Why am I gaining weight so fast during menopause? And will hormone therapy help?

You’re eating and exercising as you always have, yet you find yourself gaining weight, especially around your midsection.

What’s going on?

For women in their 40s or 50s, that's likely a sign their body is transitioning to menopause.

It’s common for those entering this natural stage of life to gain weight and belly fat (sometimes called “menopause belly”) and experience other bothersome symptoms — sleep-interrupting night sweats, hot flashes, vaginal dryness that causes pain during sex, urinary tract infections, irregular periods, depression, thinning hair, mood swings and more.

While all of these symptoms can impact quality of life, one of the most frustrating symptoms is often the weight gain.

“When my patients say, ‘I went to sleep and I woke up and I felt like I was 20 pounds heavier,’ I believe them. Because it can be a fairly rapid change if they’re not doing something about it,” said University of Chicago Medicine gynecologist Monica Christmas, MD, director of the health system's menopause program and the Center for Women’s Integrated Health.

The good news is that there are ways to help minimize weight gain and other symptoms during menopause. Christmas explains below what those things are and answers commonly asked questions about menopause-related belly fat, hormone therapy and the best way to eat and exercise during menopause.

When does menopause weight gain start?

It’s typically the worst during the onset of menopause, known as perimenopause. During perimenopause, you will still have a menstrual cycle. However, it may be changing and accompanied by symptoms like hot flashes, mood swings and weight gain. These symptoms can start up to seven to 10 years prior to menopause and are due to hormonal fluctuations in the amount of estrogen and progesterone your body is producing. Those fluctuations in hormones, along with other factors, can result in rapid weight gain.

What causes menopause weight gain?

The decrease in estrogen and progesterone, along with aging in general, triggers metabolic changes in the body. One change is a decrease in muscle mass, resulting in fewer calories being burned. If fewer calories are being burned, fat accumulates. Genetics, lack of sleep and a sedentary lifestyle play a role as well. It can be a vicious cycle. We lose muscle tone and accumulate more fat as our metabolism is slowing down, contributing to more weight gain. And that cycle continues.

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What causes the belly fat, or menopause belly?

The muscle tone lost from reduced hormone production is often replaced by fatty tissue deposits. The areas where muscle is usually lost is around the midsection, so that’s where the fatty tissue goes. Our genetics are also a factor. If the people in your family also carry more weight in the midsection, especially after menopause, there is a higher likelihood that you will, too, if nothing is being done to prevent it.

Unfortunately, HT is not the magic antidote. The best advice is to adhere to healthy eating practices and engage in regular exercise.

Can hormone therapy prevent weight gain?

Hormone therapy (HT) will not help you lose weight, nor is it indicated for weight loss. It also won’t prevent hair loss, stop wrinkles or halt the aging process. HT may actually contribute to a little bloating in the midsection for some patients. Although HT will not cause weight loss, there is some evidence that it can help redistribute fat from the midsection to the peripheral sites, thighs and gluteal region. Unfortunately, HT is not the magic antidote. The best advice is to adhere to healthy eating practices and engage in regular exercise.

Can the trendy weight-loss drugs help menopause weight gain?

Weight loss drugs may be appropriate if body mass index (BMI) is greater than 30kg/m2 or 27KG/m2 with other medical comorbidities like diabetes or hypertension. Moreover, these drugs can be associated with troublesome side effects, including nausea and diarrhea. Plus, for most people, they’re not affordable. Even though you may experience weight loss while taking the medication, once it’s stopped, it’s likely you’ll gain the weight back. It's important to discuss this with your physician.

When will menopausal weight gain stop?

The number on the scale won’t keep going up and up. It does stabilize. But in perimenopause and those initial few years after the final menstrual cycle, we see the most pronounced amount of weight gain, which can have serious implications to health and overall wellbeing. The menopause belly increases the risk of diabetes, heart disease, high blood pressure, stroke and respiratory problems. Also, the extra weight on the joints leads to arthritic issues that limit mobility and make it harder to exercise.

What is the best diet for menopausal weight gain?

The Mediterranean diet has been shown to lower the risk of cardiovascular disease, metabolic syndrome, osteoporosis, dementia and certain cancers, in addition to supporting a healthy balance of gut flora to help with digestion. The plant-forward diet, filled with anti-inflammatory foods, limits sugar, sodium, processed carbohydrates, trans and saturated fats, and processed foods. It includes whole foods rich in nutrients, fiber and antioxidants that work together to optimize health and maintenance of a healthy weight.

What if my diet was fine before menopause?

When people come to me and say, “I’ve always eaten this way, and I’ve never gained weight,” I say to them that it doesn’t matter what you always did. That doesn’t fly anymore. You’ve got to change. You have to be meticulous about what you put into your body and be diligent about the way you move your body.

I often recite a quote from Michael Pollan’s book, “In Defense of Food," in which he talks about three simple rules: "Eat (real) food. Not too much. Mostly plants.”

You can’t exercise your way out of a bad diet and you can’t eat your way out of no exercise. It’s got to be a combination of both. Especially in midlife and beyond.

What is the best exercise for menopause?

The best exercise is the one you do, but experts recommend 150 minutes of moderate-intensity physical activity and two days of muscle strengthening per week. A combination of yoga, Pilates and walking is my personal favorite regimen. The biggest bang for your effort is weight-bearing exercises, like Pilates. It focuses on core strength, which is where menopausal weight deposits. If Pilates isn’t your thing, weightlifting, tennis and high-intensity interval training all work, too. You can’t exercise your way out of a bad diet and you can’t eat your way out of no exercise. It’s got to be a combination of both. Especially in midlife and beyond.

How do you stay motivated to exercise during menopause?

Patients tell me, “I’m so tired, I’m so exhausted, I can’t exercise.” But it’s a vicious cycle: If you don’t exercise, you’re going to be more tired. You just have to do it, just go for a walk outside. I promise you, within five minutes of starting, you will feel better because endorphins are naturally released. It takes a good 20 days to set a pattern. Do it every single day for 20 days.

Don’t say, “I’m trying to work the exercise into my schedule,” because it won’t happen. You pick the time for an exercise and you work your life around the exercise. The people who fare better during the menopause transition are people who have a healthy lifestyle. I’m not saying they won’t have a hot flash or mood swings, but they tend to do better and have a better outlook.

Studies have shown obese women are more likely to report more frequent severe hot flashes than those of a normal weight. Weight loss is also associated with a decrease in hot flashes and night sweats.

Menopause is unavoidable, but weight gain doesn’t have to be.