Menopause and Weight Gain

Menopause and Weight Gain

Menopause is a natural phase of life, but many women find that it brings unexpected challenges—one of the most frustrating being weight gain. Body fat distribution often changes, leading to a thicker waist and increased visceral fat ⁽¹⁾. This change is not just about aesthetics; it has implications for overall health, including an increased risk of heart disease, diabetes, and metabolic dysfunction-associated steatotic liver disease (MASLD) ⁽²⁾.

Understanding why menopause often leads to weight gain, and how to manage it effectively, can help women navigate this transition with confidence and control.

So, what exactly causes menopausal weight gain?

For women, oestrogen plays a key role in regulating appetite ⁽³⁾, metabolism ⁽⁴⁾, and fat distribution ⁽⁵⁾. During menopause and perimenopause, a decline in oestrogen causes a corresponding drop in dopamine signalling. As a result, the drive to take exercise is reduced ⁽⁶⁾, and the food reward system often becomes dysregulated as a result, leading to increased cravings for unhealthy, high-calorie foods ⁽⁷⁾.

The brain uses dopamine to drive us to behave in ways that increase our chances of survival. The only problem is that because the human species evolved to survive during periods of famine, the human brain is much more concerned with the threat of food shortage than it is with the possibility of a chronic metabolic disease caused by obesity. So, what your survival-driven brain wants is often very different from what you yourself might want! ⁽⁸⁾

When functioning normally, the brain ‘rewards’ us by releasing small amounts of dopamine when we eat high-calorie foods. This is why these foods don’t just taste good, they make us feel good (albeit temporarily). However, when our baseline dopamine level is low, we can feel discontented and out of sorts, and like we need a treat to give us a quick boost. Low dopamine levels can occur for various reasons, but the mechanisms involved during menopause are similar to those seen during the luteal phase (the second half of the menstrual cycle), when oestrogen and dopamine production fall, resulting in increased cravings for chocolate and other ‘quick-fix’ treats ⁽⁸⁾.

Additionally, when we restrict our calorie intake with the intention of losing weight, the brain often interprets this as a threat, and it ups the ante. Now, instead of just rewarding you with a hit of dopamine when you eat high-calorie foods, the brain withholds dopamine until you succumb to the cravings, rather like a strict parent with a naughty toddler, except in this analogy, the parent wants to fatten up the toddler to give them a better chance of surviving a perceived famine! ⁽⁹⁾ When seen from this perspective, we can more easily understand why it is so difficult to lose weight and keep it off, especially during menopause.

Of course, some of the weight-related effects seen during menopause can be attributed to natural effects of aging, such as a slower metabolism and a decline in muscle mass. Since muscle burns more calories than fat, this further reduces metabolic rate ⁽¹⁰⁾. Sleep quality also plays a part for many women, and sleep disturbances caused by hot flushes and night sweats can lead to fatigue, reduced physical activity, and poor food choices ⁽¹¹⁾. And if all of that wasn’t enough to content with, as oestrogen levels drop, stress hormones often rise, with the result that the body stores more fat, particularly in the abdominal area ⁽¹²⁾.

The good news is that menopause-related weight gain can often be managed with the right strategies.

Nutrition

• Prioritise protein: Eating more protein helps preserve muscle mass and keeps you full longer ⁽¹⁰⁾.
• Stay hydrated: Drinking plenty of water supports metabolism and helps prevent overeating ⁽⁴⁾.

Exercise

• Increase daily movement: Simple habits like walking more, taking the stairs, or standing while working can help combat metabolic slowdown ⁽⁴⁾.
• Incorporate strength training: Resistance exercises help preserve muscle and boost metabolism ⁽¹⁰⁾.

Sleep & Stress

• Prioritise sleep: Maintain a regular sleep schedule, create a relaxing bedtime routine, and avoid caffeine after 2pm ⁽¹¹⁾.
• Practice stress reduction techniques: Yoga, meditation, deep breathing, and mindfulness can lower cortisol levels and prevent emotional eating ⁽¹²⁾.

Medications

• Consider hormone replacement therapy (HRT): Many women benefit from hormone replacement therapy, but this should be discussed with your GP or a menopause specialist.
• Consider medicated weight management: Some weight loss medications target appetite and act on the food reward system to reduce cravings ⁽¹³⁾. Many pharmacies and private clinics provide medicated weight management services and will be able to advise on whether this is a safe and suitable option for you.

Long-Term Habits

• Track menopausal symptoms: Monitor energy levels, sleep, and cravings to identify stressors and triggers that lead to overeating, and work on strategies to reduce their impact.

Menopause-related weight gain is a common concern, but it doesn’t have to be inevitable. A combination of balanced nutrition, physical activity, stress management, and good sleep habits, can make a significant difference in how the body responds to this transition, with or without the addition of weight loss medication or HRT. By understanding the hormonal, metabolic, and lifestyle factors involved, and through the use of mindful and sustainable weight management strategies, women can take proactive steps to maintain a healthy weight and overall well-being.

References

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