Concerns about weight and body changes during menopause are as common as other menopause symptom concerns. Approximately 70% of women gain up to 1.5 pounds per year during the menopause transition, which can last up to a decade.1
This weight gain can affect self-esteem, and women often come to their physicians confused and distressed because they don't understand why these changes are happening or what can be done about them. From a health standpoint, weight gain also increases the risk of conditions like heart disorders.
But menopause isn't the sole factor behind weight gain; genetic factors and lifestyle can also contribute. Fortunately, there are effective medications and lifestyle changes that can help manage weight and reduce the associated risks. Knowing the reasons for weight gain and understanding the available treatments can help women navigate this period with greater confidence and ease.
What causes menopause weight gain?
Researchers suggest menopause is not the only contributing factor to weight gain during this period.2 Aging, lifestyle changes, and other shifts during this stage also play a role. Here are some common factors contributing to weight gain:
Changes in Body Composition
As women age, their body composition naturally shifts, with muscle mass decreasing by 3%–8% per decade beginning in the 30s.3 This involuntary loss of muscle mass, coupled with increased fat mass, becomes more pronounced during the menopause transition.
Estrogen, a primary sex hormone in females, plays a crucial role in maintaining body composition. The reduction in estrogen during the early stages of menopause leads to a decrease in lean body mass and an increase in fat mass.4 This shift contributes to the noticeable changes in body composition that many women experience during this time.
Belly Fat
Estrogen plays a crucial role in regulating body fat distribution. As estrogen levels decrease, visceral fat — which surrounds the organs in the abdominal area, including the stomach and intestines — increases. Thus, a reduction in estrogen during the menopausal transition leads to the accumulation of central body fat deposits.
When estrogen levels are low and androgen levels are high, fat moves from the hips and thighs to the belly. This shift favors the development of abdominal obesity, a common concern for many women during menopause. During the menopausal transition, belly fat increases to 15%–20% of total body fat, compared to 5%–8% before this period.1
Gut Microbiome
Research suggests there are differences in the gut microbiome before and after menopause.5 The gut microbiome — the community of microorganisms in the human gut — influences the body’s response to foods. The diversity of the microbiome is closely linked to estrogen levels.
As estrogen levels decline during menopause, changes in microbiome diversity may contribute to weight gain. Experts have also linked changes in hormones to gut problems like irritable bowel syndrome.6 That’s why experts recommend eating whole foods and healthy fruits and vegetables to maintain a healthy gut as one enters menopause.
Fat and Sugar Metabolism
During menopause, significant changes occur in how the body metabolizes fat, leading to weight gain. Estrogen regulates fat metabolism and maintains healthy cholesterol levels. As estrogen levels drop, there is an increase in LDL cholesterol (bad cholesterol) and a decrease in HDL cholesterol (good cholesterol).7
Studies have shown that postmenopausal women have higher levels of blood sugar and inflammation markers during fasting and after eating compared to women who haven't gone through menopause. These changes in fat and sugar metabolism contribute to the overall increase in body fat and weight gain during menopause.8
Changes in Metabolism
During menopause, metabolic changes significantly contribute to weight gain. The metabolism, which is the rate at which the body burns fuel from food, is influenced by hormonal shifts during this period. Decreasing estrogen levels and increasing follicle-stimulating hormone (FSH) levels play a critical role in this process.9
This hormonal imbalance disrupts energy homeostasis by altering hunger and satiety signals. Normally, estrogen helps to inhibit hunger signals, preventing excessive calorie consumption. However, fluctuating estrogen levels during menopause reduce its effectiveness in regulating these signals. Consequently, menopausal women experience more intense hunger signals, encouraging increased food intake and weight gain.9
Lifestyle Factors
Menopausal obesity is primarily driven by hormonal imbalance and its effect on energy balance. However, several other crucial factors also play a significant role:
Stressful life events: During menopause, women often face numerous life stressors simultaneously. These can include managing the demands of teenage children, adjusting to children leaving home, caring for aging parents, dealing with midlife spouses, and navigating career changes.10 Stress is one of the contributing factors for weight gain.
Poor sleep quality: Aging and menopause-related symptoms like night sweats can lead to poor sleep quality. Insufficient sleep affects blood sugar levels, causing spikes and subsequent dips, which increase the likelihood of overeating throughout the day.11
Secondary causes: Conditions such as hypothyroidism, Cushing's syndrome, and certain medications can also contribute to weight gain.
