Winning the weight battle after menopause

Lifestyle changes may not always be enough to control biologically driven body changes.
You spend hours in the gym every day. You eat nothing but grilled chicken, fish, and salads. Yet the numbers on the scale don’t budge — or worse, they slowly creep up, along with your waist measurement.

Welcome to menopause.

“The change” actually does bring changes for many women, including weight gain that can resist even the most diligent efforts to reverse it, says Dr. Fatima Cody Stanford, instructor in medicine at Harvard Medical School.

“Women often assume that they are the source of the problem when it comes to anything regarding their weight,” says Dr. Stanford. But in many cases, hormonal fluctuations and other shifts that come with menopause are the true culprit. “These aren’t related to something they are doing,” she says.

Understanding why weight gain can occur at menopause can help women come to terms with this biological process and learn how to better manage their weight to protect their future health.

Weight gain after menopause

Many women start to see body changes when they reach their mid-to-late 40s and enter the stage known as perimenopause, the years during which your body begins the menopause transition. These changes continue even after a woman passes menopause, the point when ovulation and menstruation stop completely.

When women are younger, they tend to collect extra pounds on the hips and thighs, a pattern known as gynoid fat distribution. But during perimenopause and after menopause, hormone changes cause many women’s bodies to start collecting extra weight around the middle, a pattern called android fat distribution that is typical for men.

“It’s very frustrating to women. Not only am I going through hot flashes and other menopause-related problems, but I’m experiencing this whole change in shape,” says Dr. Stanford.

Weight gain at the waist doesn’t just affect your appearance. It’s a potential health risk, because it’s associated with an increased risk of cardiovascular problems, such as heart attack, stroke, or high blood pressure. This shifting weight distribution likely contributes to women’s rising risk of heart disease after menopause. And in addition to seeing changes in where fat accumulates, menopausal women also are more likely to put on extra pounds over all.

Hormone therapy could theoretically help reverse these weight changes. The problem is that hormone therapy comes with its own health risks, so it’s not advisable for women to use hormones to address weight gain alone, says Dr. Stanford.

Winning the weight loss battle

So, what can you do? While the following strategies might not enable you to regain the figure you had at age 20, they can help you keep the changes in check.

Plan for the long term. To successfully manage your weight, you need to make lifestyle changes that you can stick with indefinitely. “We want women to find longer-term solutions to stop the cycle of weight gain and loss,” says Dr. Stanford. Losing and regaining weight can actually make it more difficult to keep weight off over the long term. “You need to think, is this something I can commit to forever?” she says.

Eat less and move more. While some women are already doing everything they can to lose weight, for others there is room to improve health habits. This might include being extra diligent about following a healthy diet and increasing physical activity. Whenever possible, avoid fad diets, says Dr. Stanford. Very often these programs work in the short term but aren’t sustainable for most people over time. As for physical activity, any movement is better than none, but more vigorous workouts can help with weight control. Aim for workouts that make you break a sweat, says Dr. Stanford.

Add strength to your workouts. An important and often overlooked component of an effective exercise program is strength training. Women naturally start to lose muscle mass after menopause, unless they take steps to reverse it. Building muscle can increase what’s known as your basal metabolic rate, the amount of energy your body needs to keep working when you’re not moving. This energy is used for things like maintaining your body temperature, keeping your heart beating, and breathing. So, building muscle can help you burn more calories, which can help with weight control. “Women need to use weights. Many have this fear that they’re going to develop a bodybuilder physique,” says Dr. Stanford. But that’s pretty unlikely, considering that bodybuilders often can’t achieve that look without the help of performance-enhancing drugs, she says. An easy way to incorporate both strength-building exercises and cardiovascular exercises is to perform a circuit-style workout that includes both, says Dr. Stanford. It’s recommended that you do strength-building exercises at least twice a week.

Address sleep problems. Poor sleep quality becomes more common during menopause, and this can compound problems with weight gain. A lack of sleep affects your weight in much the same way as hormonal shifts, making you want to eat more and causing your body to collect fat around your middle. If you are experiencing disturbed sleep, practice good sleep habits: remove all electronic screens from the bedroom for at least an hour before bedtime, go to bed and get up on the same schedule each day, and ensure a restful sleep environment. If sleep quality doesn’t improve, seek help from your doctor or a sleep specialist.

Reduce your stress levels. Stress, like poor sleep, can lead to weight gain. Women at midlife often have numerous stressors in their lives, including caring for both their kids and aging parents. Adopt strategies to fight stress, such as meditation and exercise, or get support from a trained counselor.

Seek help from a weight-loss expert. “If you’ve maximized your diet and physical activity, reduced stress, and improved sleep quality and duration, and you’re still not able to control your weight, it may be time to seek out the help of a weight-loss professional or your doctor,” says Dr. Stanford. An obesity medicine specialist will typically be an option if your body mass index (BMI) is 27 or higher and you have a weight-related health condition, such as high blood pressure or diabetes. Women with a BMI over 30 will typically be candidates for intervention even if they don’t have a weight-related health condition, says Dr. Stanford. An obesity specialist can provide additional options such as medication or surgery to help with weight loss.

Change your expectations. For many women, accepting body changes is also something they will need to come to terms with. “Just as your body transitioned into puberty, with all the changes that followed — developing breasts, starting your period — now you’re having a different transition,” says Dr. Stanford. While you should do what you can to protect your health, you also need to accept some of these changes as a natural part of aging.