Weight gain in menopause: what helps

Menopause does not make you heavier. It moves your fat. In the largest study on this, women's weight rose in a straight line through midlife, with no acceleration around the menopause (PMID 30843880). What does speed up is your fat gain: from about 1.0% a year to 1.7% a year.

You have probably heard something else for years. That menopause makes you fat, and that you should therefore be stricter with yourself. That is not true, and it is useless advice on top of that.

Below you read what good research actually shows about your body.

Why the scale misleads you

Your fat mass rises almost twice as fast during the transition. At the same time your lean mass flips from gain to loss. On the scale those two movements largely cancel each other out. Your weight creeps up the way it already did, while your body is now put together very differently.

The SWAN study followed women for years with DXA scans. That is the most accurate way to measure fat and muscle separately. Both move there, but in opposite directions.

The scale shows you almost none of that.

This is exactly why you sometimes do not recognise yourself, while the number barely changes. Here is what the change looks like in figures.

Read that last row again. It is the correction this whole article turns on.

You gain weight from age, your fat moves because of menopause

This is the heart of the story. Researchers put it like this. Changes in your weight are due to chronological ageing. Changes in your body composition and fat distribution are mainly due to the ageing of your ovaries (PMID 27417630). Two processes, two causes. Blurring them is why the advice you get achieves so little.

So you gain weight because you are getting older. That happens to women nowhere near the transition too. It happens to men your age just as much.

Your fat moves because you are in the transition. That is a different story, with a different cause and a different answer.

Honesty matters here. Another SWAN analysis followed women for six years. Fat rose by 3.4 kg, skeletal muscle fell by 0.23 kg and the waist grew 5.7 cm (PMID 17192296). Both your age and your ovarian ageing contributed. So it is not a clean either or.

Where your fat goes, and why that does count

The fat around your organs changes the most. It is called visceral fat. Before the transition it barely moves, during the transition it rises by 6.24% a year (PMID 34061966). Your belly fat goes from 1.21% to 5.54% a year. The fat on your hips and thighs grows far more slowly, and even falls back after the transition.

That visceral fat is not a cosmetic problem. Around your final period it rises by about 8.2% a year. That rise tracks with thickening of your carotid artery, independent of your BMI (PMID 33651741).

That is what is really at stake, and it is not on your scale.

A tape measure will not help you see it, by the way. Your waist and hip circumference respond less sensitively to this shift than the scans do (PMID 34061966). Why your body sends that fat to your middle in particular is covered in menopause belly and why fat moves to your middle.

What does contribute

Four things demonstrably contribute, and none of them is a lack of willpower. You slowly lose lean mass. Your fat moves inward. You sleep worse. And your appetite defends your current weight harder than your metabolism works against it.

Muscle loss, but less than you think

Your lean mass falls by about 0.2% a year during the transition years (PMID 30843880). Muscle tissue burns energy at rest, so your burn drops a little with it. A little, not dramatically.

Sleeping worse

About 26% of women in the transition meet the criteria for insomnia (PMID 29445307). Sleep problems track with your menopausal stage and your hormone change, over and above your age.

In research, partial sleep loss raised intake by an average of 385 kcal a day, with no rise in expenditure (PMID 27804960). That research was not done in menopausal women. So the link is plausible, but it is not proven in your group.

There is more on that in menopause sleep problems and what they do to your appetite.

Your appetite defends your weight

For every kilo you lose, your expenditure drops by 20 to 30 kcal a day. Your appetite rises over the same period by about 100 kcal a day (PMID 29156185). So hunger is three to five times as strong as the effect on your metabolism.

That is not weakness. That is a system doing its job.

What does not contribute, however often you hear it

Four claims turn up in almost every article on this subject. They sound logical, they sell supplements, and they send your energy in the wrong direction. Not one of them holds up. Here they are, by name.

Your metabolism slows down in menopause. There is no good evidence for this. What does fall is your lean mass, and that effect is small.

It is a cortisol belly, your adrenals are exhausted. A systematic review of 58 studies is literally titled "Adrenal fatigue does not exist" (PMID 27557747). Adrenal fatigue does not exist as a medical diagnosis, and neither does the supplement that goes with it.

