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Understanding The Link Between Menopause and Weight Gain

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Dr. Michael Green
Medically Reviewed byDr. Michael GreenMD, OB/GYN Chief Medical OfficerRead Bio
Written ByWinona Editorial Team

Understanding the link between menopause and weight gain can be elusive, but we can provide you with some important answers. Most women in perimenopause and menopause are struggling with their weight on some level. Too much weight, weight in the wrong places, and/or you can’t seem to exercise enough to keep it off. Even worse, the diets and exercises that once worked, or the new ones that claim to be the panacea are often harsh and can escalate hormonal imbalances.1-4

Hormones have many jobs. With regards to your weight, hormones control your metabolism, where the fat is deposited, and your weight balance. The most effective way to get hormones back on track, halt the ever-present scale creep, and return to a healthy weight is to correct hormonal imbalances with Hormone Replacement Therapy (HRT). Once hormones are back in balance, weight maintenance and weight loss can begin.  

Menopause Weight Gain

Hormone changes at menopause and how those changes can cause weight gain are complicated. Your body’s hormones are all interconnected, and like a symphony, they should play together. Hormones must be in harmony and continually balance and rebalance in response to physical and emotional events in your life. Perimenopause and menopause are the phases of life when there can be huge swings in hormone levels. Those swings are normal, but the symptoms can be debilitating and lead to lifelong medical complications. Hormonal balance is the goal.

Menopause weight gain, or also called hormonal weight gain, is a struggle that very few talks about. Rarely do medical professionals emphasize the health risks associated with it. More likely than not, a healthcare provider will suggest that too many sweets or a decrease in exercise are the culprits. Sure, that might be part of it, but the drop in hormones at menopause plays the most important role in a woman’s transition from an hourglass body to more of an apple shape.

At age 40, most women don’t want to think about menopause, but it is their new reality. Hormones that regulate weight will shift whether you recognized the change or not. Ignoring what is happening to your body is not a method to prevent weight gain or achieve weight loss. Weight loss after 40 is possible by working with these hormonal changes which will make weight loss a reality. By understanding the true source of weight gain, you can shed excess weight and prevent further weight gain; ultimately helping you to feel happier and healthier.

Menopausal weight gain is directly related to the decrease in the production of hormones. To maintain a healthy weight, a delicate balance of all hormones is required. If certain hormones are off-kilter or reduced, weight gain often results.1,2 Hormones are simply a communication method that the body uses to tell itself what to do. If one hormone is off and can’t communicate properly, it alters other communication down the line. Even small shifts in hormone levels can have significant effects.

People often assume that menopausal weight gain is “natural,” and in some ways it is. But “natural” does not necessarily mean healthy or desirable. As women age, maintaining their usual body weight becomes more difficult. Many women gain weight during and after their menopause transition, especially around their abdomens. Some call it “belly fat,” and the medical world calls it “visceral fat.” Whatever you call it, it’s not healthy and it does NOT have to be inevitable.

Menopausal weight gain can be prevented and reversed, but it takes a proactive approach that deals with the natural decreases in the hormones estrogen, progesterone, and testosterone. During perimenopause and menopause, it can feel like the cards are stacked against maintaining a trim, healthy figure. But for long-term health, it is important to keep your body, and waistline, trim. Hormonal replacement therapy (HRT) can help do just that. Taking HRT, improving diet, and adding a few lifestyle changes can have powerful effects on weight.

Why is it so Critical to Prevent Weight Gain at Menopause?

Understanding The Link Between Menopause And Weight Gain article body

Throughout their reproductive years, women may notice weight gain around their hips and thighs. However, at peri- and menopause, women tend to gain weight around their abdomen and even upper back. This shift in where fat is deposited is due to the hormonal changes in estrogen, progesterone, and testosterone related to menopause. While the genetic factors of weight and fat distribution can’t be changed, women can control menopausal weight gain by adding back the hormones that are gradually decreasing.10 

Simply put, many women are overweight at midlife because their hormones are out of whack, and that type of weight gain is dangerous. The health implications of weight gain at menopause and visceral fat cannot be overstated.

