Why Does Weight Gain Happen During Menopause? What Science Tells Us
- Alastair Hunt
- Jun 7
- 12 min read
Updated: 5 days ago
Weight gain in midlife is often one of the most frustrating and confusing challenges for women. It can feel as though the scales start tipping in the wrong direction almost overnight. While lifestyle habits like diet and physical activity play a part, new evidence from the American Heart Association reveals that the menopause transition itself can be a key driver. This isn't just about calories in and out - hormonal shifts, fat distribution and changes in muscle mass are at the heart of it. And, interestingly, slowing metabolism is not.
Contributing to our article we have Dr. Tashiya Mirando and Felicia Koh, MA Human Nutrition. Tashiya is a Family Physician and the Menopause Lead & Lifestyle Medicine Co-Lead at Osler Health International (Singapore), passionately advocating for women's healthy longevity across the ages. Felicia is an SNDA accredited nutritionist, TCM trained lifestyle health advocate and co-founder of The Whole Health Practice.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to relevant studies and resources at bottom of page.
Menopause and Midlife Weight Gain: What’s Really Going On?
Many women gain about 2 to 2.3 kg (around 5 pounds) on average over a three year period in midlife. Interestingly, this increase is more closely tied to age than menopause itself when simply looking at weight. However, the story gets more complex - and more significant when we consider where that weight settles and what the body loses in exchange.
During the menopause transition, typically beginning in the mid-40s and lasting several years, women experience marked hormonal fluctuations. A central feature is a drop in oestrogen and progesterone, hormones that not only regulate reproductive health but also influences fat storage and muscle mass. Around two years before a woman's final menstrual period, the rate of fat gain doubles, while lean muscle mass begins to decline. These changes can continue for up to two years after menopause, marking a four-year window of rapid body composition change.
It's Not Just the Scales, It’s Fat Distribution
Even if the number on the scale doesn't rise dramatically, body composition is shifting. Women tend to gain more visceral fat - the type that surrounds internal organs like the liver and heart. This fat is metabolically active and is linked to higher risks of heart disease, type 2 diabetes, and inflammation.
In one study cited by the AHA, researchers used MRI imaging and found that even women who didn’t gain weight during the menopause transition had significant increases in abdominal and visceral fat. At the same time, they lost lean muscle mass. This change was independent of age, suggesting it was driven more by hormonal changes than simply getting older.
Additionally, increased paracardial fat - fat around the heart - has been observed post-menopause. This is especially concerning, as this type of fat can directly influence heart function and increase cardiovascular risk.
Why Hormones Matter
Oestrogen helps regulate where the body stores fat. When levels drop during the menopause transition, fat tends to shift from the hips and thighs to the abdomen. This “apple-shaped” body pattern is more closely linked with heart disease and insulin resistance.
Another key player is follicle-stimulating hormone, which rises as oestrogen drops. This is because oestrogen normally inhibits FSH via negative feedback in the hypothalamus-pituitary-ovarian axis. Though its exact role in fat distribution is still being studied, it's part of the broader hormonal shift that drives these metabolic changes.
Says Tashiya "Menopause doesn’t just change your periods, it rewires your metabolism. The drop in oestrogen shifts fat storage from your hips to your abdomen, increasing visceral fat even if the scale doesn’t budge. This isn’t ‘stubborn weight’ - it’s biology."
In short, it’s not just about eating more or exercising less - menopause rewires the body's metabolic map.
A Knock-On Effect on Cardiometabolic Health
This change in fat distribution coincides with other risk factors. Around menopause, levels of LDL cholesterol and apolipoprotein B (ApoB - a key indicator of heart disease risk) rise sharply, while protective HDL cholesterol becomes less effective. These changes are largely driven by the decline in oestrogen, which normally helps the liver clear LDL from the blood and supports HDL in its cholesterol-removal role.
As oestrogen falls, LDL increases, HDL function weakens, and ApoB levels rise - all of which raise cardiovascular risk, even in women whose weight hasn’t changed dramatically.
Debunking the Metabolism Myth
A common belief is that weight gain during menopause happens because our metabolism slows down. But a landmark 2021 study led by Dr Herman Pontzer, published in Science, found otherwise. The research, which analysed data from over 6,600 people worldwide, showed that metabolism - the rate at which we burn calories - remains remarkably stable from our 20s through our 50s.
This chart shows how energy expenditure - both total and basal (at rest) - changes with age when adjusted for body size. Energy use peaks in infancy, reaching about 150% of adult levels by age one, then gradually declines to adult levels around age 20. It remains steady through midlife and declines again from around age 60.
