Menopause weight gain: why it happens, when it stops

Why does weight change during menopause?

If you are in perimenopause or menopause and have noticed that you have gained weight in recent years, especially around your middle, you are not alone. The NHS lists weight gain among menopause symptoms and notes that it often happens around the belly and upper body (NHS, Menopause: symptoms).

Midlife, roughly between ages 40 and 65, is a time when both hormonal and physical changes in the body speed up. According to The Menopause Society, the main cause of weight gain at this stage is aging itself; menopause changes where fat settles in the body and tends to increase belly fat (The Menopause Society, MenoNote: Midlife Weight Gain). In other words, hormones are not the only culprit. Several factors are at work at the same time.

Four reasons for weight gain in menopause

Age and muscle loss

Muscle tissue burns more energy than fat tissue, even at rest. According to The Menopause Society, women lose 3 to 8 percent of their muscle mass every decade after age 30. As muscle decreases, the energy your body burns at rest also falls. That is why you can gain weight even if your eating habits have not changed at all (The Menopause Society, MenoNote: Midlife Weight Gain).

Hormone changes

With menopause, levels of estrogen (the main female sex hormone) drop. This drop makes it easier for the body to store fat around the belly. Doctors call this central (abdominal) fat (The Menopause Society, MenoNote: Midlife Weight Gain). Scientists have not been able to fully separate the share of aging from the share of menopause; the evidence on this is still debated (Fenton, 2021).

Sleep and hot flashes

Night sweats and hot flashes break up sleep. The Menopause Society says sleep disruption and hot flashes can contribute to weight gain, and that poor sleep and high stress are closely linked to weight gain (The Menopause Society, MenoNote: Midlife Weight Gain). If you have sleep problems, menopause insomnia has more detail.

Changes in daily life

In midlife, physical activity often decreases, eating patterns change, and work and family demands grow. These are also among the factors that affect weight (The Menopause Society, MenoNote: Midlife Weight Gain).

My weight is the same but my body has changed: is that normal?

Yes, it is common. In the SWAN study, which followed thousands of women in the US for years, the rate at which fat mass increased doubled once the menopause transition began. At the same time, lean (muscle) mass started to decrease. These changes continued until about 2 years after the final period, then leveled off. Weight, by contrast, was already rising slowly and steadily before the transition; there was no clear speed-up with the transition (Greendale et al., 2019).

What this means is that when fat goes up and muscle goes down, the number on the scale may hardly change. But the shape of your body, how your clothes fit and your waist size can change. A review also reports that waist size increases noticeably during the menopause transition, and that this change is similar across ethnic groups (Fenton, 2021).

Why does waist size matter?

Fat that builds up around the belly behaves differently from fat elsewhere in the body. According to The Menopause Society, extra weight around the waist in particular raises the risk of high blood pressure, diabetes, unhealthy cholesterol levels and fatty liver. Weight gain in midlife also raises the risk of some cancers, such as breast and colon cancer, and increases the load on your joints (The Menopause Society, MenoNote: Midlife Weight Gain).

There is a simple way to assess your waist. According to the NHS, your waist should be less than half your height. For example, if you are 164 cm (about 5 ft 5 in) tall, the aim is a waist under 82 cm (about 32 in) (NHS, Obesity). Measuring at the level of your belly button, without holding your breath, after breathing out comfortably makes your results comparable over time.

This measure is not a diagnosis. It only gives an idea of risk and is a useful number to have when you talk to your clinician.

Which weight changes are expected in menopause, and which are not?

What you might expect:

• Slow weight gain spread over years.
• Fat collecting around the belly and upper body rather than the hips and thighs.
• A feeling of less muscle strength and firmness, even at the same weight.

What is not expected and needs checking separately:

• Rapid, unexplained weight gain or loss over a short time.
• Weight gain that comes with extreme tiredness, feeling cold or constipation. These symptoms can point to other causes, such as your thyroid.
• Swelling in your legs or belly. This may be fluid buildup rather than fat.

General lifestyle information

This page does not give a diet or exercise program. Here is what the sources emphasize at a general level:

• Balanced eating. The NHS recommends healthy, balanced eating during menopause (NHS, Menopause: things you can do). The Menopause Society sees an eating pattern rich in fruit, vegetables, lean protein and whole grains as the foundation, and notes that protein helps preserve muscle mass (The Menopause Society, MenoNote: Midlife Weight Gain).
• Regular movement. The Menopause Society recommends at least 150 minutes a week of moderate-intensity aerobic activity (such as brisk walking) and muscle-strengthening exercise two days a week. Strengthening matters against age-related muscle loss (The Menopause Society, MenoNote: Midlife Weight Gain). The NHS also highlights weight-bearing, strength-building exercise (NHS, Menopause: things you can do).
• Sleep and stress. Good sleep and managing stress make it easier to maintain a healthy weight (The Menopause Society, MenoNote: Midlife Weight Gain).
• A realistic goal. Even preventing weight gain is a significant benefit to your health on its own. For people already living with excess weight, losing even 5–10 percent of body weight is said to have positive effects on health (The Menopause Society, MenoNote: Midlife Weight Gain).

These steps do not promise anyone a particular result. Managing weight is not a quick fix but a long-term process. The safest course is to work out a plan that suits your health with your clinician or a dietitian.

What can you track yourself?

• Once a month, measure your weight and waist in the morning before eating.
• Note your sleep pattern and night-time waking.
• Roughly record how many minutes you move each week.
• Write down other symptoms, such as hot flashes and irregular periods, in the same place. To see which symptoms may be linked to menopause, you can look at menopause symptoms.

When should you see a doctor, and what should you ask?

The Menopause Society stresses that in midlife it is important to have markers such as weight, waist size, blood pressure and cholesterol monitored regularly by a health professional (The Menopause Society, MenoNote: Midlife Weight Gain). See your clinician if the change in your weight worries you, if hot flashes and sleep problems are affecting your daily life, or if you notice one of the unexpected changes above.

Questions you could ask at your appointment:

• Could my weight gain have another cause, such as my thyroid, blood sugar or a medicine?
• What do my waist size and blood pressure say about my risk?
• Which blood tests would be appropriate for me?
• What options are there for my sleep problems and hot flashes?
• Would it help to be referred to a dietitian or physiotherapist?

This page does not describe treatment options. Talk to your clinician about the options for menopause symptoms.