Weight gain and menopause: 8 tips to win the battle of the middle-age bulge

Are you a woman in your mid-40s to mid-60s? Have you found that your belly is getting thicker? Are you gaining weight no matter what you do?

Maybe you’ve been dieting and exercising but the pounds are stubbornly hanging on?

We’re here to help.

This guide tells you what you need to know about menopause, plus how to manage (and potentially lose) weight during the menopause transition. In short, a low-carb diet and certain lifestyle changes can greatly help.

Millions of women around the globe are currently going through “the change.” When adding the years lived after age 60 — called postmenopause — it’s estimated that close to 1 billion women in the world today are going through menopause or are postmenopausal.1

Given that most women spend one-third of their lives in this non-reproductive state, it helps to understand what is going on with your metabolism and hormones.

What changes can you make that will help prevent or even reverse any menopausal weight gain? How can you best protect your health?

Here are our top 8 tips:

  1. This can help keep insulin low and maintain metabolism.
  2. This helps maintain lean muscle mass.
  3. This also helps maintain and build more muscle.
  4. This helps keep insulin low for longer stretches.
  5. This can decrease cortisol and reduce insulin resistance.
  6. Yoga, exercise, and meditation can all help.

For more details about what happens during menopause and why these eight tips can help, read on.


First, what is menopause?

Menopause marks the end of a woman’s menstrual cycles. It is defined as a full 12 months without a menstrual period for women over the age of 45.2 While the average age in North America is around 52, the hormonal changes can start in a woman’s mid-40s and last into her 60s.3

Research shows that the timing of menopause is a complex mix of genetics, ethnicity, geography, socio-economic status, and lifestyle factors. 4

The symptoms of menopause are well known: hot flashes, night sweats, mood changes, brain fog, headache, disrupted sleep, vaginal dryness, bloating, and more. Unfortunately, weight gain and increased body fat, especially around the abdomen, are very common complaints.5

It’s estimated that most women, without changing anything in their diet or lifestyle, gain an average of 2 to 5 pounds during the menopausal transition. However, some gain much more than this.6


Hormonal changes

Why do these symptoms and weight gain happen? Blame your hormones.

A woman’s reproductive hormones change dramatically at menopause: estrogen and progesterone decrease; follicle-stimulating hormone (FSH) and luteinizing hormone (LH) increase —and FSH stays elevated for the rest of a woman’s life. But these are not the only hormones that change.7

The change in estrogen is the one thought to be related to most of the symptoms of menopause. Secreted from the follicles of a woman’s ovaries, and called estradiol, or E2, it declines because no more eggs are being released, no more follicles being developed.

The decline of estrogen can be erratic. About one-third of women first experience a sharp rise in E2 in their mid-40s (called perimenopause) and then a sharp decline. Others just have a steady, slow decline. But by the time of the last menstrual period, all women have experienced a large decrease in estrogen levels. 8

Also related to weight gain, especially around the middle, some women during menopause experience a significant increase in the secretion of the stress hormone cortisol, especially during the night.9

Why cortisol secretion increases significantly for some but not all women is not fully known. It may be aging, biology, or the result of poor sleep due to night-time hot flashes and night sweats.10

Cortisol increase may also be due in part to menopause occurring at a stressful time of life, such as many women being sandwiched between teenage children and aging parents, working full-time, experiencing financial or relationship stress or the loss of loved ones.11

In short, however, these dramatic hormonal changes of menopause impact a woman’s metabolism, her body composition, and, all too often, her weight.


The weight-loss challenge of menopause

Losing weight can be hard for anyone. Do menopausal women have an especially tough time?

While most women believe it’s definitely more difficult for them to lose weight during “the change,” among researchers, it is a bit controversial whether or not menopausal women face unique weight-loss challenges.

