In this article:
2/ Hormonal changes and symptoms of menopause
3/ The link between menopause and weight gain
4/ What about hormone replacement therapy?
5/ Can you get rid of menopausal belly fat?
6/ 6 ways to manage weight after menopause
Like many aspects of aging, menopause has long been taboo. And that’s left a lot of women in the dark about what happens during this inevitable phase. “Menopause can feel like someone changed the rules of your body and forgot to tell you,” says Dr. Stephanie S. Faubion, M.D., director for Mayo Clinic's Center for Women's Health and medical director for The North American Menopause Society. Forgot to tell you that your new normal may include not just hot flashes and night sweats — but also weight gain. Here’s what you should know.
What is menopause exactly?
Menopause refers to the life stage when a person is no longer menstruating. It officially begins 12 months after you get your final period, with the average age in the US being 51 but generally happens between the ages of 45 and 58. Menopause can also occur with surgery that removes the ovaries, a procedure commonly performed with a hysterectomy.
For menopause that happens with aging, the two- to eight-year period leading up to that milestone is known as perimenopause. This phase is marked by fluctuating levels of ovarian hormones and, for many people, some pretty noticeable symptoms like irregular periods and the aforementioned hot flashes and night sweats.
Hormonal changes and symptoms of menopause
Here are the major hormonal shifts and how they can make you feel:
Progesterone: This hormone is generally the first to wane during perimenopause. This can slow your metabolism and lead to weight gain. It can also cause vaginal dryness, menstrual spotting, and mood changes including a heightened risk of depression or anxiety.
Estrogen: The next hormonal shift is typically a reduction in estrogen output. This is linked with a breakdown of lean tissue (a.k.a. muscle), slower metabolism, and an increased percentage of body fat. And because estrogen helps insulin — a hormone that allows our bodies to convert glucose (blood sugar) into energy — its decline may lead to elevated blood sugar levels. Lower levels of estrogen also contribute to symptoms like hot flashes and headaches, and may play a role in depression risk as well.
Testosterone: Levels of this hormone start dropping well before menopause. By the time you start menopause, your testosterone is typically about half what it was at its peak in your 20s. Testosterone helps retain lean muscle mass, and declining levels are associated with an increase in body fat, particularly in the belly region.
The link between menopause and weight gain
One comprehensive review of research on midlife women found that subjects gained an average of 1.5 pounds each year throughout their 40s and 50s. But this isn’t just because of menopause. People across the board, regardless of their biology, tend to gain weight as they get older. “Evidence suggests that midlife weight gain may actually have more to do with aging than [menopause] directly,” Dr. Faubion says. Here’s why it happens:
- Slower metabolism: “This is a major reason that people gain weight as they age,” Faubion says, in large part due to an age-related loss of muscle mass. Studies show that adults tend to lose a small amount of muscle every year starting around age 30, and that the rate of loss picks up over time. Since muscle burns more energy than fat, losing muscle mass may result in a lower metabolic rate and additional weight.
- Poor sleep: Remember those menopausal symptoms we mentioned earlier—anxiety, hot flashes, night sweats? Any one of them can make it tough to sleep, Faubion says. Research has found that poor sleep may affect weight by ramping up appetite.
- Heightened stress: Due to factors such as economic uncertainty, research shows that today’s middle-age adults experience more stress than their 1990s counterparts did. And higher levels of the stress hormone cortisol are linked to more body fat. Cortisol may also raise levels of the hormone ghrelin, which stokes appetite.
- Less activity: According to the CDC, one in four U.S. adults over 50 do not engage in any form of exercise, a percentage that rises with age. Multiple factors likely contribute to this trend — everything from busier schedules to chronic health issues.
Can hormone replacement therapy (HRT) help you lose weight?
HRT is a way to supplement your hormones that get depleted during menopause. The medication can be a mix of both estrogen and progesterone — or just estrogen — and they are typically taken via pill, patch, or cream. The goal: to reduce the side effects brought on by low hormone levels. At this point, however, there’s no solid evidence that hormone replacement therapy can make a meaningful difference on the scale. That’s because an HRT regimen is aimed at improving quality of life, not helping you lose weight. “It’s used to manage menopausal symptoms such as hot flashes, night sweats, mood changes, and vaginal dryness,” Dr. Faubion says. Your doctor can help you determine whether HRT is a good choice for you by ensuring you fully understand the potential benefits and health risks.
How can you get rid of menopausal belly fat?
