Menopause weight gain: why it happens and how to manage it
Reviewed by Yael Cooperman, MD, Ro,
Written by Gina Allegretti, MD
last updated: Sep 08, 2023
5 min read
Here's what we'll cover
Some people see menopause as a positive—no more periods, no menstrual cramps, and no need to buy pricey period supplies. At other times, menopause can feel like a chore, causing symptoms like hot flashes, vaginal dryness, mood changes, and often weight gain. Studies have shown that women tend to gain an average of about five pounds as they go through the menopause transition, but the number can be higher for many, and menopause may make it more difficult to lose that weight. We’re going to take a look at what causes menopausal weight changes and weight loss tips for this stage of life.
Menopause and weight gain: what’s the connection?
Your metabolism changes during different life stages, and menopause is no exception. Usually, it causes your metabolism to slow down, resulting in weight gain. And weight gain is more than just cosmetic. It may increase the risk of conditions like heart disease (cardiovascular disease), type 2 diabetes, and metabolic syndrome. There are many theories as to why people tend to gain weight during menopause.
Lower estrogen levels
Estrogen, a dominant hormone in the female reproductive system, decreases significantly after menopause. This contributes to many of the most familiar symptoms people describe, including hot flashes, thinning hair, night sweats, and vaginal dryness.
Some studies have found that as estrogen levels fall during menopause, body fat distribution changes. Before menopause, fat is more evenly distributed throughout the body. After menopause, there is an increase in fat around the abdominal organs like the liver and kidneys (visceral fat, or so-called belly fat).
Some data suggest that this change is due to estrogen’s effect on an appetite-controlling hormone called leptin. The decrease in estrogen may result in what’s called leptin resistance, or leptin insensitivity. Essentially, the brain doesn’t respond to leptin’s signals, so people with this condition don’t feel full as quickly as people without leptin insensitivity, resulting in more calorie consumption. Also, it can turn down the dial on your metabolism, resulting in an energy imbalance that favors weight gain.
Slower metabolism
The idea that metabolism slows down as we age is common, but is it accurate? The answer is, yes—at least in some ways.
As estrogen decreases during menopause, there’s a decrease in what’s called the basal metabolic rate (BMR). BMR is the rate at which the body burns energy (or calories) while not active. It reflects the calories you burn when you’re not exercising but still using energy for body functions like breathing and the line. As you get older, your BMR decreases, you burn fewer calories at rest and may, as a result, be more likely to gain weight as a result.
Reduced physical activity
It makes sense that as we get older, we become less physically active. Older people may work less physically demanding jobs or be less likely to chase kids around the house. Conditions that become more common with age, like arthritis, might make regular physical activity more of a challenge.
It’s not clear why spontaneous activity decreases during menopause, but it may be related to hormonal changes, especially the decrease in estrogen. Some studies found that when people in menopause are given estrogen replacement therapy, it helped increase spontaneous movement.
Decreased muscle
In general, people with more muscle (lean muscle mass, or LMM) have a higher energy expenditure, or total number of calories burned. During menopause, the drop in estrogen often causes a decrease in lean muscle mass and that can mean fewer calories burned, leading to weight gain. Upping your physical activity, particularly with activities like resistance training and weight-based exercises, can increase your lean muscle mass with the added benefit of stimulating bone regeneration to prevent osteoporosis––another condition that predominantly affects post-menopausal women.
Sleep deprivation
Changes in estrogen levels during menopause may be linked to sleep disturbances (like sleep apnea) and sleep disorders. Lack of adequate sleep can affect your metabolism, when you eat, how often you eat, and where fat deposits on your body. Getting into a more solid sleep pattern can take time, but the benefits can be enormous when you invest in proper sleep hygiene.
Changes in the microbiome
Scientists have found evidence that weight changes during menopause might be related to your microbiome, which is the population of bacteria in your body. Hormones and other factors can cause a shift in your microbiome, which plays an important role in metabolism and how the body processes and absorbs nutrients. Changes during menopause to the microbiome in the digestive system can therefore have an impact on metabolism and weight.
How to lose weight after menopause
Menopause may be associated with weight gain for many reasons, but the good news is that there are ways to take control over these hormonal changes and decrease your risk of health issues. Some tips for losing weight after menopause include:
Maintaining a healthy diet: After menopause, it becomes even more important to maintain a nutritious, balanced diet packed with nutrients, while maintaining a small calorie deficit until your weight is balanced. This doesn’t mean starving—it means shifting the focus to eating high-quality foods (like lean protein, whole grains, and fresh fruits and vegetables) rather than having too much processed food. There’s no specific menopause diet, but studies show that eating fewer carbohydrates and more protein can be helpful.
Exercise: Regular exercise and physical activity carry a range of benefits for overall health and well-being. During menopause, it’s recommended to do about two and a half hours (or 150 minutes) of moderate-intensity exercise each week. This may include biking, running, walking, aerobic exercise, resistance training, or whatever activities you enjoy most.
Hormone therapy: Hormone replacement therapy (HRT), also called estrogen replacement therapy, involves using medications to increase estrogen levels. Some studies have found that HRT may help decrease waist circumference and overall body fat.
Behavioral therapy: Some people benefit from behavioral therapy when trying to lose weight during menopause. This type of therapy may help set goals, avoid pitfalls like emotional eating, and avoid relapsing and regaining weight.
Get some sleep: Since adequate sleep is important for weight regulation, it’s important to try to get a good night’s sleep. Menopause may disrupt your sleep schedule, so try improving sleep hygiene by setting a routine, avoiding screens before bed, reducing light in your room, and eliminating noise or using a sound machine to help you fall asleep. Some studies even suggest that acupuncture may help people in menopause sleep better.
Stress less: Stress can raise cortisol levels and increase weight. Practices like yoga may help reduce stress in people during menopause. Other helpful stress-relieving techniques include meditation, mindfulness, or even just taking a quiet walk through nature.
Consider medications: Consult with a healthcare professional about whether medications like Wegovy or Ozempic (semaglutide) might help you lose extra weight. While these drugs aren’t right for everyone, they can help people with obesity or diabetes keep their weight and blood sugar under control and reduce the risk of heart disease and stroke.
Weight loss
Get access to GLP-1 medication (if prescribed) and 1:1 support to meet your weight goals
During menopause, the body goes through a series of changes that may lead to weight gain. But it isn’t inevitable—there are safe and healthy ways to lose unwanted body weight. If you have questions about weight loss in menopause, a healthcare provider can help you figure out the best diet and exercise recommendations for you.
DISCLAIMER
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
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How we reviewed this article
Current version
Gina Allegretti, MD
Yael Cooperman, MD
About the medical reviewer