Dr. Tashiya points out that "The 2021 Pontzer study debunked a major myth: Your metabolism doesn’t slow down in midlife. The real culprit? Muscle loss. For every decade after 30, women lose 3 to 5% of muscle mass, unless they actively preserve it."
Could it be the Thyroid?
Another layer to consider in the midlife weight story is thyroid health. Thyroid disorders - especially hypothyroidism - are more common in women and tend to appear or worsen around midlife, often overlapping with the menopause transition. This can make diagnosis challenging, as symptoms like fatigue, mood changes, and weight fluctuations are easily mistaken for menopause-related effects. An underactive thyroid slows down metabolic processes, which may lead to weight gain, fluid retention, and increased fatigue - further compounding the physical and emotional challenges already present in perimenopause and menopause.
Emerging research suggests that the drop in oestrogen during menopause may influence how thyroid hormones are produced and used by the body. While the average weight gain from hypothyroidism is modest (often 2 to 5 kg), the combination of hormonal shifts and muscle loss can magnify its impact. Women experiencing stubborn weight gain, low energy, or brain fog during menopause should consider a full thyroid panel, including TSH, Free T4, and potentially Free T3 and thyroid antibodies, to rule out or manage a concurrent thyroid issue. Proper diagnosis and treatment can make a substantial difference - not only in weight regulation but also in mood, energy levels, and overall wellbeing.
Dr. Tashiya advises that research shows 5 to 20% of midlife women have undiagnosed thyroid dysfunction. Notably, a simple blood test (TSH, Free T4, Free T3 +/- Thyroid Antibodies) can reveal if you are part of that group.
Insights from the Mayo Clinic Review
The 2017 review by Kapoor et al., published in Mayo Clinic Proceedings, further elaborates on the multifaceted nature of weight gain in midlife women. The authors highlight that while aging contributes to weight gain, menopause specifically leads to an increase in central fat distribution. This shift is associated with heightened risks of cardiovascular disease, type 2 diabetes and certain cancers.
Moreover, the review emphasises that menopausal symptoms such as sleep disturbances, mood disorders, and vasomotor symptoms can hinder the adoption of healthy lifestyle measures. Addressing these symptoms is crucial for effective weight management. For instance, disrupted sleep due to night sweats or insomnia can lead to daytime fatigue, lowering motivation for physical activity and increasing cravings for high-calorie foods. Similarly, depression or anxiety may reduce the likelihood of sustained dietary or exercise efforts. These symptoms often interact, creating a cycle that leads to weight gain and makes weight loss even harder.
Comprehensive care that includes medical support, counselling and, when appropriate, hormone therapy, can help break this cycle and support long-term success with lifestyle change.
What Can You Do? Practical Steps to Take
The good news is that although the hormonal landscape changes, lifestyle holds the key - and it can make a real difference.
1. Stay Active. Regular physical activity helps preserve muscle mass and prevent fat gain, particularly around the abdomen. Aim for at least 150 minutes of moderate-intensity aerobic activity per week, plus strength training twice a week to maintain muscle.
2. Watch Your Waist, Not Just Your Weight:. A healthy BMI is important, but waist-to-hip and waist-to-height ratios (an indicator of visceral fat) can be even better indicator of health risks in midlife women. Subcutaneous fat, stored under the skin - especially around the hips and thighs - is less harmful than visceral fat because it’s more metabolically stable and produces fewer inflammatory substances. Unlike visceral fat, which surrounds organs and raises disease risk, subcutaneous fat may even offer mild protective effects by safely storing excess energy and supporting hormone balance after menopause. Learn more on the waist-to-height ratio here.
3. Eat for Metabolic Health. Focus on a Mediterranean ot traditional Asian style diet rich in vegetables, whole grains, lean proteins (especially fish) and healthy fats like olive oil. Limit processed foods, sugar and saturated fats. This approach helps control insulin levels and supports heart health.
A 2020 Italian study (Lombardo et al) evaluated whether menopausal women could lose fat mass and maintain muscle mass on a lower calorie Mediterranean diet without structured exercise. Eighty-nine overweight or obese women over age 45 followed an individually tailored, calorie-restricted Mediterranean diet for eight weeks. Participants were split into two groups: those in menopause and those still menstruating. All showed significant improvements in fat mass, waist circumference, and blood pressure, with no major difference between groups. Notably, menopausal women had a greater reduction in LDL cholesterol.