Take this truth bomb as permission to quit those “fat-melting” diets forever: There’s no magic formula or food that can specifically target the size of your midsection. “You can’t spot-reduce fat,” Dr. Faubion says. Here’s what can help reduce belly fat: steady, sustainable weight management that happens holistically. That encompasses the tips we’ve mentioned — getting good sleep, moving your body regularly, and managing stress — as well as eating a nutritious diet filled with a diversity of whole foods.
6 tips for managing weight after menopause
If you gain weight around menopause, know that it’s natural and common — and also that you don't necessarily need to do anything about it. After all, weight gain isn’t always a medical concern. Talking about your overall well-being with your healthcare provider can help you get a more holistic view of your health and put any additional weight into perspective. If you and your provider decide it would be helpful for you to lose weight, or you want to avoid gaining weight, the following strategies can help.
1. Prioritize protein
Research suggests that eating more protein throughout the day may help the body hold on to muscle as you get older and experts recommend aiming for 1-1.2 grams of protein per kg of body weight. Protein-rich foods — such as fish, eggs, beans, and lean meat and poultry — also play a key role in making meals feel satisfying.
2. Eat meals mindfully
On busy days, it can be tempting to multitask as you quickly eat a breakfast wrap or poke bowl. But you may find your meal more satisfying if you are fully present while enjoying it — a practice known as mindful eating. One small study found that when people heard a prompt to focus on the aroma, flavor, and texture of their lunch, they ate fewer snacks later that afternoon than volunteers who didn’t receive the audio nudge. In addition to savoring every bite, try setting aside a designated spot to enjoy your meal without distractions, and lay down your fork between bites.
3. Put the scale in perspective
Gentle reminder: nobody’s body stays the same forever. “Give yourself a little grace,” Dr. Faubion says. “Understand that there will be body changes with age, and that’s OK.” Your body has taken you through the decades, and now that you’re entering a new era, it still needs care and nourishment. Even if you are working toward a weight-loss goal, try to be just as intentional in treating yourself with kindness. Take a moment before bed to thank your body for the things it helped you do that day, or jot down some favorite aspects of yourself and put the list by your mirror to serve as a daily affirmation.
4. ID your stress-busting strategies
You can’t remove all stressors from your life, but you can learn new tools for effectively handling the stressors. It’s not about pretending everything is perfect; it’s about coping with your circumstances in a healthy way. Figuring out what works for you might take some exploration, or a shift in perspective. Some people benefit from journaling; others ease stress by listening to music, spending time in nature, taking a break from screens, or meeting up with friends for a weekly hang. Increasing your physical movement may also help. In a nutshell? A good stress reliever is an activity that helps you feel less overwhelmed — and better equipped to face life’s challenges.
5. Get serious about sleep
On top of helping you wake up energized and refreshed, high-quality sleep supports long-term weight management. Even if you can’t avoid every hot flash, creating a consistent bedtime routine and paying attention to your sleep environment can help. About an hour before you’d like to be snoozing, try winding down by dimming the lights and taking a bath or cracking open a good book. Then, adjust your bedroom temperature to about 65°F, a thermal sweet spot that seems to keep sleepers comfortably warm without overheating. Your bed’s comfort factor matters, too — if your mattress feels lumpy or your pillows are flat as pancakes, some upgrades might be in order.
6. Build your strength
While all physical activity is beneficial, strength training in particular may be important before, during, and after menopause. That’s because it builds muscle, which can help offset some of the muscle loss you’d otherwise experience as you age, says Dr. Stephanie Zeszutek, DO, FACOG, an OB-GYN and assistant professor at Touro College of Osteopathic Medicine in New York. The CDC recommends muscle-strengthening exercises that target major muscle groups (think: legs, back, abdominals, chest, shoulders, and arms) at least twice a week. If you’re new to strength training, try starting with simple exercises that use just your bodyweight. You can always invest in resistance bands or other equipment down the road.
The bottom line
While gaining weight in midlife is often blamed on menopause, it has more to do with other aging-related factors like a slower metabolism and changes in physical activity than it specifically does with waning hormones. By prioritizing your overall well-being — getting enough sleep, managing stress, eating lean protein, and adding strength training to your fitness routine — you can help mitigate midlife weight gain, and feel good despite this stage’s many symptoms and changes.
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This content is for informational purposes only and does not constitute medical advice, diagnosis or treatment. It should not be regarded as a substitute for guidance from your healthcare provider.