 10%-15% reduction in metabolism beyond what is accounted for by the simple loss of body mass. It is a defense reaction to the loss of fat mass.
While this and other defensive reactions almost certainly do contribute to why people fail to maintain weight loss long-term, I have made no comments on that in this thread.
Going by that, every single person here who has lost at least 10% of their body weight would now have to be reducing their calorie intake 10%-15% more than what the calculators say in order to get the same result. Maybe I'm a special snowflake, but that certainly hasn't happened to me.
I have a migraine right now, so I'm not following the numbers in this too well, but... yeah... I sort of follow this... why aren't people on here complaining en masse about this effect if it's such a sure thing? I've lost 19% of my bodyweight. No need to reduce my calorie intake further than expected to get results.
Hahahaha... no, I just get them entirely too frequently. I'm one of the rare ones who got lucky enough to have them increase AFTER menopause.
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This discussion has been closed.
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