A key finding was that a higher plant-to-animal protein ratio positively correlated with the preservation of fat-free mass, especially in the menopausal group. This supports the value of plant-based protein within the Mediterranean diet. The results reinforce that a traditional Mediterranean eating pattern can be effective for fat loss and metabolic health during menopause, even with minimal exercise. However, the authors note that physical activity may be necessary to optimise long-term body composition.
When it comes to Asian cuisine, Felicia adds that “Soy is a plant protein that is nutrient dense and calorie light as compared to animal proteins. Soy consumption can also help alleviate menopause symptoms. Soy is safe - although I still come across women who think it is unsafe to consume - and can provide benefits to women in peri or postmenopause. Soy is heart healthy, osteoprotective and has anti-cancer properties."
In Asia, higher consumption of soy - especially in Chinese, Korean and Japanese women - has been linked to significantly lower incidences of hot flushes (10 to 20%) when compared to women in the West (60 to 90%).”
4. Don’t Skip Strength Training. Lifting weights or doing resistance exercises helps counter the loss of lean muscle that comes with hormonal changes, these need to be prioritised. More muscle means a faster metabolism and better blood sugar control.
5. Prioritise Sleep and Stress Reduction. Sleep disturbances increase during menopause and are associated with weight gain and poorer metabolic outcomes. Good sleep hygiene and mindfulness-based practices can be valuable tools.
Final Thoughts
Weight gain during menopause isn’t just about lifestyle - it is also driven by hormonal changes that reshape body composition and raise cardiovascular risk. Recognising this shift removes guilt and empowers action.
With targeted lifestyle strategies, taking action for their health, women can protect their hearts, manage weight and feel more in control. This is a pivotal window for prevention - and it’s never too late to begin.
Whether your interest is weight loss, healthspan and longevity, to beat chronic illness or to enhance your mental health and well-being, our consultations and programs deliver results that are tailored to your needs.
FOUNDATIONS - our premier whole person health consult - identifies and prioritises the key factors, known and unknown, that affect health and wellbeing. It provides targeted recommendations tailored to you, the individual, and your unique lifestyle.
Stay Healthy,
Alastair
Join us, or scroll down to contact us and learn more about our services:
Achieve your Health Goals
Our health, physical – mental – social - is complex and affected by multiple factors within and outside of your control. Our consults and programmes address the whole person, the root causes of ill health and maximising your health, performance & vitality.
Take the first step. Contact us to arrange an introductory call, to discuss how we can support your journey to health. We are based in Singapore and work with clients globally.
Book a Foundations Consult to assess, identify and prioritise key factors (known and unknown) that affect your health. And receive personalised recommendations on how to address them.
Want to put recommendations into action? Learn more about our programmes for individuals or teams.
Achieve your Health Goals
Our health, physical – mental – social - is complex and affected by multiple factors within and outside of your control. Our consults and programmes address the whole person, the root causes of ill health and maximising your health, performance & vitality.
Take the first step. Contact us to arrange an introductory call, to discuss how we can support your journey to health. We are based in Singapore and work with clients globally.
Book a Whole Health Consult to assess, identify and prioritise key factors (known and unknown) that affect your health. And receive personalised recommendations on how to address them.
Want to put recommendations into action? Learn more about our programmes for individuals or teams.
Related Studies and Resources
Meet: Dr. Tashiya Mirando and Felicia Koh
SingHealth: Menopause and Thyroid Disorders
British Thyroid Foundation Thyroid and menopause
Mintziori G, Veneti S, Poppe K, Goulis DG, Armeni E, Erel CT, Fistonić I, Hillard T, Hirschberg AL, Meczekalski B, Mendoza N, Mueck AO, Simoncini T, Stute P, van Dijken D, Rees M, Duntas L, Lambrinoudaki I. EMAS position statement: Thyroid disease and menopause. Maturitas. 2024 Jul;185:107991. doi: 10.1016/j.maturitas.2024.107991. Epub 2024 Apr 24. PMID: 38658290.
Logan S, Wong BWX, Tan JHI, Kramer MS, Yong EL. Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women's Health Programme (IWHP). Maturitas. 2023 Dec;178:107853. doi: 10.1016/j.maturitas.2023.107853. Epub 2023 Oct 6. PMID: 37806008.
Chen LR, Chen KH. Utilization of Isoflavones in Soybeans for Women with Menopausal Syndrome: An Overview. Int J Mol Sci. 2021 Mar 22;22(6):3212. doi: 10.3390/ijms22063212. PMID: 33809928; PMCID: PMC8004126.