Menopausal women who are taking HRT tend to have less body fat, especially belly or visceral fat.3 Visceral fat cells can set off inflammation and increase insulin resistance. Visceral fat gets worse with depression, stress, poor sleep, smoking, and drinking sugar-sweetened beverages. If that’s not enough, menopausal weight gain increases the risk of:

  • Cardiovascular disease

  • High blood pressure

  • Cancer – specifically colon, breast, uterine, esophageal, kidney, and pancreatic 

  • Stroke

  • Arthritis

  • Breathing problems

  • Type 2 diabetes

While those are the most threatening risks associated with menopausal weight gain, the decreased hormones and excess weight tend to lead to lowered libido, vaginal changes, reduced energy, interrupted mobility, poor self-image, and so much more.

Ways to Prevent & Reverse Menopause Weight Gain

  1. Try Hormone Replacement Therapy (HRT): Menopausal weight gain and the inability to lose weight are based on many factors. The decrease in estrogen, testosterone, and progesterone during menopause are the primary reasons. The calories in vs. the calories out model isn’t the whole story for menopausal women. Yes, calories matter. But in menopause and perimenopause, hormones matter more. Taking HRT can have powerful, positive effects on preventing weight gain and losing weight.

  2. Stop the Fatigue Due to Night Sweats: Night sweats associated with perimenopause and menopause can create an endless cycle of fatigue. It is clear that people eat more when they are tired.3 Without enough sleep, people snack more and consume more calories. When they are sleep deprived, the levels of appetite hormones (ghrelin and cortisol) actually increase.7 

    Very few people function well on less than 7 hours of sleep. Sleeping 7 to 8.5 hours every night is critical to reducing stress. If sleep is regularly disrupted, the stress hormone ‘cortisol’ increases, and weight gain likely follows. HRT has been shown to reduce night sweats more effectively than any other treatment, allowing for restful sleep, decreased anxiety, and weight loss.3 Fans, cooling pillows, and white noise machines are all great options to improve sleep.

  3. Regain Lean Muscle Mass: As people age, their muscle mass typically decreases, while fat levels increase.2 Muscles twitch constantly, which requires energy in the form of calories. When muscle mass decreases, so does your metabolism, and the number of calories you need per day. So, if you continue to eat as you always have, and don’t increase physical activity, weight gain is inevitable. 

    When muscle mass decreases with menopause, a woman can burn 500 fewer calories per day. At that rate, she would gain 1 lb. per week or 52 pounds in just one year! Starting at age 30, women will naturally lose about 1/2 pound of muscle mass per year. By 50 years of age, that can be 10 lbs. of lost muscle, and likely fat has replaced what used to be muscle.

    We know that muscle burns about 3x more calories than fat. So, if muscle mass is increased (or returned to pre-menopausal levels), losing weight can be a much more realistic goal. Working out to gain muscle can help decrease the severity of weight gain, and can assist with weight loss. Try strength training exercises at least twice a week. Supplementing with DHEA can also help build muscle again. To slow down signs of aging, it’s important to maintain or improve lean body mass since aging begins in the muscles.17

  4. Switch the Workouts: Unfortunately, the body doesn’t burn as many calories walking on the treadmill for 30 minutes at age 55 as it did at 35. The same work no longer gives the same benefit. So, it may be time to change it up. Like a lifelong swimmer who barely breathes hard after a mile-long swim, the efficiency of being good at something is great, but it burns fewer calories. Changing it up by trying new classes and challenges may help overcome a workout lull.

  5. Permit Mood & Anxiety Changes: Women in menopause have an increased rate of anxiety and depression. They just do. Societal norms still shame people away from seeking treatment for mood and anxiety changes. Suicide rates are at their highest for women in their menopause years.

    Research shows that those who suffer from depression and anxiety are more likely to gain weight over time, and become obese than those who don’t. At appropriate levels, progesterone acts as a natural antidepressant and can enhance mood and relieve anxiety. It stimulates the ‘feel-good’ center of the brain. So, if progesterone levels drop, it is easy to understand why anxiety and depression can follow.11-17

    Progesterone starts to drop when a woman is in her 30s and the levels drop more quickly during perimenopause. Research has shown that supplementing with progesterone, helps to relieve anxiety, irritability, and nervous tension.17,18,19 Progesterone appears to be the most potent anti-anxiety hormone for menopausal women; these positive progesterone vibes can help with weight loss.