Some studies have suggested that women’s weight gain in midlife is simply a factor of aging — which impacts both sexes — more than menopausal changes in hormones.12

Others note, however, that declining estrogen at menopause decreases women’s energy needs, slows down metabolism, and shifts body-fat accumulation from the hips to the abdomen.13

These factors are part of a number of metabolic and body composition changes that likely set women up for greater challenges losing weight, including:

Loss of muscle mass, increased body fat

At the start of the menopause transition, a woman’s rate of fat gain doubles and her lean muscle mass declines. This phenomenon, researchers say, is related to hormonal changes of menopause and not simply age. It lasts until about two years after the final menstrual period and then stabilizes.14

Sarcopenic obesity

Loss of muscle mass and reduced muscle strength combined with increased fat has a specific name, sarcopenic obesity. This is a new field of study, with a number of challenges in definitions and consistent research approaches.

However, there is an emerging consensus that sarcopenic obesity is associated with a number of health problems, including weakness and falls, reduced mobility, diabetes, cardiovascular disease and higher rates of death from all causes.15

Insulin resistance

Higher and higher insulin levels, called hyperinsulinemia, lead the body to ignore insulin’s signals, creating insulin resistance. When insulin is high, fat stays locked in cells and cannot be burned as easily for fuel.16

Insulin resistance has been shown to increase during menopause and may be caused by the loss of ovarian function and declining estrogen levels.17

Metabolic syndrome

When a collection of concerning health measurements come together — insulin resistance, obesity, and blood lipid issues — this is called metabolic syndrome. Having this collection of risk factors puts people at higher risk of cardiovascular disease and diabetes.

Unfortunately, menopause increases the risk of developing metabolic syndrome.18

Metabolic syndrome in women is present if three or more of the following five criteria are met: waist circumference over 35 inches, blood pressure over 130/85 mmHg, fasting triglyceride (TG) level over 150 mg/dl, fasting high-density lipoprotein (HDL) cholesterol level less than 50 mg/dl and fasting blood sugar over 100 mg/dl.19

Resting energy expenditure

The loss of muscle mass, the decline in estrogen, and the increase in body fat create another problem: a woman’s resting energy expenditure (the speed of her metabolism) goes down. This naturally happens to everyone with advancing age, but menopause itself amplifies the process.20


8 top tips for managing weight at menopause

Has reading this far made you depressed and discouraged? Don’t be. While you cannot prevent menopause, you can prevent some of its negative health impacts on diet and lifestyle changes.

Remember, however, good health is more than simply a number on the scale. As we have noted in other places on our site, you do not have complete control over how much weight you lose, how fast you lose it, and what body parts you lose it from. Managing these expectations is part of long-term success. Make sure you read our guide on setting expectations.

Balancing Stones On The Water

Setting realistic expectations

GuideHow long does it take to lose weight? How much weight can you lose? We explain what you can and can’t control about your weight loss journey loss.

That said, these eight tips all have scientific evidence behind them and can help improve your health while letting your body find the weight that is right for you during menopause.

Many of these steps will improve body composition and keep fat gain to a minimum. They may even help you lose body fat.

These points link to more in-depth guides, with lots of research citations, that you can explore and get more details.

1. Eat a low-carb or ketogenic diet

The carbohydrates you eat digest to glucose, which raises insulin. To reduce insulin levels and reverse insulin resistance, simply cut out sugar and the high- carb foods like rice, potatoes, bread, pasta, baked goods that rapidly convert to sugar. When insulin is low, your body can access your fat stores to burn for energy.21

Low-carb diets might even increase metabolism – potentially increasing fat burning – by between 200 and 500 calories per day.22

How low you go is up to you; even cutting out sugary drinks and added sugar can be the first positive step. Our guides will tell you how.

2. Eat enough protein

Getting enough protein at every meal maintains lean muscle mass and helps counteract the muscle loss of aging and the increase of sarcopenic obesity.23 Simply adding an egg to a meal will increase your protein.

Our protein guides give lots of other tips for how to add protein and how to calculate how much you need.

