Why Do Women Gain Weight During Menopause: Key Insights
Introduction to Menopause
The average age to go through menopause in the United States is 52 years old. During the menopausal transition (perimenopause), women experience uncomfortable symptoms like hot flashes, mood swings, and night sweats. Many women also notice difficulty maintaining a healthy weight during menopause. In fact, most women gain weight during menopause, around one to two pounds per year.
During perimenopause, 60% of women are over their ideal body mass index. Understanding menopausal weight gain is essential to reducing your risk of cardiovascular disease, metabolic syndrome, and certain cancers.
Menopausal symptoms such as hot flashes and night sweats can disrupt sleep, leading to increased appetite, snacking, and decreased physical activity, all of which can contribute to weight gain.
Contributing Factors to Menopause Weight Gain
If you exercise regularly and follow a healthy diet but still see no weight changes, that is likely due to the aging process. Aging results in a decline in muscle mass, which lowers resting energy expenditure, or “calorie burn,” while sitting. If you burn fewer calories but consume the same amount you did in your 30s, you’ll likely gain weight.
Menopause symptoms like fatigue can cause lifestyle changes in some women. Most people become less active as they age and eat out more, which can lead to extra calories consumed and not enough calories burned, increasing body weight and other health risks.
Changes in fat distribution, including stubborn belly fat, are common for women going through menopause and even postmenopausal women. Hormonal changes, such as decreasing progesterone and estrogen levels, contribute to rapid weight gain around the abdomen. Other factors that occur during menopause can also lead to weight gain, including changes in glucose metabolism and the gut microbiome, which can affect appetite and cravings.
Importance of a Healthy Diet
A diet rich in plants, protein, and fiber, and that avoids processed foods, can help promote weight loss and improve women’s health. Studies show that the Mediterranean diet helps people maintain a healthy weight and reduces the risk of cardiovascular disease and metabolic syndrome, making it the ideal diet for preventing menopausal weight gain.
What is the Mediterranean Diet?
The Mediterranean diet is a healthy eating pattern inspired by the diets of people in Greece, Italy, and Spain. It is not a strict diet but a healthy lifestyle that emphasizes nutrient-dense food and limits processed food. The Mediterranean diet can help prevent menopausal weight gain and improve overall health. This healthy eating pattern includes about five servings of fruits and vegetables per day. Whole grains, beans, nuts, seeds, and other healthy fats are also staples of the Mediterranean diet. Fish and seafood are consumed more often than other protein sources, typically three times per week. Poultry, eggs, cheese, and yogurt are eaten in moderation, while red meat, sweets, and processed foods are limited.
The Mediterranean diet is rich in unsaturated fats, omega-3 fatty acids, and fiber. It is primarily a plant-forward diet that emphasizes anti-inflammatory foods and antioxidants, helping to manage menopausal symptoms and prevent weight gain.
Implementing a Healthy Diet
Changing your diet can be difficult and feel overwhelming. Working with a registered dietitian can help ease you into diet and lifestyle changes that are realistic for you. It is best practice not to make too many changes at once—instead, focus on one diet change at a time. For example, if you mostly eat meals with animal-based protein, try swapping one of those protein sources for a plant-based one, such as beans or tofu. Focus on eating real food, staying aware of serving sizes, and mainly consuming plants to prevent weight gain and reduce the risk of chronic disease.
Lifestyle Changes for Weight Management
Lifestyle changes play an essential role in menopausal weight loss and weight maintenance. Adopting a healthy eating pattern that incorporates plenty of nutrient-dense foods is important, and engaging in consistent physical activity supports a healthy weight. The physical activity guidelines include 150-200 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity weekly, plus strength training twice a week, to prevent weight gain, increase muscle mass, and improve overall health. Resistance or strength training is especially important during this transition, as aging and hormonal changes can lead to decreased muscle mass and bone density. Physical activity, including aerobic exercise and resistance training, improves mood and energy levels and can reduce the frequency and severity of hot flashes, which are symptoms in both perimenopausal and menopausal women.
Sleep and excess stress can prevent unwanted extra pounds in menopausal women. Poor sleep increases the hunger hormone, ghrelin, which increases appetite and cravings.
If you have trouble sleeping, you can try these three things:
Limit blue light exposure: blue light comes from phones, TVs, and other screens. It delays melatonin release, making it difficult to fall asleep and stay asleep. Try limiting screen time at least one hour before bed. Instead, try reading, listening to a podcast or music, meditating, or trying yoga nidra.