  6. Tune In To Taste Expectations: There are four basic tastes on the human palate: sweet, sour, bitter, and salty. The ability to actually sense these tastes is influenced by blood hormone levels. Who would have thought that hormones are going to help taste your food? But it’s true, your sensitivity to tastes changes with menopause. The ability to taste sweet decreases when estrogen levels drop and the sensitivity to bitter tastes decreases with lowering progesterone. Both of these hormones drop precipitously with menopause. So, our ability to taste decreases with age.

    Each human is born with nearly 10k taste buds, but as women age, the number of taste buds decreases and the remaining taste buds shrink in size. Women also produce less saliva as they age. We need saliva to emulsify/break down our food and help the taste buds sense the incoming taste. With reduced saliva, there is reduced taste as compared to younger days.

    Less taste often leads to eating more to be satisfied. Choosing foods high in butter, salt, fine wines, and expensive cuts of meat will yield more flavor, but they are filled with more calories. Drinking sugar-sweetened beverages, including juices, energy drinks, flavored waters, and sweetened coffee and tea is a natural remedy for a decreased sense of taste. But those calories can account for nearly 300 calories a day in the average American diet or 31 lbs. in a year.

  7. Move More: Lack of exercise can contribute to menopausal weight gain. Physical activity, which should include vigorous, aerobic exercise as well as strength training, will help shed weight and prevent weight gain. Not only does exercise burn calories, but it also increases muscle. Muscle requires energy, but fat cells don’t. Fat cells are happy to just sit there, but muscles twitch a little bit all the time which burns calories.

    Whether menopausal women move less due to a lack of energy, embracing a slower pace of life, or not having kids to chase after, many are sitting for the majority of the day. This sedentary lifestyle makes losing weight difficult. Sitting too much has been called the new ‘smoking’ with regards to its adverse effect on overall health.

    With age, the things that women used to do to effectively burn calories and stay fit are not always available. Because of overuse or injury, bones and joints often don’t allow for a quick run at the park. There are many sports and activities that just can’t happen anymore in middle age.

    Exercising vigorously for 4 hours a week can negate a sedentary lifestyle’s health risks. Additionally, walking for a few minutes or simply getting up from the desk can make all the difference. Smartwatches can be programmed to remind you that it is time to stand up. 

    Short bursts of energy throughout the day are considered effective ways to prevent weight gain. It can last for mere seconds or for several minutes. Moving while talking on the phone or just taking a break every hour from sitting, some people call this ‘exercise snacking.’25 Exercise snacking several times a day can lead to meaningful gains in fitness and overall health. That includes even just 4-second bursts of exercise to improve fitness. 

    Exercise does not have to be considered a special event set aside at a certain time of day. It can be taking the stairs every time you go to work, or choosing to park your car further from the store to get some extra walking in.

  8. Regulate Metabolic Changes: Women lose bone and muscle as they age. It is natural, but there is much that can be done to counteract the loss. With a steady loss of bone and muscle, the body significantly reduces its resting metabolic rate (RMR). RMR is the number of calories the body needs to complete simple daily activities. Too many calories, your body tries to save it for later and stores it as fat. Too few calories and stored fat gets used and weight loss is achieved. If all of the stored fat is used up, the body will start to burn protein for energy – this is when the body starts to break down its muscle.

    Because of less muscle during menopause, women will experience a reduction in RMR which can trigger weight gain and changes in the body’s makeup. The result of weight gain in menopause is more fat around the midsection or belly fat.

  9. Intermittent Fasting: Intermittent fasting is a commonly discussed topic lately. What is it? Intermittent fasting is simply choosing to fast within certain time limits. But is it effective? Is it good for you? What about as you age?

    There are many variations of what intermittent fasting (IF) can look like. Sometimes, you eat normally most days of the week and then fast on weekends. Or, maybe have windows of eating and not eating within 24 hours (16 hrs. of fasting, and 8 hours to eat your meals), or fast every other day.