3. Lift weights or do resistance training

You’ve heard the phrase “use it or lose it”? Well, this applies to your muscles. Muscles that aren’t used become weak and flabby. Even simple movements or bodyweight exercises help maintain and build more muscle.

More muscle not only makes you stronger (and strengthens your bones, too) it means higher resting energy expenditure, a faster metabolism, better blood sugar control, and reduced insulin resistance.24

4. Introduce time-restricted eating

If you are not eating as often, insulin remains low for longer and you consume less food overall. It can be as simple as skipping breakfast. And when you are eating a low-carb or ketogenic diet, skipping a meal is easier to do.25 Also called intermittent fasting, time-restricted eating may help burn body fat stores and reduce insulin resistance.26 Longer fasts including eating just one meal a day, or OMAD.

5. Avoid excess consumption, especially snacks, nuts, alcohol and keto treats

When metabolism slows during menopause, even consuming slightly more than you need can add to weight struggles. While a low-carb or keto diet can help you keep consumption in check by reducing cravings and increasing satiety between meals, you can still go overboard on keto-approved foods.27

Paying attention to food and drinks that contain little nutrition is important for women in menopause. That means be careful with keto desserts, fat bombs, bulletproof coffee, MCT oil, alcohol, low-carb fruits, and nuts. If you’re really struggling, try eliminating dairy, such as eating lots of cheese and cream. Understanding hunger signals helps control excess consumption, too.

6. Prioritize sleep

Successive nights of bad sleep are as bad for your health as a poor diet and can lead to weight gain.28

Consistent nights of good sleep, however, decreases cortisol and reduces insulin resistance, making weight management easier.29 If menopause is making you lose sleep at night, try the tips for good sleep hygiene: have a cool, quiet room, create a relaxing sleep routine, reduce stimulants and alcohol, and turn off screens at least an hour before bed.

7. Manage stress with relaxation techniques

Diet, sleep, and exercise are not the only things that influence weight. Daytime stress and life-stress can raise cortisol and hang onto the pounds.30 Yoga, relaxing exercise like Tai Chi, meditation, and relaxation apps can all help. Relaxing hobbies can help, too.

8. Try HRT

Some women have such severe symptoms during menopause that taking hormone replacement therapy helps them sleep, deal with hot flashes, and better manage the weight and body composition changes. Talk with your doctor about a trial of HRT if you are having a very difficult menopause transition.


Summary

No question about it: Hormonally, everything changes for a woman during the menopause transition. Not only does this come with many uncomfortable symptoms and side effects, it changes a woman’s health risks and body composition. Those changes include increased abdominal obesity, insulin resistance, muscle loss, and difficulty losing weight.

But you are not alone. Millions of women share the same path. And with the adoption of a low-carb or keto diet, as well a few other lifestyle tweaks, you can still have good health and vitality, and reach the right weight for you, in menopause and beyond.

  1. By the year 2025, the number of postmenopausal women is expected to rise to 1.1 billion worldwide:

    Menopause 2014: The North American Menopause Society Recommendations for Clinical Care of Midlife Women [expert review, ungraded]

  2. Menstruation that stops in younger women is called amenorrhea and should be investigated.

  3. STATPEARLS 2020: Menopause. [Expert review, ungraded]

  4. Obstetric and Gynecology Clinics of North America 2011: The Timing of the Age at Which Natural Menopause Occurs
    [Expert review, ungraded]

    Human Reproduction 2019: Variations in reproductive events across life: a pooled analysis of data from 505 147 women across 10 countries. [pooled cohort studies, weak evidence]

  5. Endocrinology and Metabolism Clinics of North America 2015: Menopause symptoms and their management [Expert review, ungraded]

  6. Journal of Women’s Health 1998: The influence of sex hormones on obesity across the female life span [overview article; ungraded]

  7. Menopause 2019: The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN) [longitudinal cohort study, weak evidence]

  8. Menopause 2019: The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN) [longitudinal cohort study, weak evidence]

  9. Menopause 2009: Cortisol levels during the menopausal transition and early postmenopause: Observations from the Seattle Midlife Women’s Health Study. [longitudinal cohort study, weak evidence]

