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 looking at 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. Eat a low carb or ketogenic diet. This can help keep insulin low, which may help reduce abdominal fat gain.
2. Eat enough protein. This helps maintain lean muscle mass and decrease hunger.
3. Lift weights or do resistance training. This also helps maintain and build more muscle.
4. Introduce time-restricted eating, such as skipping breakfast. This helps keep insulin low for longer stretches and may be an easy way to decrease caloric intake.
5. Avoid excess consumption, especially snacks, nuts, and alcohol.
6. Prioritize sleep. This can decrease cortisol and reduce insulin resistance.
7. Manage stress with relaxation techniques. Yoga, exercise, and meditation can all help.
8. Talk with your doctor about a trial of hormone replacement therapy (HRT) if you are having a very difficult menopause transition. While HRT is associated with only a small decrease or no change in weight, it may specifically help with fat accumulation around the middle.

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

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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 40.² While the average age of onset in North America is around 52, the hormonal changes can start in a woman’s early 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

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Hormonal changes

Why do these symptoms and weight gain occur? You can blame your hormones for much of it.

Estrogen and progesterone — a woman’s reproductive hormones — change dramatically at menopause.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 the follicles have been depleted.

The decline of estrogen can be erratic.⁸ 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.⁹

During menopause, some women will also experience a significant increase in the secretion of the stress hormone cortisol, especially during the night.¹⁰ There is very weak evidence suggesting that this may contribute to increased hunger and weight gain, especially around the middle.¹¹

Why cortisol secretion sometimes increases during menopause is not completely understood. It appears more likely to be related to internal physiologic changes, as opposed to a response to social stressors, but the data are inconclusive.¹²

In summary, the hormonal changes seen during menopause have the potential to cause numerous symptoms, in addition to negatively affecting a woman’s body composition.

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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.¹³

While mouse studies show that inducing low estrogen levels by removing the ovaries causes a decrease in energy expenditure, human studies of premature ovarian failure have not shown weight gain; in fact, these women tend to be leaner.¹⁴

Most research in the field of menopause recognizes that the trajectory of weight gain seen in mid-life doesn’t usually change during the menopause transition. Rather, it’s the body composition — with greater accumulation of body fat — that tends to change the most.

Physical and metabolic changes during menopause include:

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.¹⁵

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 regarding definitions and consistent research approaches.

However, there is 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.¹⁶

Insulin resistance

Insulin resistance can develop for a number of reasons. In menopause, specifically, it may increase due to declining estrogen, increased abdominal fat, aging, and of course genetic factors.¹⁷

As insulin resistance increases, the pancreas works harder to produce more insulin in an effort to keep blood sugar levels normal. Higher insulin levels promote the storage of fat, keeping it locked up and harder to burn as fuel.¹⁸

Metabolic syndrome

When a collection of concerning health measurements and biomarkers are found together — insulin resistance, obesity, high blood pressure, and lipid problems — this is called metabolic syndrome. Having these risk factors puts people at higher risk of cardiovascular disease and diabetes.

Unfortunately, menopause increases the risk of developing metabolic syndrome.¹⁹

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.²⁰

Resting energy expenditure

The loss of muscle mass and the increase in body fat create another problem: a woman’s resting energy expenditure (the speed of her metabolism) may go down. This can happen to anyone with advancing age if boay fat increases, but it is possible that a dramatic menopause-induced change in body composition could make it worse.²¹

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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 through 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.

That said, these eight tips all have supporting scientific evidence 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, keeping fat gain to a minimum. They may even help you lose body fat.

Each subsection below links to our more in-depth guides, which you can explore for further details.

1. Eat a low carb diet

The carbohydrates you eat digest to glucose, which raises insulin. To reduce insulin levels and possibly reverse insulin resistance, simply cut out sugar and high carb foods like rice, potatoes, bread, pasta, and baked goods that rapidly convert to sugar. Keeping insulin low may allow your body to more easily access fat stores to burn for energy.²²

Low carb diets might even increase metabolism – potentially increasing fat burning – by between 200 and 500 calories per day.²³

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

• Why low carb can help you lose weight
• A low carb diet for beginners
• A ketogenic diet for beginners
• Eating better: Six steps down the carb mountain

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. Critically, it is also the most satiating macronutrient, meaning that eating protein is the best way to turn off your brain’s desire to eat.²⁴ A 2022 paper found that because of the hormonal loss of lean muscle during menopause, women are driven to consume more calories in attempts to replace lost protein, a process also known as “protein leverage.” ²⁵  An excellent blog by nutritional coach Marty Kendall explains this phenomenon of the body seeking to meet higher protein needs in more detail.

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.

• How much protein should you eat?
• Protein on a low carb or keto diet: the complete guide
• Target protein tables

3. Lift weights or do bodyweight 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 bodyweight exercises like squats and knee-pushups help maintain and build more muscle.

More muscle not only makes you stronger (and strengthens your bones, too), it can help you maintain resting energy expenditure, improve blood sugar, and reduce insulin resistance.²⁶

• Exercise and health: A guide for what type of exercise is best for you
• Three at-home workout plans
• Let’s get moving: Exercise course for beginners
• Video: Ketogenic diets and resistance training

4. Introduce time-restricted eating

If you are not eating as often, you will tend to consume fewer calories overall, plus insulin levels remain low for longer. It can be as simple as skipping breakfast. And when you are eating a low carb diet, skipping a meal is often easier to do.²⁷ Time-restricted eating is just one type of intermittent fasting that may help burn body fat stores and improve certain health biomarkers.²⁸ Other types of intermittent fasting include eating just one meal a day, or OMAD.

• Time-restricted eating: a detailed intermittent fasting guide
• Intermittent fasting for beginners
• What you need to know about OMAD
• All intermittent fasting guides

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 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.²⁹

Paying attention to food and drinks that contain little nutrition and/or lots of calories 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 replacing full-fat dairy like cheese and Greek yogurt with lower fat versions.

Understanding hunger signals helps control excess consumption, too.

• Keto and low carb dairy: the best and the worst
• Low carb alcohol: the best and the worst drinks
• Guide: 7 things you need to know about alcohol and the keto diet
• How to manage hunger when trying to lose weight
• Is it hunger? Or is that pang a need for something else?
• Low carb nuts – the best and the worst
• Keto snacks- the best and the worst
• Keto sweeteners guide

6. Prioritize sleep

Like a poor diet, successive nights of bad sleep are also bad for your health and can lead to weight gain.³⁰

Consistently good sleep, however, may help decrease cortisol and reduce insulin resistance, making weight management easier.³¹

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.

• Weight loss for good program: improve sleep and lose weight
• Low carb hacks: sleep enough

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, possibly making it harder to drop those excess pounds.³² Though it’s hard to prove, we believe that yoga, relaxing exercise like Tai Chi, meditation, and relaxing hobbies can all help.

• How to break a weight loss stall

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.³³ Talk with your doctor about a trial of HRT if you are having a very difficult menopause transition.

• Hormone replacement during menopause

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Summary

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

But you are not alone – millions of women are dealing with the same issues. And with the adoption of a low carb diet, as well as a few other lifestyle tweaks, you can still have good health and vitality, reaching the right weight for you, in menopause and beyond.