In today’s post, we’re covering weight and body changes that can occur during the menopause transition. I discuss why weight can change and why dieting is not the solution to weight gain. I also share some ideas to consider for improving health during menopause.
First, let’s acknowledge that it is normal for bodies to change across the lifespan – including midlife. Our physiology changes as we age, so it makes sense that we would see a change in our bodies as a result.
I’m turning 40 this year, and I’ve already started to notice many changes to my body. There’s more fat on it, my skin is less elastic, and holy crap, the bloating.
Sadly, we live in a society that praises thinness and equates it to health. And God forbid a woman age anything but gracefully. (P.S. have you ever heard anyone say, Wow! That dude has aged so gracefully. Still with the double standards… I digress.)
Still, if you grew up in the 80s and 90s during the low-fat Jenny Craig era (diet culture’s coming-of-age), it makes sense that you might not be feeling so great about how your body is changing in midlife. And it happens quickly too – like almost overnight, it seems.
You might be reading this, hoping for a dietitian’s secret to weight loss during menopause.
You might be reading this to understand why your body is changing or how you can focus on your health during midlife. And, you’re probably hoping that in making changes to your health, you’ll lose a bit of weight in the process.
I get it. It’s okay to want to lose weight. I’m not here to judge or tell you what you should or shouldn’t do with your body.
I’m also not here to tell you how to avoid getting a “menopot” (which is an insulting and made-up phrase that doesn’t mean anything). Or stop the dreaded “middle-age spread” (equally insulting).
I’m here to help you understand why menopause may change your weight and shape and how the menopause transition can affect your health.
I’ll also share some things for you to consider trying to help improve your health and quality of life during this transformative time. As always, any changes that you make to your health behaviours will result in one of three weight outcomes: it’ll stay the same, go up, or go down. I can’t predict what it will be for you. No one can.
Now, let’s get into it, shall we?
Does menopause cause weight gain?
For menopause to cause weight gain, there would need to be a change in physiology that drives this change. And there is plenty of change happening during menopause! At the root of these changes are hormone shifts.
The main female sex hormones that affect the transition are estrogen and progesterone. It was once thought that estrogen declined steadily in a linear fashion, but we now know that isn’t true. Instead, estrogen levels fluctuate and eventually fall until the ovaries produce a minimal amount.
Progesterone will decline more steadily throughout the transition. Of course, there are other hormonal effects too, but we’ll try to keep things simple and focus on these two.
Hormone imbalance is the hallmark of the menopause transition. Estrogen may be high or low relative to progesterone. This can temporarily affect weight, which we will discuss shortly. The decline in estrogen at menopause will also play a role in weight and body composition.
Female-sex hormones can temporarily affect weight
Estrogen’s primary role is to promote the health of female reproductive organs, but it has many other functions. It helps preserve bone mass, is protective of heart health, and can cause fluid retention. Progesterone’s primary role is to prepare the uterine lining for pregnancy. It can also act as a natural diuretic.
During the transition, when hormones fluctuate, there may be temporary effects on weight. For example, if estrogen levels are high relative to progesterone, water retention might contribute to a higher weight. Remember the bloating? It’s normal to see fluctuations in weight throughout your menstrual cycle due to these hormonal shifts. As you progress through the menopause transition, bloating may last longer or be more frequent, depending on what is happening with your hormone levels.
Menopause appears to change body composition and body shape
A study reviewing weight changes in menopause noted that it is challenging to tease out changes resulting from ageing versus those attributed to the menopause transition. Studies that separated the two show menopause can increase adipose tissue (fat) by ~5% of body weight and decrease lean tissue (namely, muscle and bone) by a similar amount. According to these studies, this results in no net change of weight. Essentially, fat mass replaces lean tissue. It seems as though the hormonal changes in menopause contribute to accelerated gains in fat mass and corresponding losses of lean tissue that also occur with ageing.
We also have evidence from hormone therapy studies to suggest that estrogen affects body composition and benefits health. Research shows that estrogen hormone therapy decreases fat mass in younger postmenopausal women (50-59). It can also improve bone mineral density and preserve muscle and bone tissues.
Other studies that investigate weight changes in menopause show it is common for weight gain to occur and that various factors contribute. Psychological factors like depression, eating patterns, and poor sleep are a few examples.
Progesterone also helps promote relaxation and restful sleep. Low progesterone levels may contribute to poor quality sleep. In addition, estrogen fluctuations contribute to hot flushes, further disrupting sleep. We know that poor sleep is associated with weight gain. Lack of sleep can interfere with the normal function of hunger and satiety hormones, increasing appetite.