Pontzer H, Yamada Y, Sagayama H, Ainslie PN, Andersen LF, Anderson LJ, Arab L, Baddou I, Bedu-Addo K, Blaak EE, Blanc S, Bonomi AG, Bouten CVC, Bovet P, Buchowski MS, Butte NF, Camps SG, Close GL, Cooper JA, Cooper R, Das SK, Dugas LR, Ekelund U, Entringer S, Forrester T, Fudge BW, Goris AH, Gurven M, Hambly C, El Hamdouchi A, Hoos MB, Hu S, Joonas N, Joosen AM, Katzmarzyk P, Kempen KP, Kimura M, Kraus WE, Kushner RF, Lambert EV, Leonard WR, Lessan N, Martin C, Medin AC, Meijer EP, Morehen JC, Morton JP, Neuhouser ML, Nicklas TA, Ojiambo RM, Pietiläinen KH, Pitsiladis YP, Plange-Rhule J, Plasqui G, Prentice RL, Rabinovich RA, Racette SB, Raichlen DA, Ravussin E, Reynolds RM, Roberts SB, Schuit AJ, Sjödin AM, Stice E, Urlacher SS, Valenti G, Van Etten LM, Van Mil EA, Wells JCK, Wilson G, Wood BM, Yanovski J, Yoshida T, Zhang X, Murphy-Alford AJ, Loechl C, Luke AH, Rood J, Schoeller DA, Westerterp KR, Wong WW, Speakman JR; IAEA DLW Database Consortium. Daily energy expenditure through the human life course. Science. 2021 Aug 13;373(6556):808-812. doi: 10.1126/science.abe5017. PMID: 34385400; PMCID: PMC8370708.
Abildgaard, J., Ploug, T., Al-Saoudi, E. et al. Changes in abdominal subcutaneous adipose tissue phenotype following menopause is associated with increased visceral fat mass. Sci Rep 11, 14750 (2021). https://doi.org/10.1038/s41598-021-94189-2
Thomson ZO, Kelly JT, Sainsbury A, Reeves MM. Weight loss outcomes in premenopausal versus postmenopausal women during behavioral weight loss interventions: a systematic review and meta-analysis. Menopause. 2020 Dec 21;28(3):337-346. doi: 10.1097/GME.0000000000001684. PMID: 33350666.
El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, Limacher MC, Manson JE, Stefanick ML, Allison MA; American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020 Dec 22;142(25):e506-e532. doi: 10.1161/CIR.0000000000000912. Epub 2020 Nov 30. PMID: 33251828.
Ko SH, Kim HS. Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients. 2020 Jan 13;12(1):202. doi: 10.3390/nu12010202. PMID: 31941004; PMCID: PMC7019719.
Lombardo M, Perrone MA, Guseva E, Aulisa G, Padua E, Bellia C, Della-Morte D, Iellamo F, Caprio M, Bellia A. Losing Weight after Menopause with Minimal Aerobic Training and Mediterranean Diet. Nutrients. 2020 Aug 17;12(8):2471. doi: 10.3390/nu12082471. PMID: 32824413; PMCID: PMC7468767.
Makarem N, St-Onge MP, Liao M, Lloyd-Jones DM, Aggarwal B. Association of sleep characteristics with cardiovascular health among women and differences by race/ethnicity and menopausal status: findings from the American Heart Association Go Red for Women Strategically Focused Research Network. Sleep Health. 2019 Oct;5(5):501-508. doi: 10.1016/j.sleh.2019.05.005. Epub 2019 Jul 10. PMID: 31302068; PMCID: PMC6801046.
Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, Cauley JA, Finkelstein JS, Jiang SF, Karlamangla AS. Changes in body composition and weight during the menopause transition. JCI Insight. 2019 Mar 7;4(5):e124865. doi: 10.1172/jci.insight.124865. PMID: 30843880; PMCID: PMC6483504.
Kapoor E, Collazo-Clavell ML, Faubion SS. Weight Gain in Women at Midlife: A Concise Review of the Pathophysiology and Strategies for Management. Mayo Clin Proc. 2017 Oct;92(10):1552-1558. doi: 10.1016/j.mayocp.2017.08.004. PMID: 28982486.
Derby CA, Crawford SL, Pasternak RC, Sowers M, Sternfeld B, Matthews KA. Lipid changes during the menopause transition in relation to age and weight: the Study of Women's Health Across the Nation. Am J Epidemiol. 2009 Jun 1;169(11):1352-61. doi: 10.1093/aje/kwp043. Epub 2009 Apr 8. PMID: 19357323; PMCID: PMC2727246.
Comments