Menopause Weight Gain: Why It Happens and What Helps

Is it the menopause or just age?

Both play a part, and the research separates them more than you might expect.

The scale. In 2012, a review for the International Menopause Society (Davis and colleagues, Climacteric) concluded that weight gain itself cannot be blamed on the menopause transition. The society's summary was that how much weight women gain depends on non-hormonal factors.

Body composition. The menopause does change what that weight is made of. The SWAN study, which followed women through the menopause with body scans (Greendale and colleagues, 2019, JCI Insight), found:

• before the transition, both fat and lean mass were slowly rising;
• at the start of the transition, the rate of fat gain doubled and lean mass began to fall;
• both changes continued until about two years after the final period, then levelled off;
• total weight kept rising steadily before the transition, did not speed up during it, and flattened afterwards.

So you can gain fat and lose muscle around the menopause without the scale moving much at all. That is why your clothes may fit differently even when your weight looks the same.

Metabolism. A large 2021 study in Science (Pontzer and colleagues) found that daily energy use, once body size is taken into account, stays stable from age 20 to 60. A smaller study that followed 156 women for four years (Lovejoy and colleagues, 2008, International Journal of Obesity) found that physical activity fell from about two years before the menopause and stayed low, and that energy used during sleep fell a little more in the women who went through the menopause. Losing muscle and moving less are both things you can work on.

Where the fat goes, and why it matters

In the Lovejoy study, all the women gained fat under the skin over the four years, but only those who became postmenopausal had a significant rise in visceral fat, the deeper fat around the organs. The Davis review linked the hormonal changes of the menopause to more total body fat and more abdominal fat.

That matters for more than appearance: the same review notes that extra weight in midlife raises cardiovascular and metabolic risk. A tape measure round your waist, at the same point each time, tells you more about this than the scale does.

What helps: what the research shows

1. Strength training, ideally with some cardio

A 2023 meta-analysis by Khalafi and colleagues (Frontiers in Endocrinology) pooled 101 trials with 5,697 postmenopausal women. Exercise training increased muscle mass and reduced fat mass, body-fat percentage, waist size and visceral fat. Aerobic or combined training did more for fat, and resistance or combined training did more for muscle, so doing both covers both.

The NHS also recommends exercising regularly around the menopause, with a focus on weight-bearing exercise to build strength, and lists weight-bearing activity among the ways to protect your bones. If you are new to lifting, weight training for women is a good place to start. If you have an injury, joint problems or a health condition, check with your GP or a physiotherapist first.

2. Enough protein

With muscle under pressure, getting enough protein matters. A 2018 meta-analysis by Morton and colleagues found that the benefit of protein for building muscle with training levelled off at around 1.6 g per kg of body weight a day, with 2.2 g/kg covering most people. How much protein to build muscle has food ideas. If you have kidney disease, speak to your doctor first.

3. A modest calorie deficit, if you want to lose fat

Energy balance still decides whether you lose fat. Aim for about 0.5 to 1% of your body weight a week, as Helms and colleagues (2014) recommend for keeping muscle, keep lifting while you diet, and keep protein towards the top of the range above. Crash diets cost muscle, and around the menopause you have less to spare. Losing fat over 40 sets out a full plan.

4. Daily movement

Since activity tends to drop around the menopause, a daily step target is a simple way to protect your energy use without adding much fatigue. Pick a number a little above what you do now and hit it every day.

5. Sleep, hot flushes and alcohol

The NHS suggests regular sleep routines, a cool bedroom and lightweight clothing at night, and says cognitive behavioural therapy (CBT) can help with hot flushes, low mood and anxiety. It also suggests not drinking more than the recommended alcohol limit, as alcohol may affect your symptoms, and avoiding triggers such as spicy food, caffeine and hot drinks if they set off hot flushes. If night sweats or hot flushes are wrecking your sleep, raise it with your GP.

What about HRT?

Hormone replacement therapy (HRT) is a prescribed treatment for menopause symptoms. It is not a weight-loss treatment.

• Does it cause weight gain? An older Cochrane review (Kongnyuy and colleagues) of 28 trials with 28,559 women found no evidence that HRT affects body weight.
• Does it prevent menopause weight gain? The same review found no evidence that it does.
• Fat distribution: the Davis review reported evidence that oestrogen therapy may partly prevent the shift of fat to the middle, while calling for more research on who benefits.

Whether HRT is right for you depends on your symptoms, your health and your own risks, so that decision belongs with you and your doctor. If you take a medicine, keep taking it as prescribed and raise any questions with your doctor, rather than acting on something you read online, including here.

When to speak to your GP

The NHS suggests seeing a GP if you think you have menopause or perimenopause symptoms and want to know your options, and also if you have palpitations, heavier bleeding than before, or any bleeding after your periods have stopped for 12 months. Also see your GP if your weight is changing quickly without an obvious reason, since the menopause is not the only possible cause.

How coaching helps

The menopause changes what your plan needs to protect, especially muscle, and it can make progress harder to read. With one-to-one coaching from CoachAk, your training program is written around your schedule, experience, equipment and injury history, and your calorie, macro and step targets sit alongside it in a private app. You log your weight daily, along with body measurements and the daily habits your coach sets. Each weekly check-in takes about three minutes and covers your weight, training and nutrition adherence, steps, sleep, energy, hunger and stress. Your coach replies with written feedback and adjusts your plan as your body responds. Coaching sits alongside your GP's care, not in place of it.

If you want a plan built for the body you have now, apply for coaching.