If anything, the research shows what we already know:
- Life is freaking busy during middle age
- It’s normal for bodies to change
- Weight is complex and nuanced
And, there’s more to the story: weight is an outcome of many factors
Regardless of life stage, a person’s weight is determined by many factors. Genetics will play the most significant role in deciding what weight range our bodies naturally fall into. How much our bodies resist intentional attempts to change our weight is also largely due to genetics. Some people notice weight changes highly coincide with food intake and exercise changes. Others don’t. This is an example of genetic diversity. It’s normal for humans to come in a wide range of shapes and sizes. It’s our culture that tells us otherwise.
Ageing is another factor independent of menopause. Again, this makes assessing the research regarding weight and menopause more challenging. Our metabolism slows as we age, meaning that at rest, our bodies don’t require as much fuel to maintain normal physiological processes. Research from the SWAN study demonstrates that menopause itself is not likely to cause weight gain. Instead, it’s ageing that contributes.
Stress and the stress response also impact weight. In particular, adverse childhood events and ongoing exposure to stress increase cortisol and can lead to weight gain and metabolic changes at any age. For some, the menopause transition can be incredibly stressful.
Dieting history is often overlooked as a contributor and rarely assessed in studies that examine weight. When we look at the research investigating weight cycling (aka yo-yo dieting), we see that dieting history can contribute to overall weight gain in the long run. It is also linked to an increased risk of heart disease, independent of weight.
Sleep and medications also play a role. Chronic sleep deprivation is correlated with higher weight, and some drugs alter metabolism and can either increase or decrease appetite.
One study found that alcohol and exercise were more strongly correlated to weight changes than hormonal changes.
These are a few examples of the different factors that can affect weight. It’s important to recognize that every individual is different. These factors may or may not be within a person’s control or desire to change depending on circumstances.
Does weight change in menopause affect health?
This is the question at the root of many of my clients’ concerns about weight. And the answer is, it depends.
Fat tissue is metabolically active, so it can affect your health – either positively or negatively. Subcutaneous fat appears to be protective of health, and we see this type of fat in female-sex type fat deposits. They are found on the butt and thighs. Fat stored in these areas release insulin-sensitizing molecules as well as compounds that help to lower the number of fatty acids found in the blood. Together, these actions have protective cardiometabolic effects.
Conversely, visceral fat, located around the midsection and liver, is associated with adverse health outcomes, such as increased blood pressure, fasting glucose, and dyslipidemia. Research shows that visceral fat releases more fatty acids and more pro-inflammatory signalling compounds compared to other types of fat. This is one reason for increased cardiometabolic health risk.
Our bodies change shape during menopause
Fat appears to be redistributed from the butt and thighs to the midsection during perimenopause. But, and this is an important distinction to make, we don’t know whether or not this fat redistribution contributes to metabolic disease or if it is a marker of underlying mechanisms in the process.
We also don’t know the threshold for each individual regarding how much excess fat tissue would have metabolic effects. It is highly individualized, and likely genetics play a significant role here. Further, weight loss or fat loss does not guarantee positive health outcomes. We are talking about associations and changes to an individual’s risk – not absolutes.
We do know that independent of weight, the menopause transition comes with changes to our heart, bone and brain health. Perhaps, efforts are better focused on improving these areas of health, regardless of where our weight lands.
Will dieting help me lose weight in menopause?
It’s not a secret anymore: diets don’t work.
Sure, in the short term, maybe you might lose some weight from going on a diet. In the long-term, research tells us that you’re probably not going to sustain those losses, and there’s a chance of weight regain.
Many fail to consider that dieting is not a benign act. There are risks to assess and evaluate against any potential benefit from weight loss. The first is that weight loss is not a guarantee for improved health. Yes, some research suggests that modest weight loss may reduce adverse health risks. Still, we don’t honestly know how much of this is due to weight loss or the behaviour changes that resulted in weight loss. Some research suggests that higher weights can be protective of health, particularly in older adults.
Weight stigma is harmful to health
For some folks, it’s not so much the weight itself that is problematic – it’s being a person in a larger body. The Fat Doctor highlights this brilliantly in her article on weight-inclusive care (a must-read).
Weight stigma is when people are assumed to be lazy, lack willpower, or are in poor health based on their body size. Sadly, people in larger bodies are treated differently by society and our health care system. And in ways that harm their health. Weight stigma is linked to increased all-cause mortality, increased disordered eating, alcohol consumption, and sleep disturbance.
