Why Am I Gaining Weight During Menopause?

Causes of “Meno Belly” and What You Can Do

You’re doing everything by the book. Eating healthy and counting calories. Exercising consistently. Getting enough sleep. And yet, when you dare to step onto a scale, the results are … well, disappointing. Indeed, you’ve noticed that you’ve inexplicably gained a couple of pounds or more in the past year. How can that be?

“I hear it from my patients all the time,” says Grettel Garcia, M.D., an internist at the University of Miami Health System who is also a menopause expert. “They’re doing what they’ve always done, or even sometimes exercising more and eating less, and the weight creeps up on them anyway. It’s very frustrating.”

If that describes your experience, know that you’re not alone. And you’re not necessarily to blame, either. For the overwhelming majority of mid-life women, the long transition into menopause means weight gain, particularly visceral fat that accumulates in the belly.

Hence, the term meno-pot (or meno-belly)

Meno-belly describes the waistline expansion or sudden appearance of a kangaroo pouch around the middle that bedevils even the fittest women, beginning in their 40s.

According to The Menopause Society, “aging is the primary driver of weight gain” but hormonal changes play a significant role in redistributing fat, often to the midsection. Multiple longitudinal studies back this up. A 2019 analysis that looked at sample data over 20 years found that fat mass increased sharply beginning 2 to 3 years before the final menstrual period. Conversely, lean mass declined. Researchers put total weight increase for women going through menopause at about 1.5 kg (3.3 lbs).

An older research paper, also part of the Study of Women’s Health Across the Nation (SWAN) a longitudinal, and multi-ethnic study tracking more than 3,300 middle-aged women, found the weight gain was significantly higher, about 0.5 kg a year (1.1 lbs/year) during the transition. That adds up to a total of 10 pounds — or more than a 20% weight gain for women.  

And that meno-pot that so many mid-life women complain about?

It’s very real. Waist circumference increased 5 to 7 cm (1.97 inches to 2.76 inches) whether or not women gained weight.

There’s a physiological explanation for these changes. As a woman begins her 40s, levels of the hormone estrogen, which help in muscle repair and fat distribution, begin to drop. This means fat that is usually stored in the hips and thighs moves to the abdomen.

Fluctuating hormonal levels can also translate into night sweats, hot flashes, mood swings and brain fog.

Those physical, biological and physiological transformations “throw off your circadian rhythm and cortisol levels” says Dr. Garcia, who is a Menopause Society Certified Practitioner. Because cortisol is one of the body’s main circadian synchronizing hormones, the resulting dysregulation affects not only a woman’s sleep but also her mood, immunity and cardiovascular health.

“There’s a cascading effect,” says Dr. Garcia. “You begin to feel bloated and fatigued and you don’t sleep as well, so you may not be as physically active. There’s also an uptick in insulin resistance, even if you don’t gain weight and are eating the same things you’ve always eaten.”

All this happens at a time when a woman is losing muscle mass and her metabolism is slowing.

It’s estimated that women begin to naturally lose muscle mass at a rate of 3% to 8%  once they hit 30. And because muscle uses more energy than fat, women can gain weight gain even when they’re maintaining the same diet of their earlier years.

The consequences of these changes can be serious. In addition to higher rates of overweight and obesity, extra fat also raises the risk of cardiovascular disease, diabetes, and certain cancers. Extra weight around one’s belly negatively affects blood pressure and cholesterol levels and raises the risk of colon and breast cancer, particularly hormone receptor-positive breast cancer. In fact, some meta-analysis studies link up to 40% of certain cancers to excess fat and weight increases in postmenopausal women.

However, “physical changes are associated with more than increased mortality and comorbidities,” Dr. Garcia adds. “They also affect how a woman feels about herself. There are mood changes and irritability, also a general feeling of sadness. They come in not feeling good about how they look or what’s happening [to their bodies].”

While menopause is inevitable if a woman lives long enough, adding extra pounds in midlife is not.

Dr. Garcia suggests a “proactive attitude” to help stop or slow weight gain:

Exercise for the recommended 150 minutes a week.

Make sure to combine moderately paced aerobic activity with strength training two to three times a week. That will help maintain muscle mass. And the more muscle mass you have, the more calories you’ll burn.

Eat right.

That mean a diet heavy in plant foods (fruits and vegetables) whole grains, and lean proteins. Skip the processed food. If you find that you’re gaining weight regardless of what you do, one study recommends cutting back your daily intake by 500 to 700 calories.

Get your Zzzz’s.

Practice a sleep hygiene routine.

• Keep a consistent wake-up schedule
• Maintain a cool, dark bedroom
• Aim for a screen-free period before bedtime
• Avoid alcohol, coffee, tea and stimulants for several hours before bedtime

Remember, sleep disturbances are associated with chronic conditions such as diabetes and cardiovascular disease, and sleep deprivation also increases the risk of becoming overweight.

Seek medical care from a menopause expert.

This physician will do a clinical workup and order blood tests to determine hormone levels. If they’re low, the physician is likely to recommend hormone replacement therapy, the gold standard for menopausal symptom treatment. Fewer than 10% of menopausal women use hormone replacement therapy. That’s despite it proving effective in treating hot flashes and night sweats, vaginal dryness, and cognitive changes like “brain fog.” HRT can also reduce irritability and improve sleep. While HRT doesn’t directly work as a weight-loss treatment, it can reduce fat in the midsection and help preserve muscle. If hormone therapy is not an option, there are also non-hormone therapies, including FDA-approved oral medications.

HRT prescriptions fell after a 2002 Women’s Health Initiative (WHI) study reported increased risks of breast cancer and cardiovascular events. But experts say these findings were misinterpreted and the risks applied mainly to older women starting HRT long after menopause. This led to decades of under‑treatment. In 2022, The Menopause Society’s issued a Hormone Therapy Position Statement which acknowledged HRT as “the most effective treatment.”

“You don’t have to go at this alone,” Dr. Garcia says. “We can treat the symptoms that will not only make you feel better but also help you retain your health longer.”

Written by Ana Veciana-Suarez. Medically reviewed by Grettel Garcia, M.D.

Tags: Dr. Grettel Garcia, estrogen and metabolism, meno belly causes, menopause weight gain