As a board-certified obesity medicine physician, one of the most common questions that I’ve heard from women in their mid-life is that despite eating the same way and sticking to their workout routine, they are still gaining weight, especially around their belly.
The answer, more often, lies in the significant hormonal shift that women experience in their 40s and beyond. This phase of a woman’s life is marked by the gradual end of the menstrual cycle, a transition that happens in three phases: perimenopause, menopause, and postmenopause.
This stage in their lifecycle is marked by a sharp fluctuation in key reproductive hormones—estrogen and progesterone, which in turn affect the way the body stores fat, processes food, and maintains muscle mass.
Let’s know about these three phases and how they lead to weight gain:
Perimenopause – The Transition Phase
Perimenopause is the transitional phase that leads up to menopause. It can start as early as your mid-30s, but more commonly begins in your 40s and can last anywhere from a few years to over a decade.
During this time, estrogen and progesterone levels begin to fluctuate unpredictably. These fluctuations cause irregular periods, hot flashes, mood swings, sleep disturbance, and significant changes in weight.
During this phase, the progesterone levels go down, which leads to water retention and bloating.
There’s a significant fluctuation in estrogen levels. This affects fat deposition in the body, often redirecting it from the hips and thighs to the abdomen.
Cortisol (the stress hormone) rises due to poor sleep or increased anxiety, which can further encourage abdominal fat storage.
Insulin resistance begins to develop in some women, making it harder to process sugars and starches.
As a result, you start gaining weight even when you’re doing all things “right”.
Menopause: The Turning Point
A woman is said to be officially in her menopause when she goes without a menstrual period for 12 consecutive months. The average age for menopause in the U.S. is 51, though it can vary widely.
At this stage, estrogen levels drop significantly and cause changes in the body composition.
- The muscle mass declines
- Fat distribution shifts from hips and thighs to the abdominal region (and you get what is commonly known as “menopausal belly”).
- Appetite hormones like ghrelin and leptin become imbalanced, leading to an increase in hunger and cravings.
- Mood changes reduce your motivation to exercise or eat well.
Menopause doesn’t just slow you down – it rewires the systems that used to help you stay fit.
Post Menopause: The New Normal
Post Menopause is the phase following menopause. It lasts for the rest of your life. While the intense hormonal fluctuations have passed, its effects continue for the rest of your life.
In their postmenopausal phase, many women notice:
- Stubborn weight gain that just refuses to go.
- Joint pain or reduced mobility, which may limit their activity.
- Slower metabolism due to decreased muscle mass and thyroid changes.
- Increased risk for insulin resistance, Type 2 diabetes, and cardiovascular disease.
How to Manage Weight During This Phase?
While hormonal changes are out of your control, how you respond to them isn’t. In fact, many women have successfully lost weight during menopause and regained their health post-menopause with a customized weight loss diet and exercise routine.
Here are some science-backed, menopause weight loss strategies that you can follow to navigate weight gain during this phase:
1. Add More Protein to Your Diet
Loss of muscle mass is a major culprit in slowed metabolism. To make up for the loss, eat enough protein. Aim for 1.0–1.2 grams of protein per kilogram of body weight. This will help you preserve lean muscle, boost your metabolic rate, and improve insulin sensitivity.
2. Strength Train Regularly
As we age, especially during and after menopause, we naturally lose muscle mass. That’s why strength training becomes even more critical. Incorporate resistance exercises into your routine. Lift weights, enjoy bodyweight exercises (squats, lunges, push-ups), or exercise with resistance bands at least 2–3 times per week. Strength training will not only help you preserve muscles, it will also enhance your bone health.
3. Balance Blood Sugar
Hormonal shifts increase your sensitivity to carbs. Choose complex carbs (like whole grains, legumes, and vegetables) over refined ones, and pair them with protein and healthy fats to minimize blood sugar spikes. Also monitor your fasting insulin or HbA1C levels if you suspect insulin resistance.
4. Monitor Your Sleep Pattern
Lack of sleep affects every hormone in your body, right from cortisol to ghrelin to insulin. To manage them effectively, aim for 7–9 hours of restful sleep. Limit your caffeine intake in the afternoon, avoid screens before bed, and create a relaxing bedtime routine.
5. Manage Stress Mindfully
Chronic stress during midlife is common. It leads to weight gain. To reduce stress and improve hormonal balance, practice yoga, meditation, deep breathing, or small strolls in nature.
6. Don’t Overdo Cardio
While cardio is important, too much (especially when combined with a low-calorie diet) can backfire during menopause as it increases cortisol levels in the body. Instead of focusing on cardio, mix it with strength training and low-impact activities like walking or swimming.
7. Monitor Thyroid Levels
Thyroid function often declines with age. Symptoms of hypothyroidism include fatigue, weight gain, dry skin, and constipation. They can overlap with menopause. That’s why it is important to monitor your TSH, Free T3, and Free T4 levels to ensure thyroid fluctuations are not inhibiting your weight loss efforts.
Bottom Line
Weight gain during menopause is common, but with the right strategies and some expert help, you can easily keep it off. Seek support and guidance from a board-certified obesity medicine physician like Dr. Mona Lala. With the right support, lifestyle adjustments, and sometimes medical intervention/ hormonal therapies, you can lose weight, regain energy, and feel confident in your skin again.
Listen to your body, be patient with yourself, and contact our weight loss doctor for expert help. Remember, every woman’s journey is unique, and so should be your weight loss plan.
