Menopause Belly Fat: What Causes It And What Actually Works

Weight gain is a common issue during menopause, but if you’re worried about belly fat in particular, you’re not alone. The hormonal shifts that happen during both the perimenopause and menopause transition can change your body composition. This can cause more fat to be stored on your abdomen than elsewhere.

In this expert guide we’ll share why that happens and what actually works if you’re looking to lose weight from around your middle.

Article summary:

• Menopause is caused by a drop in hormone levels. The resulting symptoms and the hormonal changes themselves can affect your weight and body shape.
• An increase in belly fat is common during menopause, as the changes in hormones may cause your fat to be stored in your body differently.
• Medicated treatments and lifestyle changes, including regular exercise, a balanced diet and sleeping well, can help you to manage your weight and body shape during menopause.

What is menopause? 

Menopause is a natural biological stage that occurs when your periods change and eventually stop altogether. This is due to changes in your reproductive hormones (oestrogen, progesterone and testosterone) which happen as you age. [1]

As you get older, your ovarian function slows down, affecting the production of these hormones. It’s the steep drop in oestrogen in particular that causes the main symptoms of menopause, but all three hormone levels decline and can have an impact on your physical and emotional wellbeing. [2]

There are three stages of menopause:

Perimenopause is a transitional phase, where you start to notice that your periods are changing compared to your usual cycle. For example, you may find that your periods are less regular or more unpredictable, you may have a heavier or lighter flow, or they may be shorter or longer than they were before. This stage tends to happen between the ages of 45 and 55, but some people notice these changes as early as in their late thirties.

Menopause is when you haven’t had a period for 12 consecutive months.

Postmenopause is the stage after you notice your periods have stopped.

Menopausal symptoms can happen at any of these stages, and they’re not just limited to changes in your menstrual cycle. Other symptoms may include: [1]

• Hot flashes (sometimes known as hot flushes), where you experience a sudden feeling of heat in your face, neck and chest
• Night sweats
• Disrupted sleep or insomnia
• Loss of muscle mass and weight gain, especially around your waist
• Vaginal dryness and decreased libido
• Brain fog and poor memory
• Mood swings, anxiety or depression
• Hair thinning or hair loss
• A faster, slower or more noticeable heartbeat

When does menopause happen? 

Most women experience menopause between the ages of 45 and 55, but it can also happen earlier or even later. When you experience it may be related to your family history, medications (such as chemotherapy), or lifestyle choices.

The average age for menopause in the UK is 51. [3]

How does menopause affect your weight and body shape? 

Weight gain is common during perimenopause and menopause. Studies suggest that on average, women gain 1.5lb a year during the menopause transition. [4] But if you’re noticing more belly fat, it’s not necessarily that you’ve put on weight. It could be down to the common changes in body composition that happen during menopause.

Changes in fat distribution

Even if your weight doesn’t increase, the fluctuations in your hormone levels can affect where fat is stored in your body. You may notice that you have more fat around your waist and abdomen, often referred to as ‘menopause belly’.

This is partly caused by the decline in the oestrogen hormone, which previously distributed fat to your hips, thighs and bum. When your oestrogen levels drop, the balance between oestrogens and androgens (like testosterone) changes. This can cause fat to be stored around your abdominal area instead. [5]

This is why many women find their body shape shifts from ‘pear-shaped’ to ‘apple-shaped’, even if their total body weight doesn’t change drastically.

Increases in insulin resistance

Low oestrogen levels also reduce your body’s ability to use blood glucose (known as your insulin sensitivity). If your body doesn’t respond well to insulin, this is called insulin resistance. It can cause high blood sugar, causing your body to release even more insulin into your blood to help to clear it.

High insulin levels can lead to the storage of fat around your waist and stomach, causing a higher concentration of belly fat. [6]

Imbalanced hunger hormones

The drop in your oestrogen levels also disrupts the balance of two hormones responsible for your appetite: ghrelin and leptin. While ghrelin signals when you feel hungry, leptin tells you when you’re full.

The decline in oestrogen can cause an increase in ghrelin, and a decrease in leptin. The result? You may feel hungrier and be less satisfied after meals, which can cause you to eat more and potentially gain weight. [7]

Menopause symptoms

The hormonal changes in menopause can indirectly impact your weight, because of the other symptoms they cause. Poor sleep, for example, can affect your appetite and increase levels of your hunger hormone, which may lead to overeating. [8] And extended periods of disrupted sleep may affect your energy levels, making you less likely to exercise.