    To say the jury is out on intermittent fasting is an understatement. Many swear by it, but there’s just no evidence to prove its effectiveness, long-term repercussions, and sustainability. Winona believes in taking care of your body during the very vulnerable time of perimenopause and menopause. We understand the desire to get our bodies back in shape. The best way to do that is to understand what has changed and remedy the underlying causes of weight gain – hormone insufficiency – by starting hormone replacement therapy and working to increase lean muscle.

  10. Eat and drink less: A woman in her 50’s can expect to burn about 200 fewer calories per day than she did in her 30’s and 40s. This adds up to an easy 20 lb. weight gain per year. To reduce calories without skimping on nutrition, choose more fruits, vegetables, and whole grains, particularly those that contain more fiber. Fiber will swell and make you feel more full. 

    Alcoholic beverages add excess calories and increase the risk of gaining weight. With menopause, it is harder to metabolize alcohol. Many women say that drinking makes mood swings, hot flashes, and insomnia worse. Doctors warn that alcohol can be more dangerous as women age.24 

Why Take Hormone Replacement Therapy  

Most women in perimenopause and menopause are struggling with their weight on some level. As we discussed, hormones control metabolism and weight balance.

The most effective way to get hormones back on track, halt the ever-present scale creep, and return to a healthy weight is to correct hormonal imbalances with HRT. Once hormones are back in balance, weight loss can begin.

Details About The Hormones of Weight Gain 

Estrogen: Estrogen is one of the two female sex hormones and is responsible for the beginning of puberty, the menstrual cycle, and when it drops, perimenopause. 

Symptoms of low estrogen & progesterone

  • Insomnia and night sweats

  • Hot flashes

  • Vaginal dryness and thinning

  • Low libido

  • Moodiness or irritability

  • Headaches

  • Dry and sagging skin

At appropriate levels, estrogen can strongly regulate and reduce food intake which translates to weight. Too little or too much estrogen and weight gain often result. Replacing the decreased estrogen in a menopausal woman can likely reverse excess food intake.1 

Estrogen and progesterone are called “sex steroid hormones,” and are involved in the metabolism, as well as the accumulation and distribution of fat.1 Estrogen regulates feelings of hunger, keeping the pace of the metabolic rate, and the accumulation and distribution of fat.1,17-25 

The Stress Hormone Cortisol & Belly fat: Cortisol is known as the “stress hormone.” At too high of levels, it also causes belly fat or visceral fat deposits.10 Some people call it the ‘fight or flight’ hormone. When the mind perceives stress, cortisol is released into the bloodstream. If too much cortisol is released, it can lead to overeating and weight gain, especially in the midsection.6

Cortisol has a direct interplay with other hormones related to weight, sleep, and feelings of mood. While some of the weight gains might be due to ‘stress eating,’ cortisol will cause weight gain if too high. High cortisol is also linked to depression, food addiction, and sugar cravings.14

While meditation and exercise are great ways to reduce stress, sleep is also critical for stress reduction. If sleep is disrupted, like when night sweats occur, cortisol levels shoot up. HRT has been shown to reduce night sweats more effectively than any other treatment. 

High levels of cortisol will deplete the ‘happy brain chemicals’ (serotonin and dopamine) leading to depression or mood swings. People with depression often have very high cortisol.17

High cortisol levels can increase food intake and promote weight gain. Eating a balanced diet, managing stress, and sleeping at least 7 hours per night can help normalize cortisol production.

Insulins Impacts on Weight: Insulin regulates fat storage, specifically how much fat to store, where to store it, and how much to use as energy. Insulin imbalances can lead to weight gain, obesity, and eventually type 2 diabetes. This is age-related, at least in part due to lower circulating hormone levels. 

Leptin and Appetite: Leptin is a hormone made by fat cells that can decrease appetite. Leptin signals the brain that a person is full. When working correctly, leptin will send signals to the brain that the body has enough energy stores (body fat), and doesn’t need to eat again. Some call it the ‘satiety’ hormone. If leptin fails to send the right signals, or if the amount of leptin release isn’t accurate, a healthy weight is hard to achieve because you are hungry.6 

When leptin levels are balanced, there is good communication between leptin and the brain and people don’t overeat because they feel appropriately full after a meal. That fullness should last for hours. 