Menopause makes you insulin resistant. In SWAN, glucose and insulin followed your calendar age, not your transition (PMID 20082925). Only your cholesterol makes a real jump around the menopause.

You lose 3 to 5% of your muscle per decade. In the transition years the measured loss is about 0.2% a year. The popular figure is an order of magnitude off.

Does hormone therapy make you gain weight?

No, the research does not show that. A Cochrane review of 22 randomised trials found no significant weight difference between women with and without hormone therapy (PMID 10796730). That review is old, with a search cut-off in 1998. So read it alongside newer work.

A later analysis of 107 randomised trials saw abdominal fat fall by 6.8% on hormone therapy (PMID 16918589). Insulin resistance fell as well.

Many women turn down an effective treatment out of fear of the kilos. That is a shame, and on this ground it is not needed. The full picture is in does hormone therapy cause weight gain.

What a blood test does and does not do here

A blood test will not tell you why the scale has stalled. Hormonal disease is a rare cause of weight change. What a test does show is what this fat redistribution is doing to your health. And whether that is heading the right way or the wrong way.

That is not a detail. In 13.7% of women, a metabolic syndrome appears around the final period that was not there before (PMID 18663170). You will not see that in the mirror, and not on your weight.

A complete metabolic panel shows your blood sugar, your cholesterol and your liver values, among others. You use it to follow what is happening, not to explain why you gained weight. Which hormone values shift in this phase is covered in hormone balance in menopause.

Discuss an abnormal result with your GP. Thuisarts.nl has reliable information on menopause, and the Voedingscentrum sticks to ordinary, sustainable eating rather than cures.

Frequently asked questions

Does everyone gain weight in menopause?

Women gain weight gradually through midlife, but that process does not speed up because of menopause itself (PMID 30843880). What does change is the ratio of fat to muscle, and where that fat settles.

Why do my trousers not fit while my weight stays the same?

Because your fat is moving to your middle while your lean mass falls. Fat takes up more room at the same weight. You are not heavier, you are distributed differently.

Does my metabolism slow down in menopause?

There is no good evidence for that. Your burn drops a little along with your lean mass, and that loss is about 0.2% a year. That is not the same as a metabolism grinding to a halt.

When this article is not for you

Weight loss is not a healthy goal for everyone. Do not follow this article if you have or have had an eating disorder, are pregnant or breastfeeding, are underweight, use insulin, or have had bariatric surgery. Speak to your GP first.

If thoughts about food or your body start to take over, talk to your GP or contact an eating disorder helpline. That is not weakness. That is sense.

What to do next

You now know why your body is changing. The next question is what to do about it, and the answer is not being stricter with yourself. The answer is holding on to muscle, eating enough protein and choosing a pace you can keep up for a year.

Put two strength sessions in your diary this week, then read the plan.

That plan is in weight loss in menopause: what works and what does not.

References

1. Greendale GA et al. Body composition and weight across the menopause transition. SWAN, JCI Insight 2019. PMID 30843880.
2. Greendale GA et al. Visceral and abdominal fat across the menopause transition. JCEM 2021. PMID 34061966.
3. Karvonen-Gutierrez C. Weight, body composition and the menopausal transition. PMID 27417630.
4. Sowers M et al. Six-year changes in body composition in midlife women. SWAN. PMID 17192296.
5. Matthews KA et al. Cardiovascular risk factors around the menopause. SWAN, JACC. PMID 20082925.
6. Samargandy S et al. Visceral fat and carotid artery thickening. SWAN. PMID 33651741.
7. Janssen I et al. Metabolic syndrome around the final menstrual period. SWAN. PMID 18663170.
8. Baker FC et al. Sleep problems during the menopausal transition. PMID 29445307.
9. Al Khatib HK et al. Sleep loss and energy intake. PMID 27804960.
10. Hall KD, Kahan S. Long-term maintenance of lost weight. PMID 29156185.
11. Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. PMID 27557747.
12. Cochrane review. Hormone therapy, weight and body fat distribution. PMID 10796730.
13. Salpeter SR et al. Hormone therapy and the metabolic syndrome. PMID 16918589.

Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.