How to Manage Weight Gain During Menopause

The transition to menopause is different for every woman. Some experience symptoms that severely affect their quality of life, such as hot flashes, night sweats and mood swings, while others don’t. There is one symptom, however, that most women experience in their 40s or 50s: weight gain.

“Even people with healthy lifestyles tend to notice some changes with their weight,” says UNC Health obstetrician-gynecologist Rachel Urrutia, MD. “They may notice that eating even a little bit extra causes weight gain or that their clothes are fitting differently than before.”

On average, women gain 5 to 10 pounds in the years before menopause, when reproductive hormones are fluctuating as the body prepares to stop ovulating.

“Weight is already such a sensitive topic,” says UNC Health obstetrician-gynecologist Katelin Zahn, MD. “Women receive toxic messages about their weight for years before menopause, so it’s upsetting to see a shift in outer appearance that doesn’t match how they’re feeling inside.”

Drs. Urrutia and Zahn share what you need to know about weight gain during menopause.

What causes menopausal weight gain?

Although many women gain weight during the years leading up to menopause, the extra pounds might not be a direct result of menopause or the hormonal changes taking place.

“It’s probably more related to aging in general,” Dr. Urrutia says. “As we age, our metabolism slows, so we may have to exercise more and eat less to maintain a certain weight. It just becomes harder to lose weight compared to when we were younger.”

In 2020, the most recent data available, only 22.7 percent of women ages 35-49 and 17.6 percent of women ages 50-64 engaged in at least 150 minutes of moderate-intensity exercise per week, as recommended by the U.S. Department of Health and Human Services.

“As they get older, women may have increased responsibilities for work and family, and those stressors can lead to limited physical activity and less adherence to healthy eating,” Dr. Zahn says.

Though the hormonal changes of menopause may not be driving the weight gain, the changes may affect how weight is stored in the body. Women tend to see the weight show up in the belly rather than the hips or thighs. This is a concern for medical professionals, as extra weight in the belly is associated with an increased risk of cardiovascular disease and diabetes.

How can I manage menopausal weight gain?

Hormone therapy can help with many of the symptoms of menopause, including hot flashes and night sweats, but it is not an approved weight-loss treatment.

“Hormone therapy won’t help with weight management, but you might indirectly benefit,” Dr. Urrutia says. “If you feel better, you might be more likely to exercise. It’s hard to work on weight loss if you’re not feeling well.”

Drs. Urrutia and Zahn say that while an extra 5 to 10 pounds can be distressing, it may not be an immediate concern if you’re in otherwise good health.

“We have to be mindful of weight, but for some people, it’s less about a number on the scale and more about the healthy practices they have,” Dr. Zahn says. “If we really look at what it means to be healthy, it’s about exercising, maintaining muscle strength, eating well and getting good sleep.”

It’s also important to give yourself some grace.

“When people are in their 40s and 50s, they learn that there are a lot of things they have to do differently,” Dr. Urrutia says. “You can’t treat the body the same as you did when you were young because it can’t bounce back as easily. Getting used to the new normal can be challenging, but it is possible to thrive there as well.”

For people who may be at increased risk of health issues due to obesity, Drs. Urrutia and Zahn recommend consulting with a dietitian or going to a medical weight-loss clinic. A specialist can offer counseling and coaching on healthy diets and sustainable goals. Obesity medicine providers also can help you consider whether weight-loss medications are appropriate.

“If you’re concerned about weight gain in menopause, make an appointment with your doctor to discuss proactive steps to take,” Dr. Zahn says. “The menopause transition should be a time to celebrate the strength and wisdom of growing older and can be an opportunity to reprioritize your health.”

Questions about menopause? Talk to your doctor. If you need a doctor, find one near you.