Estrogen has long been considered important in eating behavior – that feeling of being full or hungry. Part of estrogen’s role in metabolism is to regulate leptin. Too little estrogen, then too little leptin, and everything is thrown off leading to leptin ‘resistance,’ chronic sensations of hunger, and potentially obesity.1

The Little Known Ghrelin Hormone: Ghrelin is a hormone that increases appetite, and also plays a role in body weight. Ghrelin is sometimes called the “hunger hormone.” It is released from the stomach, communicates with the brain, and signals hunger, or that it’s time to eat. Ghrelin is what helps the body identify that the stomach is empty. It plays a big role in determining how quickly hunger comes back after eating (generally about three hours). After a meal, ghrelin levels are low and then they increase as the stomach empties.6 At least that’s the way it is supposed to work…

HRT has been shown to decrease blood levels of ghrelin so you don’t feel hungry as fast or as strongly.7

Thyroid Gland Has a Critical Job: The thyroid plays a major role in mood and regulating how many calories a person burns – also known as metabolism.17 If thyroid hormones are low, or not working properly, weight gain, fluid retention, hair loss/thinning, and depression can all occur. Estrogen helps regulate thyroid cells and directly impacts your metabolism.15 

Testosterone: While we know a lot about estrogen and progesterone’s role in menopause symptoms, most people don’t think of testosterone. Testosterone is typically identified as the man’s hormone, but women produce and need it too. Testosterone helps women maintain muscle, and even partners with other hormones to regulate the fat distribution and the base metabolic rate.22,23 Similar to estrogen and progesterone, testosterone peaks when women are in their early 20’s and start to decline in their 30’s. Then, it sharply drops during the menopausal years. The average testosterone levels fall by about 50% by the mid-’50s.23,25

Women with more lean muscle mass burn more calories at rest than women with lower muscle mass – even at the same body weight. Women with lower testosterone tend to gain weight more quickly because they have a lower metabolic rate. When testosterone replacement is given at normal levels, it is very safe with mild or no side effects. Replacing testosterone can help with weight loss and prevent weight gain.


There are natural ways to lose weight, but the most natural way is to pay attention to the hormone changes that are constantly occurring in your body. With perimenopause and menopause, women can easily gain between 12-15 lbs. after the age of 40. 

Hormone replacement therapy (HRT) is a great natural option for weight loss and weight gain prevention. One of the most natural home remedies for weight loss includes replacing the hormones estrogen, progesterone, and testosterone that are dropping with perimenopause and menopause. 

When hormones are in balance, neither too high nor too low, women look and feel their best. But when hormones are imbalanced, a range of symptoms that include fatigue, sugar cravings, weight loss resistance, bloating, belly fat, trouble sleeping, anxiety or irritability, and constant stress may occur. 

Some companies charge high fees for unnecessary blood, urine, or saliva testing. The tests are completely unreliable, just like the levels of your menopausal hormones from day today. We know from your symptoms how far off hormone levels are. That being said, hormone regulation is complicated. The body’s hormones are all interconnected. The hormone systems must work in harmony and continually rebalance in response to physical and emotional events in a woman’s life.  

If perimenopausal and menopausal women fail to address the hormonal root causes of weight gain, and weight loss resistance, their goals will not be achieved. At perimenopause, women will experience a cascade of hormone imbalances. By starting HRT, a woman can begin the process of repairing the imbalances of these critical hormones. 

Winona believes in nurturing your body during the very vulnerable time of perimenopause and menopause. The best way to do that is to understand what has changed and remedy the underlying causes of weight gain – hormone insufficiency – by starting hormone replacement therapy. 

Winona offers our female patients a unique experience. Winona’s healthcare platform is a place to safely connect with a healthcare provider to receive care and to ask difficult and maybe even embarrassing questions. Winona is not just a site to get a quick prescription. The decision to treat, and whether to prescribe a product available through Winona, is up to the patient and their Winona affiliated providers who are all licensed, board-certified, and never financially motivated to prescribe.

Winona is proud of our doctors, providers, and scientists who work tirelessly to treat all of the symptoms of menopause in the most effective way. That treatment might be a prescription or it could be one of our many over-the-counter treatments, but it will be the treatment that the patient and their doctor devise together. 

Winona is open 24/7 for our female patients who are suffering from peri or menopausal symptoms. We pride ourselves on our service to our patients.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”


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