  10. Menopause 2009: Cortisol levels during the menopausal transition and early postmenopause: Observations from the Seattle Midlife Women’s Health Study. [longitudinal cohort study, weak evidence]

  11. Women’s Midlife Health 2015: Challenges of women’s midlife health: Themes from the Seattle Women’s Study. [longitudinal cohort study, weak evidence]

    Menopause 2009: Is the menopause transition stressful? Observations of perceived stress from the Seattle midlife Women’s health study. [longitudinal cohort study, weak evidence]

  12. American Journal of Obstetrics and Gynecology 2019: Fat mass changes during menopause: a meta-analysis [meta-analysis of observational studies; weak evidence]

  13. Climacteric 2012: Understanding weight gain at menopause [review of animal and human studies; ungraded]

  14. Journal of Clinical Insight 2019: Changes in body composition and weight during the menopause transition [observational study, weak evidence]

  15. Frontiers of Endocrinology 2020: Health consequences of sarcopenic obesity: a narrative review [Expert review, ungraded]

  16. Clinical Biochemist Reviews 2005: Insulin and insulin resistance [overview article; ungraded]

  17. Clinical Science 1992: Ageing and the Response of Plasma Insulin, Glucose and C-peptide Concentrations to Intravenous Glucose in Postmenopausal Women [observational study, weak evidence]

  18. Climacteric 2017: Metabolic syndrome in menopause and associated factors: a meta-analysis [meta-analysis of observational studies, weak evidence]

  19. Disease Models & Mechanisms 2009: A comprehensive definition for metabolic syndrome [Expert review, ungraded]

  20. International Journal of Obesity 2008: Increased visceral fat and decreased energy expenditure during the menopausal transition [observational longitudinal study, weak evidence]

  21. In most randomized controlled trials (RCTs), low-carb diets have been found to be more effective for weight loss than other diets:

    PLOS ONE 2015: Dietary intervention for overweight and obese adults: comparison of low-carbohydrate and low-fat diets. A meta-analysis [strong evidence]

  22. British Medical Journal 2018: Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial [moderate evidence]

  23. NRC Research Press: Protein: A nutrient in focus [overview article; ungraded]

    Nutrients 2016: Protein consumption and the elderly: What is the optimal level of intake? [overview article; ungraded]

  24. Resistance training and high-intensity interval training (HIIT) may be especially beneficial for improving body composition and metabolic rate:

    Journal of Applied Physiology 2012: Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults [randomized trial; moderate evidence]

    British Journal of Sports Medicine 2017: Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies [systematic review of randomized trials; strong evidence]

    Journal of Obesity 2012: The effect of high-intensity intermittent exercise on body composition of overweight young males [randomized trial;moderate evidence]

  25. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here [weak evidence].

  26. Cell Metabolism 2019: Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome [non-controlled study; weak evidence]

    American Journal of Clinical Nutrition 2009: A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults
    [randomized trial; moderate evidence]

  27. Obesity Reviews 2014: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

    Obesity 2007: The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms [moderate evidence]

  28. Physiology & Behavior 2018: Effect of sleep curtailment on dietary behavior and physical activity: a randomized crossover trial [moderate evidence]

    Nutrients 2019: Increased hunger, food cravings, food reward, and portion size selection after sleep curtailment in women without obesity [randomized trial; moderate evidence]

  29. Clinical Endocrinology 2003: Obstructive sleep apnoea syndrome impairs insulin sensitivity independently of anthropometric variables [cohort study; weak evidence]

    European Respiratory Journal 2010: A randomized controlled trial of nasal continuous positive airway pressure on insulin sensitivity in obstructive sleep apnoea [moderate evidence]

  30. Obesity (Silver Spring) 2017: Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight [non-controlled study; weak evidence]