Focus on health and well-being instead of weight
Since so many factors influence weight, why reduce our health to a single number on the scale? Our weight is simply a reflection of the effects of gravity.
Yes, menopause may change our weight, and there is an opportunity to change our relationship with our bodies and how we view health.
Rather than focus on weight, focus on changing health behaviours to improve health. Weight will settle at a comfortable place when we are doing this.
Health behaviour changes to consider
- If you smoke (nicotine), consider quitting. In addition to causing cancer and contributing to lung disease, heart disease, stroke, and diabetes, smoking increases the risk of early menopause. Early menopause increases the risk for heart disease, osteoporosis and mood disorders.
- Look for ways to add movement or continue making it a regular part of your life. Physical activity improves cardiovascular fitness and reduces all-cause mortality, regardless of BMI or weight. Weight-bearing exercise can reduce rates of osteoporosis, cancer, and cognitive decline. It’s also a great stress buster and can help to combat menopause-related fatigue.
- Speaking of sleep – can you work to improve your sleep hygiene? In addition to poor quality sleep affecting our hunger and satiety hormones, it also impairs cognition. Sleep deprivation is linked to higher blood pressure, atherosclerosis, and type 2 diabetes. If you experience hot flashes that interfere with your sleep, consider talking to your doctor about menopause hormone therapy. You may be able to reduce their impact on getting enough rest.
- Work towards an eating pattern that you enjoy and feels good. Look for opportunities to add in foods that support brain, bone, and heart health. These include vegetables, fruits, whole grains, fats from nuts and seeds and protein from beans, legumes, fish, poultry, eggs, and meat. There’s no special ‘menopause diet,’ and these foods can be enjoyed as part of all types of cuisines.
- Can you reduce stress or find healthy ways to manage it? Engaging in regular activity and nourishing your body well can help. You can also look to mindfulness practices, setting healthy boundaries, or working with a therapist.
- Finally, attend regular medical appointments and health screenings if you are able. This can be more challenging for those who live in rural communities or those in larger and/or racialized bodies who don’t have access to safe medical care.
Consider a weight-inclusive approach
I take a weight-inclusive approach to health in my practice. This means I accept that body size diversity is normal. It’s normal for people to be fat and normal for people to be thin. Just as it’s normal for people to be short and normal for people to be tall. I work with clients who are most interested in improving health behaviours above all else. Many still desire weight loss, and that’s okay.
Rather than focus on weight loss as the primary goal, we focus on gentle nutrition, stress management, sleep hygiene, and movement. I also work with folks to heal their relationship with food. I can’t predict what will happen to people’s bodies when they change health behaviours. Weight may or may not change, but health and quality of life can be improved.
Your Body, Your Decision
It’s not up to me to tell you what you should or shouldn’t do with your body. However, it’s helpful to understand the potential harms and benefits of engaging in or stopping particular health behaviours. I hope I was able to provide some information here to that end.
I also acknowledge that it’s not easy to live in our society when in a larger body. Weight stigma is wrong and harmful, and it’s not something I’ve experienced first-hand. I have the privilege of living in a straight-sized, white, cis-gendered body. I know that experiencing the world outside of this privilege can play a significant role in the decision to pursue weight loss and the ability to access safe healthcare.
If intentional weight loss is your ultimate goal, it is essential to find a practitioner who is supportive, compassionate, and knowledgeable in the complexities of weight management. Typically, the amount of weight loss that a person might sustain over the long term is far less than what is desired. It’s important to have honest conversations in a safe space to be fully informed when making any decision about your weight or your health.
Bottom Line: Menopause is an opportunity to focus on health
The truth is some women might gain weight, others might not. Likely, your body shape will change. And effects of these changes on your health will depend on your health status going into the menopause transition and your ability to access healthcare. Remember, your worth is not determined by your weight – neither is your health.
It’s unhelpful to blame and shame and use fear-based language, like “menopot” and “middle-aged spread.” This perpetuates weight stigma and fatphobia and doesn’t help people focus on health change. It’s also unhelpful to shame people who want to lose weight.
You may find that unresolved body image and food relationship issues come to the forefront during this time. This makes sense, given society’s general response to menopause. Working with a therapist for support with these issues can be helpful.
You deserve to feel your best and pursue health in a way that works for you.
Thank you to UBC Food, Nutrition, and Health Student Victoria Fung for her help with finding and reviewing research articles for this post.
