How To Reduce Menopause Weight Gain, According To Experts (2023)

Menopause marks the point at which an individual has not menstruated for 12 months or more, absent of pregnancy or another health condition. The transition leading up to menopause (known as perimenopause) causes changes in hormone production, with decreasing estrogen, progesterone and testosterone levels.

As individuals enter perimenopause, these changes in hormones, particularly estrogen, can cause missed or irregular periods and reduced fertility. Periods can be heavier, lighter, longer, shorter and eventually stop when the ovaries do not produce any more eggs. Shifting levels of estrogen, progesterone and testosterone can also cause various symptoms, including mood changes, hot flashes, increased sweating, skin thinning, vaginal dryness and weight gain.

Several factors can lead to weight gain during and after menopause, not all of which are necessarily due to menopause itself. It’s often difficult to separate the causes of midlife weight gain since hormones, changes in activity levels and other lifestyle circumstances can all play interconnected roles.

Sex Hormones

Hormonal changes and their impact on an individual’s metabolism is often the most significant factor of weight gain after menopause, according to Mona Orady, M.D., director of the Dignity Health Center for Advanced Gynecology and Minimally Invasive Surgery in San Francisco.

“As you get older, the body produces less estrogen and progesterone, hormones that play a large role in the body beyond just regulating the menstrual cycle,” adds Karla Robinson, M.D., a licensed, board-certified family physician in Charlotte, North Carolina. Hormonal changes in the body due to menopause can impact body composition by changing where and how much your body stores fat and decreasing muscle mass, continues Dr. Robinson.

Muscle Loss

Muscle loss occurs with age and can directly impact metabolism. “Muscle-to-fat ratio and physical activity levels impact metabolism and weight gain,” says Dr. Orady. Losing muscle due to aging is called sarcopenia, which happens in varying degrees in most people as they age.

Sarcopenia typically begins after age 40, leading to a 30% to 50% decline in muscle mass by age 80. The exact causes of age-related muscle loss vary and can be different for each person, but experts believe the effect is primarily a combination of reduced sex hormones and the tendency to do less physical activity with age.

Insulin Resistance

During and after menopause, fat distribution and storage can shift. Both muscle loss and insulin resistance can contribute to these changes. The natural decrease of hormones during this time makes women increasingly prone to insulin resistance, which can increase abdominal fat stores.

“Postmenopausal women begin to gain weight in their belly, and this [central] body weight gain is linked to worse health outcomes with women more likely to develop metabolic syndrome, sleeping and breathing issues and have an increase in cardiovascular events,” explains Kathleen Jordan, M.D., chief medical officer of Midi Health, a virtual care clinic for women over 40.

Poor Sleep

Getting enough quality sleep is another vital aspect of reaching and maintaining a healthy weight, according to Dr. Jordan. “Poor sleep is linked to weight gain, and midlife is where we see the incidence of sleep difficulties skyrocket,” she explains, noting that the incidence of sleep apnea and other sleep issues double in midlife, leaving people with daytime fatigue and cravings for processed sugars and high-calorie, nutrient poor foods, which can lead to weight gain.

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(Video) How to Avoid Menopause Weight Gain | Ask the Doctor

As a result of aging and hormonal changes, it’s common for postmenopausal women to gain about 1.5 pounds per year in their 50s and 60s, which can lead to increased health risks^[1]Kapoor E, Collazo-Clavell ML, Faubion SS. Weight gain in women at midlife: a concise review of the pathophysiology and strategies for management. Mayo Clin Proc. 2017;92(10):1552-1558. . “We see an increase in the number of women with metabolic syndrome, obesity and diabetes—all of which increase their risk of heart disease and strokes,” says Dr. Jordan.

Abdominal Visceral Fat

Insulin resistance and hormonal shifts during menopause can increase the storage of abdominal visceral fat in some individuals. Visceral fat is the more dangerous type of body fat that accumulates around the organs and in the abdomen, leading to weight gain around the belly. A higher amount of visceral fat and a higher waist circumference can lead to an increased risk of death from all causes, according to research in Obesity^[2]Koster A, Murphy RA, Eiriksdottir G, et al. Fat distribution and mortality: the ages-reykjavik study: fat distribution and mortality. Obesity. 2015;23(4):893-897. .

Heart Health and Cholesterol

Heart health can be impacted by hormonal changes before, during and after menopause due to estrogen’s role in keeping arteries flexible and maintaining healthy blood pressure. “The hormonal changes you experience during menopause can affect your heart by increasing your blood pressure or stiffening blood vessels,” explains Dr. Robinson. “A change in estrogen may also affect cholesterol and blood sugar levels and cause them to rise.”

High cholesterol and high blood sugar are both risk factors for heart disease. Heart health, blood pressure and blood sugar levels are all better managed when weight is at a healthy level.

Dr. Orady recommends individuals of all ages—but certainly postmenopausal women—focus on healthy eating and maintaining a consistent regimen of aerobic exercise, such as walking, swimming, cycling, hiking and strength training.

Resistance training in particular is helpful when it comes to muscle loss. “A lot of people just focus on cardio for heart health, but strength training exercises are very important to focus on as we age,” advises Dr. Orady. She suggests at least 15 minutes of weight training a few times a week to positively impact weight and overall health after menopause.

Diet is also an essential factor in menopausal weight gain and maintaining a healthy weight no matter your age. Dr. Robinson recommends implementing a heart-healthy diet. “Focus on foods high in fiber, unsaturated fat and vitamins,” she says. “Some examples include vegetables, fruit, oily fish and whole grains.” Dietary fiber itself has been shown to be very effective in reducing blood glucose.

Dr. Jordan recommends limiting “empty” calories by selecting nutritious, low-sugar foods. “Diet plans that lean into fresh foods that are high in fiber, high in protein and lower in carbohydrates are effective in weight management [because they] optimize nutrition and energy levels while improving blood sugar and cholesterol levels,” she explains.

Focusing on sleep hygiene is also imperative, according to Dr. Jordan, as it helps improve quality and quantity of sleep. “No computer screens, no work in the bedroom, keep a regular schedule and routine around sleep [and] limit alcohol intake, especially in the hours immediately preceding sleep, as detectable blood levels of alcohol prohibit deep, restorative sleep,” suggests Dr. Jordan.

It’s also crucial to treat night sweats if you have them. “Night sweats in menopause are associated with poor quality sleep, and treating them results in improved quality of sleep,” says Dr. Jordan, who recommends estrogen replacement as the most effective treatment for night sweats. “For women who can’t take hormones, there are also other prescription and integrative solutions that help, too,” she adds.

Hormone replacement therapy (HRT) is another option for perimenopausal and postmenopausal women. “Hormone replacement has been shown to improve the bad-for-you central weight gain;in other words, it helps women battle the belly weight gain distribution,” says Dr. Jordan.

Hormone therapy can also help with poor sleep, mood changes and energy levels, she adds, which contribute to weight gain. “HRT also has a positive effect on our lipid and glucose metabolism, thereby lessening the development of other cardiovascular risks,” she says.

See a clinician that understands the menopausal transition and uses evidence-based care to help you achieve your healthiest weight. “Prescription medications may be part of a solution for some women, but I would look for care that also includes support for lifestyle modifications, nutritional strategies and other interventions linked to sustained weight management,” advises Dr. Jordan.