Menopause is a time of signficant physical change for women during midlife. While stopping of the menstrual cycle may be the most obvious change, many women would identify weight gain as another very common and frustrating physical change of menopause. But what is the relationship between menopause and weight gain? Is weight gain inevitable for all women in midlife? This article will take a more in-depth look at this complex relationship and provide guidance to women who are struggling with weight gain during menopause. 

How does menopause cause weight gain?

There are many changes occurring in midlife that can contribute to weight gain. Studies suggest that hormonal changes, a decrease in lean muscle mass, and lifestyle factors such as decreased physical activity are just some of the contributors to weight gain and the changes in body composition that occur during menopause. 

Is menopausal weight gain just hormonal?

Not exactly, although the hormonal changes occurring during menopause do appear to be at least partly to blame. At present, the research is inconclusive, however, there are studies to suggest that changes occurring with multiple female hormones during menopause may lead to reduced energy expenditure (how many calories you burn in a day) and possibly even increased appetite, both of which have the potential to cause weight gain. 

One thing we do know for certain about the hormonal changes of menopause and weight is how these hormonal shifts change where we put on weight. Women going through menopause may notice a change in how their pants fit even if the scale doesn’t change much. This is because declining estrogen levels cause a shift in fat storage from the hips and thighs to the midsection. This central weight gain (also known as “menopause belly”) is not only frustrating for women, but can also increase the risk for cardiovascular disease and diabetes in later life. 

What other factors contribute to weight gain during menopause?

• Loss of lean muscle mass - It’s unclear if this is related to normal aging or hormonal changes, but studies do show a loss of lean muscle mass in postmenopausal women. This is significant because lean muscle mass is important for burning calories. When there is less lean muscle mass, we burn fewer calories, making weight gain more likely. 
• Poor sleep -  A very common symptom of menopause, poor sleep, has also been shown to cause weight gain. This is related to an increase in hunger hormones and cravings as well as a lower energy level leading to reduced interest in physical activity. 
• Changes in mood - Studies show that women going through menopause are at a higher risk for depressive symptoms. Depression has been associated with elevated body weight, and emotions affect what we eat, why we eat, our physical activity level, and our sleep, all of which can adversely affect our weight. 
• Medication side effect - Medications such as selective serotonin reuptake inhibitors (SSRIs) and beta blockers, which are often used to help with hot flashes, night sweats, and changes in mood, have weight gain as a potential side effect. There are options that are less likely to cause weight gain though, so review this with your healthcare provider if you are considering medication to help with menopausal symptoms. 
• Diet and physical activity - While not specific to menopause, a high calorie diet and limited physical activity are often contributing factors to weight gain during midlife. Studies have specifically identified decreases in non-exercise physical activity such as walking, standing, and other activities of daily living as being a primary contributor to menopausal weight gain. While these activities may not seem like much on their own, they do add up to burn calories.

How much weight do you gain during menopause?

This is going to vary significantly from person to person as it depends on a number of factors including genetics and lifestyle. Some studies suggest that women gain an average of 1 pound per year during menopause with about 20% of women gaining 10 pounds or more. But weight gain during menopause isn’t inevitable. There are studies to show that women who participate in a lifestyle intervention program with attention to caloric intake and regular physical activity during the menopausal transition can prevent the typical weight gain experienced during this time. 

Would taking hormones help with menopausal weight gain?

Possibly. Recent studies suggest that hormone replacement therapy (HRT) initiated early in menopause is associated with less weight gain and specifically, less weight gain in the midsection when compared to women not taking HRT. This is in contradiction to earlier studies from the 90’s which showed no effect or even some weight gain as a result of oral HRT. It should also be taken into consideration that most of this data on HRT and body weight is from women who do not already have overweight or obesity, so this research may not apply to women with excess body weight. At the end of the day, it’s best to have a thorough discussion about HRT risks and benefits with your healthcare provider if this is a treatment option you’re considering for menopausal symptoms.

Is it possible to lose weight after gaining weight in menopause?

It may feel more difficult to lose weight during and after menopause, but there are studies to prove that it can be done! Consider these tips: 

Top 5 tips to lose weight gained during menopause

1. Increase physical activity level. 

Increasing physical activity level is a key component of any weight loss program, but it is especially important during and after menopause given that this appears to be a key driver of weight gained during this time of life. Additionally, regular resistance exercise can help to prevent some of the loss of lean muscle mass that occurs. Aim to get 150-300 minutes of moderate-intensity physical activity per week, but keep in mind that even some activity is better than none.  

2. Follow a reduced-calorie, healthy diet. 

There is no best diet for weight loss, but effective weight loss programs consistently have one thing in common: reduced calorie intake. The key is to find a way to do this that feels sustainable for you versus just another fad diet. Additionally, studies show that eating more fruits, vegetables, whole grains, and healthy fats and fewer foods with added sugar and saturated fat (such as the Mediterranean Diet) can help with weight loss while also reducing cardiovascular disease risk and improving menopausal symptoms. 

3. Get adequate sleep. 

This can be challenging as hot flashes are a very common symptom of menopause and freqeuently disrupt sleep, but there are some things you can do. For one, physical activity has been shown to improve sleep quality in postmenopausal women and there are no side effects to getting more exercise. If that’s not enough, talk to your doctor about other options. They can also screen you for a condition called sleep apnea, which has been associated with weight gain and aging as well as poor sleep quality. 

4. Seek out professional assistance. 

Group and individual sessions with a trained professional, whether in-person or online, have been shown to help with adherence to a diet and exercise program with improved weight loss outcomes. Seeking assistance from a Registered Dietitian or medical provider with regular follow-up can be effective for helping you to shed the pounds and keep them off. 

5. Consider the use of weight loss medication. 

If you haven’t been successful with diet and exercise alone, it may be time to consider weight loss medication. FDA-approved prescription weight loss medications decrease appetite and cravings to help you stick to a reduced-calorie diet. Medications are not appropriate for everyone, though, so be sure to discuss this with your healthcare provider or a doctor that specializes in weight management. 

How Form Health can help you lose weight gained during menopause 

For women going through menopause, weight gain can often be a frustrating part of the process. Form medical experts can help by using research-backed tools to help you lose weight and improve your overall health. Our insurance-covered medical weight loss program gives you the tools to help you lose weight and keep it off during your next stage of life. Our Board Certified Doctors and Registered Dietitians will create a personalized weight loss plan that includes nutrition, physical activity, mindset shifts and FDA-approved medication, if appropriate. The program is delivered entirely through the Form Health app which allows patients unlimited, frequent communication with their care team via video visits and messaging, weight and food tracking, and access to educational content.

If you are looking for an online weight loss doctor who can help you lose weight you’ve gained during menopause, Form Healths medical weight loss program may be right for you. Get started today by taking our quiz to see if medical weight loss is right for you.