Why can’t I shift my menopause belly?

Understand the hormonal changes that can affect your weight

Anna, 48, has been slender all her life. A Pilates teacher, she walks her dog every day, is fit and active and yet: ‘Over the last couple of years, since I started getting perimenopausal symptoms, I’ve developed what can only be described as a pouch of fat around my belly. I eat a healthy diet and think I’m doing everything ‘right’ but I just can’t shift it.’

The balance app’s community pages – where women can share their experiences of perimenopause and menopause and offer support – are full of similar stories. Faye, 36, had a hysterectomy two years ago and has been taking HRT for 18 months. She asks: ‘I can’t seem to lose weight and it’s getting me down. I’ve recently completed Couch to 5K and try to eat well but I’m so hungry all the time! It used to be so much easier to lose weight, has anyone found a diet or exercise routine that helped?’

In a Newson Health study of 5,744 women, two thirds (68 per cent) said they had gained weight since the start of perimenopause or menopause [1]. This can influence self-esteem and body confidence. Plus, it can be hard enough to lead a healthy lifestyle when you are struggling with symptoms of menopause but if you’re trying to do so and still gaining weight, it’s not only disheartening but can be demotivating.

RELATED: Help – I’m heading for the menopause and I can’t control my weight!

Often, women will find that while their eating habits haven’t changed, the weight has crept up on them, particularly around the waist. For many, the average weight gain – approximately 1½lb each year during midlife [2] – might not seem significant, rather it’s the appearance of the “spare tyre” that causes concern.

Why am I getting a belly in middle age?

While there is no single reason for the midlife tummy, hormones, age, changing body composition, and lifestyle factors can all contribute.

Does oestrogen affect belly fat?

When oestradiol (oestrogen) levels fall, such as during perimenopause and menopause, it can lead to several changes in your body:

Insulin resistance

Oestradiol, progesterone and testosterone all help regulate how your body uses insulin, a hormone produced by the pancreas that controls blood sugar levels. When you eat, your blood sugar levels rise. In response, your pancreas releases insulin. Insulin acts like a key, unlocking cells so glucose can enter and be used for energy. In insulin resistance, the cells in your muscles, fat, and liver don’t respond well to insulin. It’s like the key (insulin) isn’t working properly, so glucose can’t enter the cells as easily.

To overcome this, your pancreas produces more insulin. Initially, this extra insulin can keep blood sugar levels normal. Over time if the cells become more resistant, even the extra insulin isn’t enough to keep blood sugar levels in check. This can lead to higher blood sugar levels, a condition known as hyperglycaemia. Persistent insulin resistance can lead to prediabetes and eventually type 2 diabetes. It also contributes to weight gain, especially around the abdomen, because high insulin levels promote fat storage.

Think of it like this: imagine trying to open a door with a key that doesn’t fit well. You might be able to jiggle it and get the door open at first, but over time, it becomes harder and harder until you can’t open the door at all. Lower hormone levels can make your body less sensitive to insulin, causing insulin resistance.

Metabolic changes

Oestradiol also plays a role in maintaining a healthy metabolism (the rate that your body uses calories). Lower levels can slow down your metabolism. Also, during menopause, your lean muscle mass reduces, which in turn affects your metabolism. A slower metabolism is one reason that your weight can still increase even if you are eating the same as you always have, and continue the same amount of exercise.

Change in fat distribution

During the perimenopause and menopause, your body tries to combat decreasing levels of oestradiol by trying to obtain it elsewhere – chiefly from a different form of the hormone, called oestrone. This is produced in your fat cells (as well as your adrenal glands) and is less effective than oestradiol and is more inflammatory in your body.

Oestradiol regulates your body’s fat distribution.  Before menopause it distributes fat mostly to your breasts, bottom and thighs but as levels of oestradiol fluctuate and reduce during perimenopause, fat distribution shifts to your abdomen. The fat is also different – rather than subcutaneous fat (the type that sits just below your skin), it’s visceral fat, a deeper, internal fat that surrounds your vital organs. Visceral fat is hormonally active, which means it can release hormones that affect your metabolism. One study has found that during perimenopause the rate of fat gained doubled [3].

Can stress affect my weight?

Your sympathetic nervous system (the part that increases heart rate, blood pressure and breathing rate) is supported by oestradiol. Low levels of oestradiol can trigger a fight/flight/freeze reaction, which is your body’s way of facing a perceived threat. This stress reaction also releases the stress hormones adrenaline and cortisol, which causes your liver to release glucose to give you energy (to run or fight). However, when this glucose isn’t used – because you are, for instance, stressed at your desk at work – insulin is released, which then stores the glucose away as fat. Too much stress, and resulting cortisol, can therefore increase your risk of visceral fat.

RELATED: Why is the menopause so stressful?

What else can give me a belly?

Some women find their menopausal symptoms – such as joint pains and vaginal dryness – mean they don’t exercise as much as they did previously. Others experience poor sleep and/or anxiety, both of which can contribute to food cravings, often those high in sugar or unhealthy fats, which the body lays down as oestrone-producing abdominal fat. Dr Louise Newson, GP, menopause specialist and balance founder confirms: ‘A study I was involved in, led by epidemiologist Professor Tim Spector, demonstrated that menopausal women are more likely to weigh more, eat more sugary foods, have higher levels of glucose and insulin and to report sleep difficulties. Menopausal women are also more likely to have raised glucose levels after eating.’ [4]

Is belly fat dangerous?

Even if your weight stays stable or within a healthy range, carrying extra fat around your middle can increase your risk of health issues. Metabolic changes and accumulating visceral fat can lead to a greater risk of insulin resistance (increasing glucose levels and increased risk of type 2 diabetes) and a rise in cholesterol [5,6].