Risks Associated with Weight Gain
Weight gain during menopause has more than just psychological effects. The accumulation of belly fat and other metabolic changes elevate the risk for various health conditions:(1)
Cardiovascular diseases: Increased belly fat and metabolic changes raise the risk of heart disease, hypertension, and stroke.
Type 2 diabetes: Higher insulin levels and insulin resistance associated with weight gain can lead to the development of type 2 diabetes.
Joint problems: Excess weight puts additional stress on joints, increasing the risk of osteoarthritis and other joint-related issues.
Sleep apnea: Weight gain, particularly around the neck and abdomen, can lead to obstructive sleep apnea, which disrupts sleep and exacerbates other health issues.
Cancer: Obesity is linked to a higher risk of several types of cancer, including breast, colon, and endometrial cancer.
Mental health issues: Beyond body image concerns, weight gain can contribute to depression, anxiety, and reduced quality of life.
How to Stop Menopausal Weight Gain with Lifestyle Modifications
Managing weight during menopause can involve both pharmacological and non-pharmacological approaches. Non-pharmacological methods include dietary and lifestyle modifications, while pharmacological options often involve hormone replacement therapy (HRT). In some cases, weight loss medications or surgery may be recommended. Here are some lifestyle modifications to maintain healthy body weight:12
Eating a Healthy Diet
Dietary management during menopause focuses on creating a caloric deficit while improving the overall quality of the diet. Achieving a calorie deficit involves reducing 500–750 kcal from the current intake, considering caloric expenditure, baseline BMI, and any associated comorbidities. Generally, an intake of 1200–1500 kcal per day is suggested in clinical practice.
Protein: 20%–25% of total calories. Healthy options include eggs, lean meats, and dairy.
Fat: Less than 30% of total calories. Healthy options include fatty fish, flaxseeds, and walnuts.
Carbohydrates: 40%–50% of total calories. This can include fiber-filled choices like whole grains, fruits, and legumes.
Staying Active
Physical activity can help achieve a negative calorie balance and relieve vasomotor symptoms. Experts advise the following activities to help manage weight, improve mood, and enhance overall health during this transitional period.
Moderate-intensity aerobic exercise: Activities such as walking, jogging, swimming, and cycling for at least 150 minutes per week can help manage weight, improve cardiovascular health, and reduce the severity of vasomotor symptoms.
Resistance training: Performing resistance training exercises 2–3 times per week helps maintain bone density and muscle mass, which are particularly important during menopause, and supports overall physical strength and metabolic health.
Balance exercises: Incorporating yoga into a routine enhances physical fitness and stability, reducing the risk of falls and improving coordination. It’s also seen to relieve hot flashes, reduce stress, and improve the quality of sleep in menopausal women.
Maintaining Sleep Hygiene
Sleep is crucial for the body to rest, recover, and maintain overall health. Good sleep is especially important for menopausal women due to the physical and hormonal changes of this transition. Poor sleep can negatively impact mood, weight, and cognitive function.
Key steps to enhance sleep quality include sticking to a regular bedtime schedule and creating an environment ideal for rest – dark, quiet, and cool. It's also recommended to limit exposure to electronic devices before bedtime, as they can disrupt the natural sleep cycle.
Relaxation techniques such as deep breathing, progressive muscle relaxation, or visualization may further promote restful sleep.
Can hormone replacement therapy help weight management during menopause?
Hormone replacement therapy (HRT) helps alleviate vasomotor symptoms like hot flashes and night sweats, supports bone health by preventing osteoporosis, and enhances cognitive functioning. Additionally, HRT has been shown to reduce abdominal fat, improve insulin sensitivity, and lower cardiovascular risk factors.
The effectiveness of HRT depends on several factors, including the estrogen dose, combination with progesterone, duration of therapy, time of initiation, and route of administration. A physician will consider all these factors before deciding the type of HRT, mode of administration, and appropriate dose to ensure the best outcomes for weight management and overall health during menopause.
Experiencing menopausal weight gain? Discover if HRT is right for you.
If you’ve entered the menopause transition and are struggling with weight gain, you don’t have to suffer in silence. Take our brief menopause quiz to see if you’re an eligible candidate for HRT. Get started with Winona to take the first step toward feeling better.
