The Connection Between Menopause & Belly Fat

August 24, 2023

Many older women notice that they start gaining belly fat, especially in the years leading up to and following menopause.

“Like so many things related to women’s health, it’s complicated,” says Jean Marino, CNP, menopause specialist at University Hospitals. “Research tells us that the number one reason for increased belly fat is a decrease in physical activity, but for women in the menopause transition, there are almost always other factors at play, including hormonal changes, stress levels, dysfunctional sleep patterns and some medications.” Marino explains why abdominal weight gain is so common in older women and what can be done about it.

Hormonal Changes

During menopause and the years leading up to it (perimenopause), women undergo complex hormonal changes. The balance of estrogen and progesterone – which work together during the reproductive years to trigger ovulation and support pregnancy – begins to shift, with levels of both hormones dropping sharply. These changes trigger other hormonal changes that can contribute to weight gain, including:

More available testosterone. Testosterone is produced by the ovaries and adrenal glands in small amounts throughout a woman’s lifetime. When estrogen levels drop in menopause, the amount of available testosterone increases, which can trigger a redistribution of body fat, often causing accumulation in the abdominal region.
Changes in production of the hunger hormones, leptin and ghrelin. Less estrogen causes a decrease in leptin (a natural appetite suppressant) and, when sleep patterns are disrupted, an increase in ghrelin, a hormone that signals hunger and prompts the body to hold onto excess weight.

Increased Stress & Mood Swings

“During perimenopause and menopause women have a higher risk of mood changes, especially women with a prior history of anxiety, depression, PMS or postpartum depression,” says Marino. “Mood changes during this time may present differently than in premenopausal women and include symptoms of fatigue, feeling overwhelmed or lower self-esteem.”

“In addition, women at this stage of life are often dealing with significant life challenges, including children leaving home, the demands of caring for aging parents and relationship changes with a spouse or partner. The emotional and physical stress that often accompanies these changes can lead to changes in eating habits and weight gain,” she adds.

Changing Sleep Patterns

“Lower estrogen levels in menopausal women, combined with common mood disorders like anxiety and depression, may make it more difficult to fall or stay asleep and increase the risk of sleep apnea” says Marino. “Women who are not getting enough sleep feel tired the next day, are less likely to be active and more likely to reach for comfort foods – most often simple carbohydrates which can lead to weight gain.”

Medications

Certain medications often prescribed to treat depression, anxiety, hot flashes and high blood pressure can cause weight gain. These include serotonin and norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), gabapentin and beta blockers. “Sometimes you can’t get around it, but I advise women to talk to their prescribing provider about alternate medications that treat the condition but do not have weight gain as a side effect,” says Marino.

The Health Risks of Belly Fat

One of the many changes that occurs with menopause, is a tendency for subcutaneous fat (fat that is stored just beneath the skin) to convert to visceral fat. Visceral fat is stored deep within the abdominal cavity and surrounds important organs like the stomach, liver and intestines, increasing the risk of fat-related illnesses like cardiovascular disease, diabetes (due to insulin resistance) and certain types of cancer in menopausal women.

How to Battle the Belly Bulge

“There is no magic way to lose belly fat,” says Marino. “It really comes down to the basics of diet and exercise. And, it’s important to note that you don’t need to lose a lot of weight to realize health benefits. Dropping just 5-10 percent of body weight can improve your metabolic profile and reduce risk.”

Marino advises women to consider the following when trying to lose weight and improve health:

Diet. When the metabolism slows during menopause, it is important to cut back on calories to avoid weight gain. “The tricky part is to choose a diet you can stick to,” says Marino. “Ideally, it should be largely plant-based and low in fat and processed foods.”

Exercise. Increased physical activity combined with fewer calories is the best formula for weight loss at any age. Menopausal women should focus on both aerobic exercise for heart health and weight training to build lean muscle and protect bones.

Hormone Therapy. “Menopause hormone therapy (MHT) does not cause weight gain and can, in an indirect way, help with weight loss. MHT can help women sleep better, have more energy and fewer negative mood changes and less joint pain – all of which support weight loss efforts. Women who are perimenopausal, within 10 years of their last menstrual period or younger than 60 years old are usually the best candidates for hormone therapy,” says Marino.

Stress Management. Keep your stress levels under control using a combination of better nutrition, exercise and integrative health approaches, including acupuncture, meditation, yoga and massage therapy. Sometimes behavioral health counseling may also be useful.

Surgery/Medications. For women with risk factors for weight-related illness or complications, bariatric surgery or weight loss medications may be an option.

“Above all else, I encourage my patients to embrace the changes in their body and not rely on the numbers on the scale for their self-esteem,” says Marino. “Women can be really hard on themselves and our culture has very strict beauty standards – try to show yourself a little love and compassion during this new stage of life.”