- Many women gain weight around their midsection before, during, and after menopause.
- This weight gain largely stems from dropping hormone levels, which can also make it difficult to lose weight after putting it on during menopause.
- Sustained changes to your diet and exercise routines can help you lose weight or prevent you from gaining it in the first place.
- Surgical options are also available for weight loss and body contouring.
Menopause comes with many symptoms and side effects — and unfortunately, one of the most reliable ones is gaining weight around your midsection.
This abdominal weight gain stems from hormonal and lifestyle changes, and while these changes are inevitable, gaining weight (or keeping weight you’ve already gained) is not.
Here, we’ll explain the hormonal and physical changes that occur during menopause and how these contribute to weight gain.
We’ll also explore how diet and exercise can help you lose weight, briefly outline some surgical options, and offer some preventative tips for keeping the weight off in the first place.
What happens during menopause
Each woman is born with a finite number of eggs, and menopause occurs when your body stops releasing an egg every month and menstruating.
Menopause usually occurs naturally when a woman reaches her 40s or 50s, but it can also happen earlier due to a number of factors, such as hysterectomy or chemotherapy. When menopause happens before the age of 40, it is called premature menopause.
For one to two years leading up to menopause (a period known as perimenopause), the ovaries make less and less estrogen and eventually stop producing it almost entirely.
Symptoms of menopause include the infamous hot flashes, irregular or skipped periods, mood swings, fatigue, depression, irritability, racing heart, headaches, joint and muscle pain, changes in sex drive, vaginal dryness, and bladder control issues.
Why women gain weight during menopause
Many women find that they begin gaining weight around their midsection as they enter menopause, even if their calorie and activity levels remain the same. Indeed, some women don’t gain weight overall, but still find fat from their hips, thighs, and bottom resettling around their abdomen.
“Life events such as pregnancy, weight loss, and menopause can lead to stubborn fat, skin laxity, poor body shape, and stretch marks,” says Dr. Joseph Cruise, a board-certified plastic surgeon who has been practicing for over 15 years. “Problem areas for women typically include the upper and lower abdomen, hips, thighs, and back.”
Falling hormone levels
“As far as fat distribution is concerned, estrogen unequally distributes more fat in what is called subcutaneous tissues like the arms, legs, and buttocks when compared to abdominal fat. This is what is likely associated with the pear shape in women,” explains Dr. Latasha Murphy, M.D., a skilled gynecologist and surgeon at The Gynecology Center at Mercy Medical Center in Baltimore, Maryland.
“After estrogen levels fall during menopause, the fat distribution is more equal, so there is the similar amount of fat being stored around the abdomen (visceral fat),” says Dr. Murphy.
For example, a recent study published in The Journal of Clinical Endocrinology & Metabolism found that women undergoing hormone therapy for menopause symptoms tended to gain less weight due to their ingestion of estrogen, progesterone, and/or progestin, which raises these hormone levels.
The body’s resting metabolism rate falls as you age, partly due to drops in estrogen for women and drops in testosterone for men.
As a result, your body burns fewer calories even as you perform the same activities — so if you don’t reduce the amount of calories you’re consuming, you’ll gain weight. In addition, the more fat you develop, the more likely you are to gain even more weight since fat burns fewer calories than muscle.
Other symptoms related to menopause can also add to the weight gain, such as sleep deprivation from insomnia, increased cortisol levels as a result of stress, and reduced activity levels due to physical discomfort.
Why it’s important to reduce belly fat
If you’ve developed a menopause “muffin top,” know that you’re not alone — and that you probably didn’t do anything to cause it. However, you should look into reducing menopausal belly fat, and not just for personal appearance reasons: carrying too much visceral fat is associated with numerous health risks.
Visceral fat accumulates deep within the abdominal cavity around your organs or visera, hence the name. Visceral fat contrasts with subcutaneous fat, which is the fatty tissue just beneath the skin.
While you can see and pinch subcutaneous fat, it poses less of a health risk than visceral fat, which hides deeper within the body — and unfortunately, menopause tends to lead to an increase in visceral fat.
Excess visceral fat can lead to inflammation and has been associated with an increased risk of developing multiple conditions, including heart disease, diabetes, and cancer.
An animal study published in the journal Oncogene found that visceral fat cells produce large amounts of a protein called fibroblast growth factor 2 that can cause a healthy cell to turn cancerous. Keeping visceral fat low is key to living a long, healthy life.
“Visceral fat is metabolized or broken down by the liver,” Dr. Murphy explains. “This turns into LDL, or bad cholesterol, which is circulating through the body. The more LDL is circulating, the more likely it is to form plaques or blockages in the arteries. This leads to heart attacks and other cardiac disease.”
How to lose weight during menopause
During menopause, it is important to implement dietary changes that aren’t too dramatic and that can be sustained over time.
In fact, drastically cutting calories can actually lead to unintended negative side effects, such as reduced muscle mass and lower bone density, which can further reduce your metabolism and lead to osteoporosis.
Watching portion sizes and calorie counts is, of course, an important component of losing weight. However, the type of food you’re eating can be just as important as the number of calories you’re taking in.
Your menopause meal plan should include plenty of fruits, vegetables, and whole grains that offer a lot of volume with fewer calories. Seek out healthy protein options such as legumes, nuts, soy, fish, and chicken, and try to limit sweets and alcohol.
As for exercise, you should aim for 150 minutes of moderate aerobic activity every week or 75 minutes of vigorous aerobic activity. Seeking out a variety of exercises — including jogging, swimming, yoga, and lifting weights — will ensure that you burn fat, build your muscles and bones, and stave off boredom.
Even brisk walking is a great way to start moving, and you can build an exercise habit from there.
Given the metabolic changes that occur during menopause, sometimes diet and exercise changes aren’t enough to make your belly fat budge.
If you are highly overweight, with a BMI between 35 and 40, there are several options for weight loss surgery. Popular weight loss procedures include gastric balloons, gastric banding, sleeve gastrectomy, gastric bypass, and duodenal switch surgery.
It is important to remember that surgery is only the first step in any weight loss journey.
“With all of these surgeries, however, you have to commit to a healthier life to maintain the benefits of the surgery,” Dr. Murphy counsels. “The gastric banding procedure or gastric sleeve procedure are both excellent launching tools, but the success is in the commitment to eat better and be more active.”
If you’re looking for a little bit of body contouring rather than extreme weight loss, you can also remove some of the fat cells directly through liposuction.
“For women who find diet and exercise cannot correct the problem to their satisfaction, cosmetic surgery such as liposuction or a tummy tuck may be an option for getting their body back,” says Dr. Cruise.
However, it’s important to note that liposuction is not a weight loss procedure and doesn’t address the root cause of weight gain. You’ll need to exercise and eat less to maintain the result and ensure that your body doesn’t end up gaining more visceral fat.
Weight gain prevention tips
Of course, the best way to lose weight is to never gain it in the first place. Many of the same general tips for weight loss can also help keep you from ever putting on those extra pounds in the first place: monitoring your food intake, eating a healthy diet, and exercising regularly.
Surrounding yourself with a support group who’s also trying to make healthy choices — whether that’s your spouse, workout class buddies, or other female friends going through menopause — can make weathering this life change a lot easier.
Menopause is a natural part of aging, but that doesn’t mean it’s always pleasant, and a support group makes it easier to start and maintain a healthier lifestyle.
That being said, if you haven’t had success with lifestyle changes and still want to lose some abdominal weight, it might be time to ask a doctor for more information about which surgical procedure could be right for you.
» To find out more about surgical weight loss and body contouring options, connect with our medical review team.