Visceral fat vs. subcutaneous fat

Menopause can also affect the type of fat you store, not just how much you weigh. Before menopause, oestrogen helps promote fat storage in the hips, thighs and bum as subcutaneous fat, which sits directly under the skin. When oestrogen drops, the body stores fat more centrally, and this includes visceral fat. [9]

This type of fat sits deeper, surrounding your internal organs, and is metabolically active. This means it can release hormones that affect your metabolism, as well as cytokines (small proteins that help control inflammation). Higher amounts of visceral fat are associated with insulin resistance, high blood pressure, cholesterol changes, cardiovascular disease and type 2 diabetes. [10]

How to reduce belly fat during menopause 

There are things you can do to help manage your weight during menopause and beyond, from physical activity and strength training to minimising your stress levels.

Increase your muscle mass

Physical activity is important during menopause for many reasons, as it has wider benefits for your health. But one of the main ways it can help is by improving your body composition (the proportions of fat, muscle and bone in your body). [11]

Firstly, it can help with fat burning, using your body’s stored fat as fuel for energy. [11] This helps to increase your caloric deficit which may help you to lose weight.

Movement can also help you maintain muscle mass, which often falls as your oestrogen levels decrease as part of the menopause transition. [12] This is why resistance training is so important in midlife. Lifting weights or doing bodyweight exercises a few times a week can help to stimulate muscle growth. As well as helping to keep you feeling strong, muscle is important for weight management, because it can help you to burn energy even while you’re resting. [13]

Weight training and resistance exercise can also help maintain or improve bone mineral density, which is necessary as weaker bones are another result of declining oestrogen levels. [14]

Optimise your nutrition and diet 

Eating a healthy, balanced diet is key for managing your weight at any age, but during menopause there are specific changes you can make. One is to prioritise your protein intake, as it provides the building blocks you need to help maintain muscle mass. [15] It also helps you to stay fuller for longer, making you less likely to overeat. [16]

Research also shows that following a Mediterranean diet that’s low in red and processed meat, and high in vegetables, fruits, fibre and wholegrains may help to reduce the risk of weight gain. [17] It can also help to limit foods high in sugars and refined carbohydrates, as well as processed foods and alcohol. This may make it easier to achieve a calorie deficit, which is key for weight loss.

Managing stress and cortisol levels

Another hormone to consider is cortisol. Known as your stress hormone, it’s released as part of the body’s stress response. While small, short term rises are perfectly normal, too much cortisol can affect appetite and blood sugar control. [18] [19]

Your menopause symptoms and lack of sleep may contribute to your stress levels, so treating these alongside stress management techniques like yoga, relaxation and movement can help to keep your cortisol in check.

Optimising sleep hygiene 

Making sure you get enough sleep is key for your overall health, as well as for weight management. A lack of sleep can increase stress, but it can also affect your energy levels which can have a knock-on effect on your motivation to exercise and eat healthily. Research has shown that sleep deprivation can increase hunger and cravings for energy-dense foods the next day. [20

Try to stick to a regular sleep routine. Reduce your screen time before bed to help you to wind down, and limit your caffeine and alcohol intake late in the day as these can impact your ability to fall and stay asleep. [21] [22]

Assess your sleep environment, too: is it cool enough? Are your nightwear and bedsheets made of a light, breathable cotton or linen? These can help to reduce the impact of hot flashes and night sweats, for a less disrupted sleep.

Medicated treatments for menopause and weight loss 

You don’t have to struggle through menopause alone. There are treatments that can help to alleviate your symptoms and support weight loss alongside healthy lifestyle changes.

Hormone replacement therapy (HRT)

Hormone replacement therapy is a treatment that works by replacing oestrogen and progesterone, helping to reduce menopause symptoms. In particular, HRT can help to reduce hot flashes and night sweats (known as vasomotor symptoms), as well as helping to ease joint pain and stiffness. [23]

Restoring oestrogen levels can also help to support weight management or reduce the risk of belly fat, by helping to distribute fat to the thighs and hips rather than your stomach. [24]

And while some people worry HRT causes weight gain, there is no evidence to support this, though some types can cause temporary fluid retention. [25] In fact, HRT may help you to manage your weight more effectively because of the way it helps with easing menopause symptoms.[26]

Medicated weight loss treatments 

There are now medicated treatments that can help with weight loss by mimicking a natural hormone in your body, such as GLP-1 (glucagon-like peptide-1) medications. These medications help regulate blood sugar levels, reduce hunger, and slow digestion to increase feelings of fullness. [27]

Medications are available on prescription to those who are eligible, which is based on your body mass index (BMI) and health history. They can be taken in the form of a weekly injection or a once-daily pill.

Need help with weight management during menopause? At MedExpress, we offer online consultations with regular clinical check-ins, and a range of weight loss treatments including Mounjaro Pen, Wegovy Pen, Wegovy Pill and Foundayo, and our team can help you find the right treatment for you.

References

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