Menopause is a natural stage of life that comes with a variety of changes, and the way these changes show up varies greatly from person to person. One common concern women share during this time is weight gain, especially around the waistline, what is sometimes called "menopause belly."
As we age, our metabolism tends to slow down, making it easier to gain weight and harder to shed it. In fact, studies suggest that up to 70% of women experience some degree of weight gain during the menopause transition1.
This isn’t just about the number on the scale—it’s also about where that weight tends to settle. Menopause is a period where fat distribution shifts, with more of it accumulating around the abdomen.
This isn’t just about aesthetics; menopause is also a time when the risk of obesity increases. Unfortunately, many of us become less physically active during this stage of life, which can make it even harder to manage weight2 and this drop in activity levels further contributes to the challenge.
But here’s the good news: while a "menopause belly" can feel like an uphill battle, it’s absolutely possible to take control. In fact, the years leading up to and immediately following menopause—known as perimenopause- and the timeframe right after menopause can be a great window of opportunity. By taking intentional steps, you can counteract the changes your body might go through and set yourself up for long-term health and confidence.
Menopause and weight gain—why does it happen?
Weight gain during menopause is a multifaceted issue influenced by hormonal, lifestyle, and metabolic changes. While it’s a common concern, understanding the “why” behind it is the first step in addressing it effectively.
The role of hormones fluctuations
One of the primary factors is the drop in oestrogen levels during menopause, though it’s not the only reason and the mechanism is a complex one. Oestrogen plays a role in regulating where fat is stored in the body, and its decline contributes to a shift toward more fat accumulation around the waistline3. Additionally, hormones like oestrogens are involved in appetite regulation, which means these changes can also affect how hungry or full you feel, adding to the challenge4.
Poor sleep quality
Another often overlooked factor is sleep. Many women experience disruptions in their sleep during menopause, which has been shown to contribute to weight gain5. Poor sleep can influence hormones that regulate hunger and satiety, making it harder to resist cravings and easier to overeat.
Health risks of weight gain
The weight gained during menopause isn’t just about appearance; it’s also linked to serious health risks, including an increased risk of developing cardiovascular diseases or type-2 diabetes6. On the other hand, carrying excess weight can worsen some menopause symptoms, such as hot flushes and sleep disruptions, creating a challenging cycle7.
Once weight is gained during menopause, it can be particularly difficult to lose. This is due to the body’s digestive functions slowing down and changes in how the body stores fat. That’s why establishing a healthy routine early is crucial5.
Understanding the “Menopause Belly”
What makes menopause-related weight gain unique is how fat distribution changes. During the years leading up to menopause—when body composition changes most dramatically—fat tends to settle around the abdomen, waistline, and lower back. This includes the accumulation of what is referred as “visceral fat”, which is stored deeper between the organs and tissues2,8.
Our team of specialists has extensive expertise in addressing physical changes during menopause. They can recommend a tailored approach to managing weight gain. Simply book a consultation with one of our specialised menopause doctors.
How to effectively lose weight during menopause
Losing weight during menopause—and tackling the so-called "menopause belly"—requires a balanced approach that focuses on a combination of healthy eating, good nutrition, regular exercise, and lifestyle habits. It’s about supporting your whole well-being.
While spot-reducing fat is challenging, a combination of targeted exercises, full-body workouts, and lifestyle changes can make a real difference!
Here are some strategies to explore:
Exercise routine
The key to combating weight gain during menopause is a well-rounded fitness routine that includes strength training, aerobic exercise, and mobility work. Here’s how to structure your workouts:
- Strength training: Incorporate exercises like squats, pushups, or weightlifting. Strength training helps preserve muscle mass, which tends to decline with age, and supports bone health9.
- Aerobic exercise: Engage in activities that increase your heart rate, such as HIIT (high-intensity interval training), running, cycling, swimming, or dancing. Aim for at least 150 minutes of moderate aerobic exercise per week, which can be split into 30-minute sessions over five days10.
- Mobility work: Activities like yoga and stretching not only improve flexibility but also enhance joint health and reduce the risk of injury9.
This balanced approach to physical activity doesn’t just target weight—it also promotes better bone health, cardiovascular fitness, and overall mobility9.
Exercise to tackle menopause belly
To strengthen your core and improve posture, consider incorporating bodyweight exercises like planks, side twists, and Pilates into your routine. Pilates, in particular, is widely recognized for building deep core muscles and easing lower back pain.
However, it’s important to set realistic expectations. Ab workouts alone won’t make the fat around your belly vanish. Instead of focusing solely on crunches or other abdominal exercises, think about the bigger picture—maintaining a healthy weight overall. This holistic approach will be far more effective in addressing menopause belly over time.