RELATED: Navigating your diabetes and the menopause

What can I do about belly fat?

Consider your diet

Considering your diet is not the same as dieting. While it’s sometimes touted that women in their 50s might need about 200 fewer calories a day than they did in their 30s and 40s to maintain their weight, the situation is complicated and individual. And it’s worth remembering that according to the BMS, no high-quality studies evaluating the effectiveness of popular diets such as ketogenic, time-restricted eating and fasting have been conducted amongst perimenopausal and menopausal women [7]. What works for men won’t necessarily work for women, and what works for younger women won’t necessarily work for midlife women.

RELATED: Nutrition, mindset and maintaining a healthy weight in menopause

What you can do is optimise your diet.

Protein helps to keep you fuller for longer between meals by reducing levels of the hunger hormone ghrelin, while boosting levels of the appetite-regulating hormone peptide YY. Although we need protein throughout our lives, during menopause it can help energy levels, which can be at a low ebb.

Carbohydrates are another important energy source. They are not all created equal – try to obtain your carbohydrates from low-GI sources. These are foods that are broken down slowly so will cause smaller increases in your blood-sugar levels, keeping you satisfied for longer, and encourage your body to burn fat. Vegetables such as lettuce, broccoli, cabbage, cauliflower and peppers are great sources as they also contain fibre and other nutrients.

In contrast, high-GI foods, such as white bread, white rice, potatoes and sugary soft drinks, can cause blood-sugar levels to rise rapidly (causing your pancreas to release more insulin) and then quickly fall. This can lead to you craving food and/or overeating.

Maximise your exercise

Many women (and men!) become less active as they age. It might be that your menopausal symptoms are preventing you from exercise or the habit has dwindled. Being active doesn’t have to mean punishing gym workouts – if you enjoy the exercise, you’ll more likely stick at it. Think about your everyday activity levels – have you got in the habit of driving to the shops instead of walking, for instance?

Strength or resistance exercise is paramount at this stage of life – not only will the likes of squats, ankle taps, bicep curls and press up (start by doing them against the wall), help tackle the decline in muscle mass, it can increase your metabolic rate.

RELATED: Get stronger during the menopause

Remember to think long-term when setting yourself goals. The BMS says calorie reducing diets with increased exercise, including strength exercise, is the route to achieving long-term (over four years) weight management, and leads to both reductions in waist circumference and body fat [8].

Learn about HRT

If you are experiencing perimenopausal or menopausal symptoms, HRT is the first-line treatment. A study found that women taking HRT had less visceral fat, lower glucose and insulin levels [10]. More research is needed to determine if HRT directly influences visceral fat or if because it helps women manage their menopause symptoms, they are more likely to feel better and look after themselves through healthy diet and exercise.

Many women find that when they take testosterone in addition to their HRT, they have more energy and stamina so exercising is easier. 

RELATED: Will HRT make me gain weight?

Be kind to yourself

Sometimes you can do everything “right” but still gain fat around your belly. Hopefully, by understanding the physiological changes behind this, you can turn off your inner critic, be kinder to yourself and learn to appreciate your body throughout all its changes.

References

1. Glynne, Sarah et al. ‘Overcoming barriers to health: diet and exercise habits in perimenopausal and menopausal women’. Maturitas, Volume 173, 37
2. Sternfeld B, et al. (2004), ‘Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women’s Health Across the Nation’, Am J Epidemiol, 2004. 160(9): p. 912–22. https://doi.org/10.1093/aje/kwh299
3. Greendale G.A., Sternfeld B, Huang M, Weijuan Han , Carrie Karvonen-Gutierrez , Kristine Ruppert , Jane A. Cauley , Joel S. Finkelstein , Sheng-Fang Jiang , Arun S. Karlamangla,(2019) Changes in body composition and weight during the menopause transition}, JCI Insight,3 (4) https://insight.jci.org/articles/view/124865},
4. Bermingham, K. M., Linenberg, I., Hall, W. L., Kadé, K., Franks, P. W., Davies, R., Wolf, J., Hadjigeorgiou, G., Asnicar, F., Segata, N., Manson, J.E., Newson, L. R., Delahanty, L. M., Ordovas, J. M., Chan, A. T., Spector, T. D., Valdes, A. M., Berry, S. E. (2022), ‘Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study’, EBioMedicine, 85:104303. doi:10.1016/j.ebiom.2022.104303
5.  Zhu, D., Chung, H. F., Dobson, A.J., Pandeya, N., Brunner, E. J., Kuh, D., Greenwood, D. C., Hardy, R., Cade, J. E., Giles, G. G., Bruinsma, F., Demakakos, P., Simonsen, M. K., Sandin, S., Weiderpass, E., Mishra, G. D. (2020), ‘Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies’, Human Reproduction, 35(8), pp. 1933–43. doi:10.1093/humrep/deaa124
6. Christakis, M. K., Hasan, H., de Souza, L. R., Shirreff, L. (2020), ‘The effect of menopause on metabolic syndrome: cross – sectional results from the Canadian Longitudinal Study on Aging’, Menopause, 27 (9) pp. 999–1009. doi: 10.1097/GME.0000000000001575
7. BMS: Nutrition and Weight Gain
8. BMS: Nutrition and Weight Gain
9. Bermingham, K. M., Linenberg, I., Hall, W. L., Kadé, K., Franks, P. W., Davies, R., Wolf, J., Hadjigeorgiou, G., Asnicar, F., Segata, N., Manson, J.E., Newson, L. R., Delahanty, L. M., Ordovas, J. M., Chan, A. T., Spector, T. D., Valdes, A. M., Berry, S. E. (2022), ‘Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study’, EBioMedicine, 85:104303. doi:10.1016/j.ebiom.2022.104303