Why Weight Changes During Menopause Happen and How to Manage Them

Besides causing bothersome symptoms such as hot flashes or trouble falling asleep, the menopausal transition can also lead to changes in body weight and fat distribution. During this time, people assigned female at birth (AFABs) gain an average of 1 pound, or around half a kilo, per year.

While these changes can make you feel different in your own skin, it's not only the looks that make paying attention to midlife weight gain important. In this article, we explain the changes in body composition during menopause and how they might affect your overall health.

Disclaimer
We strive to use gender-inclusive language to promote equality and avoid discrimination. However, we may use specific terms such as 'female' or 'woman' to accurately reflect the terminology used in referenced sources. In these cases, we refer to individuals assigned female at birth (AFAB).
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Causes of weight gain during menopause

Staying at usual weight may become more difficult in perimenopause, which may start years before menopause. There are multiple reasons why people experience weight gain during the menopausal transition.

weight gain during menopause why it happens

While it's tempting to blame hormonal changes for it, genetics, the natural aging process, as well as changes in metabolism and lifestyle are likely to be the culprits.

In addition, medications prescribed to manage conditions and symptoms associated with menopause or aging may also promote weight gain. These include antidepressants and certain types of drugs used to manage high blood pressure, such as beta-blockers.

In postmenopausal women, lean muscle mass decreases and body fat mass increases as well as redistributes. If you gain weight, it's more likely to accumulate in the abdominal area, not in the thighs, buttocks, or hips (causing abdominal, or belly fat, also called visceral fat). This process in particular is associated with menopause-related changes in estrogen levels.

Should I worry about weight gain during menopause?

Weight itself shouldn't be a worry in the first place knowing that the additional stress may only add to gaining weight further. However, keeping your weight under control is worth it as extra weight, especially belly fat, is associated with a higher risk of:

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  • Heart and blood vessel disease
  • Metabolic syndrome
  • Muscle and bone disorders
  • Several types of cancer, including breast and uterine cancers
  • Gallbladder disease
  • Sleep apnea

It's estimated that around 4 in 10 individuals in menopause are considered obese, which is associated with increased mortality. This means that a considerable part of post-menopausal women might benefit from losing weight.

Can you lose weight during menopause?

While it may be more difficult than at a younger age, weight loss after menopause is feasible. There are multiple evidence-based strategies to help reach a healthy weight or maintain it.

If you feel like you're struggling to get moving, or, on the contrary, tend to exercise compulsively, catch yourself overeating, or restrict yourself from eating, let your healthcare provider know. These signs might be symptoms of an eating disorder, which requires medical attention.

Balanced diet

Nutrition not only helps prevent weight gain but may also help you lose weight. Currently, there's no single optimal dietary plan recommended for women in menopause. For example, a systematic review published in 2024 has shown that adherence to the Mediterranean diet had beneficial effects on weight, blood pressure, and blood cholesterol levels in post-menopausal women.

Long-term, sustainable weight loss can be achieved by reducing energy intake from the baseline. However, it shouldn't be done by eliminating nutritious foods or, even worse, starving yourself. Instead, consider reducing the consumption of processed and ultra-processed foods, controlling meal portions, and looking into mindful eating.

Exercise

Physical activity is of exceptional importance in menopause as it not only helps you stay at a healthy weight but also plays a role in preserving muscle mass. Muscle also helps your metabolism and makes it easier to prevent weight gain, whereas exercising might contribute to better sleep — which, on its own, may help avoid gaining body fat.

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Most healthy adults should engage in moderate-intensity aerobic exercise (such as walking) for 150–200 minutes per week, or do at least 75 minutes of more vigorous aerobic exercise, like jogging. Strength training should be done twice a week.

Individual exercise routines can be recommended to those aiming to reduce body fat. Multiple studies show that high-intensity interval training might be particularly beneficial to postmenopausal individuals with obesity.

Weight loss drugs

In addition to lifestyle changes, various medications may be used to manage obesity. Healthcare providers might consider prescribing drugs for individuals with a body mass index (BMI) higher than 30 or for those with a BMI of 27 who also have type 2 diabetes, high blood pressure, or hyperlipidemia (high cholesterol levels).

Drugs approved in the United States by the Federal Drug Administration (FDA) for long-use management of obesity include:

  • Phentermine-topiramate (Qsymia)
  • Tirzepatide (Zepbound)
  • Liraglutide (Saxenda)
  • Semaglutide (Wegovy)
  • Naltrexone-bupropion (Contrave)
  • Orlistat (Xenical, Alli)

These medications might help combat obesity in different ways; some alter your hunger or satiety, others might change how your body absorbs fat.

Weight loss surgery

Bariatric, or weight loss surgery is often the last resort option in the management of obesity. During the surgery, changes to the digestive system are made. For example, some make the stomach smaller in order to restrict the amount of food that can be consumed at a time to achieve clinically significant weight loss.

It might be recommended to those with a BMI of 35 or higher or those with a BMI of 30 to 35 and poorly controlled type 2 diabetes, and if any serious health problems related to obesity are present.

Why you should focus on overall health, not just weight

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While it's known that weight loss may improve the risks of heart and blood vessel disease as well as decrease mortality, being in menopause makes losing weight more difficult. This means it might take you a bit longer to sustainably reach your goals.

Therefore, it's important to know to keep your expectations realistic and remain self-compassionate. It's common for women to gain weight with age, so there's no need to be hard on yourself for gaining a few pounds around this time.

Interventions as simple as following a balanced, healthy diet, such as the Mediterranean diet, and engaging in physical activity are proven to help maintain a healthy weight. Exercise may also enhance your mood, potentially help decrease menopause symptoms such as hot flashes, and help gain and maintain muscle mass.

Healthy weight during menopause: slow but steady wins the race

Making health-conscious choices on a daily basis and focusing on your overall well-being instead of the number on the scales will help keep your weight under control without making you feel stressed. And if you think you might be obese, there are many options to discuss with your healthcare provider for managing excess weight — you're not alone in this.

Did you manage to stay at or return to a healthy weight in menopause yourself? We'd be more than happy to hear how you've dealt with menopausal weight gain. Share your experience with fellow Healthnews readers in the comment section below.

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