Hormone Replacement Therapy (HRT)
The impact of hormone replacement therapy (HRT) on weight management is still uncertain. Some studies suggest that oestrogen therapy could potentially help with weight management, particularly in women without significant health risks11. Some women using testosterone therapy for low libido, see improvement on body composition and weight. Here as well, the evidence is slim regarding the impact of testosterone on body mass index (BMI), or body fat but testosterone is known to be important for muscle growth and increasing lean muscle mass and directly influences metabolism, fat storage and energy levels.
Interestingly, how the therapy is administered may also play a role—some research indicates that transdermal oestrogen (patches or gels) may result in less fat gain compared to oral administration4. While HRT may have potential benefits, it’s important to consult with your healthcare provider to determine whether it’s a good fit for you and your overall health profile.
Although it’s debatable to connect HRT to weight loss directly, many women do lose weight and feel considerably better when using HRT, which often means that they would feel more motivated to look after themselves again.
Diet: nourish your body
Focus on balanced, nutrient-rich meals that include:
- Fruits and vegetables: Packed with fiber, vitamins, and minerals, these foods help keep you full while providing essential nutrients.
- Whole grains: Choose options like brown rice, quinoa, or whole-grain bread, which release energy slowly and keep you satisfied longer.
- Lean proteins: Foods like chicken, fish, eggs, and tofu support muscle health and promote satiety.
- Healthy fats: Include avocados, nuts, seeds, and olive oil in your diet for their heart-healthy benefits.
Reducing or eliminating processed foods, sugary snacks, and beverages can also help you maintain a healthy weight. The Mediterranean diet, which emphasises fresh produce, whole grains, and healthy fats, is a great template for menopause-friendly eating.
Additionally, foods high in phytoestrogens—plant-based compounds that also mimic oestrogen—such as soybeans, flaxseeds, and chickpeas, may help reduce symptoms like palpitations and irritability. While these foods are not a cure-all, they can complement a balanced diet to support overall well-being during menopause. Foods like soya-based foods are also worth mentioning. They contain isoflavones, a subcategory of phytoestrogens. Research suggests that isoflavones may help alleviate certain menopause symptoms, such as hot flushes, and potentially support weight management by promoting a balanced hormonal environment6.
Don’t forget the basics: staying hydrated by drinking plenty of water can help control your appetite and keep you feeling energised.
Sleep and stress management
Poor sleep can hinder weight management, as it disrupts hunger-regulating hormones and increases stress levels. Prioritise getting 7-9 hours of quality sleep each night and address any sleep issues early. Avoid caffeine and screen time close to bed for example.
Having a consistent, restful sleep helps in turn with healthy body weight, a balanced mood and feeling energised energy levels, all of which are essential elements.
Besides sleep, incorporating stress-reducing techniques, such as cognitive behavioural therapy (CBT), meditation, or yoga, can also help you maintain a healthy weight and improve your emotional well-being.
Takeaway
Addressing menopause-related weight gain is about more than just diet and exercise—it’s about taking a holistic approach that supports your physical, emotional, and mental health. With the right strategies, including a balanced diet, consistent exercise, quality sleep, and stress management, you can regain control and feel your best.
At Menopause Care, we have specialists who can guide you in creating holistic strategies, develop a treatment plan that works for you and give you evidence-based advice. This includes our consultant dietician Marcela or Rohini who provides nutritional recommendations and plans based on your experiences and needs. Reach out to our menopause experts to get guidance and recommendations for your unique needs. Navigating weight loss during menopause can feel daunting, but you don’t have to take this journey alone — our team is here to help.
¹Predictors of weight variation and weight gain in peri- and post-menopausal women Pimenta et al. (Aug.2014)
²Increased visceral fat and decreased energy expenditure during the menopausal transition Lovejoy et al. (June 2008)
³Body weight and fat mass across the menopausal transition: hormonal modulators Moccia et al. (Febr. 2022)
⁴Sex hormones, appetite and eating behaviour in women. Hirschberg A. L. (March 2012)
⁵⁶Understanding weight gain at menopause 
Davis et al. (Oct. 2012)
⁷⁸Changes in Body Composition in Women over Six Years at Midlife: Ovarian and Chronological Aging, Sowers et al. (March 2007)
⁹Exercise beyond menopause: Dos and Don’ts Mishra N, Mishra VN, Devanshi (July 2011)
¹⁰Physical activity guidelines for adults aged 19 to 64 NHS (August 2021)
¹¹Estrogen Deficiency and the Origin of Obesity during Menopause Lizcano & Guzmán (2014)