Reduce your caffeine intake: This is self-explanatory, but caffeine close to bedtime can disrupt sleep. Try to avoid caffeine 3 to 4 hours prior to bedtime. If you like something warm to sip on at night, try an herbal decaffeinated tea or chamomile tea.
Lower the room temperature: according to the Sleep Foundation, setting the bedroom temperature between 65 and 68 degrees Fahrenheit can help you fall asleep and stay asleep.
Stress can exacerbate menopausal symptoms. Stress increases the hormone cortisol, which can increase the frequency and intensity of hot flashes and night sweats, cause mood swings, and lead to sleep disturbances. High cortisol levels also promote greater abdominal fat storage. Here are a few ways to start lowering cortisol levels:
Establish a consistent sleep schedule: getting 7 to 9 hours of sleep allows cortisol to naturally lower.
Move your body: Regular, moderately intense exercise can help lower cortisol levels.
Explore relaxation techniques: deep breathing, meditation, yoga, and overall being mindful are ways to lower your cortisol levels.
Support your natural circadian rhythm: get plenty of sunshine in the morning, avoid blue light before bed, and keep a consistent sleep/wake schedule.
Developing consistent routines for eating, exercise, sleep, and stress management before perimenopause can help reduce extra pounds during menopause, making it essential to adopt healthy lifestyle choices early on. You don’t have to make these changes alone; a registered dietitian can help you build a customized plan that fits your lifestyle.
Hormone Replacement Therapy Options
During menopause, women may consider hormone replacement therapy (HRT) to help manage symptoms that affect their overall well-being, including weight changes. Hormone therapy, like HRT, is not recommended solely to lose weight, but it may help redistribute fat, specifically a fat called visceral fat, around the abdomen and improve menopausal symptoms. Visceral fat lies deeper inside the body, surrounding internal organs. A higher percentage of visceral fat, typically greater than 10% is associated with increased risk of cardiovascular disease, type 2 diabetes, high blood pressure, and cancer. Estrogen plays a huge role in fat distribution. When estrogen levels decline, visceral fat increases, making lifestyle and diet changes crucial.
During menopause, estrogen and progesterone levels naturally decline, leading to symptoms like hot flashes, mood swings, sleep disturbances, and a slower metabolism. HRT works by replacing the hormones the body no longer produces. The two most common forms of HRT are estrogen therapy and combined progesterone therapy. For women in menopause, combination hormone replacement therapy (HRT) is the better choice because adding progesterone reduces the risk of endometrial hyperplasia and cancer that can be increased by using only estrogen.
It’s also important to distinguish between standard hormone replacement therapy (HRT) and bioidentical hormone replacement therapy (BHRT). Standard HRT uses synthetic hormones for menopause symptoms. In contrast, BHRT uses plant-based hormones that are chemically identical to those the body naturally produces, resulting in better compatibility and fewer side effects. Recent studies have highlighted risks associated with traditional HRT, such as increased chances of breast cancer and cardiovascular issues. In contrast, BHRT is generally preferred as it is considered safer and may yield better outcomes for patients.
These hormones can be delivered in multiple ways, such as through injections, pills, gels, vaginal rings, sprays, or patches. HRT can improve menopausal symptoms such as hot flashes and night sweats, making it easier to manage weight and adopt healthy lifestyle choices.
While HRT is not used directly for weight loss, it helps women sleep better, which means more energy to adopt healthier eating and exercise habits. Research shows that hormone therapy, such as estrogen therapy, is an effective way to redistribute fat, helping women to make changes to their total body weight.
If you are struggling to manage your menopausal symptoms and noticing an increase in belly fat, seek support from a dietitian and talk to your doctor to see if HRT is right for you.
Benefits of Maintaining a Healthy Weight
Eating habits, consistent exercise, and other factors, such as hormone therapy, help with weight loss and weight maintenance. Losing excess weight increases motivation and improves overall well-being, reducing the risk of menopausal symptoms and improving body composition.
A 10-pound weight loss can lower blood pressure by about 5 points, lower LDL (bad cholesterol) and increase HDL (good cholesterol), and reduce the risk of type 2 diabetes, heart disease, and stroke. Maintaining a healthy weight makes aging feel better. A healthy weight protects joints, reduces the risk of arthritis, and improves mobility. It can also help with steadier energy levels, better sleep, and a stronger immune system.
Weight loss and weight maintenance have surprising benefits on mental health. Studies show that healthy weight management is linked with lower levels of anxiety and depression, increased confidence and self-worth, and better motivation.
That being said, if weight loss is achieved in an unhealthy way, it can also have negative impacts on mental health. Working with a registered dietitian can help you navigate your relationship with food and body image, enabling you to lose weight safely and improve your overall quality of life.
