Your POV: Menopause is just around the corner, and everything you thought you knew about weight management suddenly seems less straightforward. For most of your life, you have been told that weight loss comes down to one golden rule: calories in v. calories out. So, you have cut back on carbohydrates, you have added more protein to your meals and snacks, you are committed to exercising regularly, and you even made stress management a priority. Yet, the stubborn belly fat is still not coming off. Why?

Menopause and the Hormonal Juggling Act

While the thought can be hard to avoid, it is important to know that your body is not broken. Many factors—such as hormonal fluctuations, lifestyle changes, aging, stress, and more—can affect weight and fat distribution, especially in a hormonally dynamic time such as perimenopause or menopause.

Estrogen and Progesterone

Estrogen and progesterone are two main hormones produced by the ovaries and that are primarily involved in the menstrual cycle. What some people may not realize is that these ovarian hormones also have a significant influence on metabolism. As estrogen and progesterone levels begin to decline in perimenopause and remain low after menopause, metabolic rate decreases.[1] There is also a relative predominance of androgens (i.e., testosterone) during this time, as they are no longer opposed to the same degree by estrogen and progesterone. These hormonal fluctuations set the stage for obesity. Fat distribution can also shift towards the abdomen or midsection. The transition from perimenopause to menopause then to postmenopause is associated with an average weight gain ranging from 2 to 5 kg.[2]

Another hormone, called follicle-stimulating hormone (FSH) and which is involved in menstrual-cycle regulation, conversely rises in menopause. The FSH level increase in menopause seems to have an independent effect on metabolism. Estrogen does not fully suppress FSH, so this may explain why estrogen therapy alone may not fully mitigate fat changes in menopause.[3]^, [4]

Insulin

Insulin sensitivity can decrease during perimenopause, making some people more prone to higher insulin levels and becoming insulin-resistant. Insulin is a hormone that acts like an energy storage switch. When you eat, carbohydrates are broken down into glucose (sugar), and your blood-glucose levels rise. Insulin is then produced by the pancreas to help your cells and tissues take up the glucose and convert it into usable energy. When there is more energy consumed than what your body immediately needs, insulin helps to store the extra glucose for later use as glycogen in the liver and muscles, or, when energy intake exceeds storage needs, it turns it into fat.

The metabolic effect of decreased estrogen levels during perimenopause may contribute to increased abdominal fat, which in turn is associated with reduced insulin sensitivity and increased inflammation. Interestingly, abdominal fat is considered an active endocrine (hormone-producing) tissue, able to produce many adipokines and other substances associated with insulin resistance, type 2 diabetes, and metabolic syndrome. Reduced sensitivity or resistance can be a major driver for weight gain during perimenopause, even without significant changes in diet, lifestyle, exercise, or stress.[5]^, [6]

Cortisol, Stress, and Sleep

Outside of biological and hormonal changes, life changes—such as shifts in employment or changes in family dynamics—can occur at any stage of life. When these stressors overlap with perimenopause and menopause, they may place additional strain on the stress response and contribute to its dysregulation.[7]

Chronic stress can lead to persistently elevated cortisol, often referred to as the “stress hormone.” Stress may also contribute to behavioural changes—such as increased cravings, greater consumption of comfort foods, etc.—that can lead to weight gain over time.[8]^, [9] Abdominal or visceral fat accumulation and weight gain, as well as sleep disturbances, can happen as a result.[10] Your circadian rhythm influences not only the regulation of sleep but also many other functions, including appetite, hormonal activity, and glucose and lipid metabolism. When your internal clock is disrupted—for example, by poor sleep quality, sleep apnea, irregular schedules, or other reasons—insulin sensitivity may be reduced. Some known consequences of poor or insufficient sleep are increased hunger hormones like ghrelin and decreased levels of leptin, the hormone that signals fullness.[11]

Aging

Aging and the natural loss of muscle mass and function, known as sarcopenia, play a role in metabolism too. The significant reduction in estrogen during perimenopause, along with age-related changes in testosterone levels, may amplify sarcopenia. Researchers have identified different mechanisms involved, such as mitochondrial dysfunction, increased inflammation, and reduced muscle contractility. Muscle-mass decline can also be attributed to a decrease in physical activity.[12]^, [13]

Thriving in Menopause

Weight gain can feel like an insurmountable project, let alone experiencing it on the hormonal roller-coaster of perimenopause/menopause. A few strategies can help target what we know to be the key barriers to healthy weight management. Work with your trusted health-care practitioners to get properly screened, run necessary laboratory tests, and develop a personalized plan for what your body needs.

Mindful and Substantial Nutrition

Before you get started on the long and winding road of confusing dietary trends for weight loss, aim to have consistent nutrient-dense meals. Prioritize consuming enough protein and fibre during the day to support muscle health as well as insulin sensitivity. The recommended goal is for 1–1.2 g of protein per kilogram of body weight per day and to aim for 25–30 g of fibre per day. Protein- and fibre-rich foods—such as fish, eggs, whole grains, beans, nuts, legumes, lean meat, and poultry—also play a key role in keeping you feeling full longer.[14] Eating mindfully and staying present during meals may also help prevent digestive disturbances, help to regulate the stress response discussed earlier, and potentially minimize excessive snacking later.[15]^, [16]

Regular Movement

While all physical activity is beneficial, strength training at least twice a week may be important for menopause. This type of exercise can promote muscle building, which is important to stave off sarcopenia and hormonal decline.[17]^, [18] Start at a comfortable pace and ideally seek help from a trainer or professional that can safely guide you with muscle-strengthening exercises that target major muscle groups.

Stress Management and Self-Compassion

Being kinder to yourself is not just cheesy advice: it is logical. Bodies change over time. A practical way to apply self-compassion at the table is by not putting yourself under stress with dietary restrictions. High food restrictions can be a significant source of stress on the body, which may complicate already complex processes of weight management during menopause.[19]

Feeling chronically stressed can be exhausting and does not make the transition to menopause any easier. Stress is not always escapable, hence why it is so important that you are supported in affirming your boundaries and applying techniques to help you cope. Consider mindfulness and meditative practices; deep-breathing exercises; gentle stretching; practicing gratitude; ensuring you get enough sleep; and prioritizing doing activities that can help you feel more like yourself such as going outside and enjoying nature, playing a musical instrument, or spending time with friends and family.[20]

Discuss Nutrient Supplementation

Working with a health-care practitioner who is trained in prescribing targeted nutritional supplementation—like a naturopathic doctor, dietitian, or nutritionist—can be beneficial in furthering your weight-management goals. Certain micronutrients and herbs have been reviewed and regarded for promoting insulin sensitivity, improving sleep quality, modulating cortisol metabolism (stress resilience), reducing hot flashes, and mitigating metabolic disease processes associated with nutrient deficiencies.

Consider Hormone Therapy

Besides weight gain, some people going through menopause may also experience other disruptive symptoms that are significantly affecting their daily life and overall function. Hormone therapy (including bioidentical hormone therapy) is clinically indicated for relieving vasomotor symptoms (e.g., hot flashes or night sweats), mood swings, and insomnia.[21] Do consult with your health-care practitioner (e.g., medical doctor, naturopathic doctor, or nurse practitioner) to get a thorough health history and risk assessment to receive appropriate care.

Menopause: A New Lease on Life

For something that affects half the population, menopause remains an underdiscussed health topic, and its research is globally underfunded. Fortunately, the cultural stigma of menopause is finally lifting. Perspectives can be positively shaped by seeing menopause not as something pathological but rather as a catalyst and the beginning of a welcomed chapter: A new lease on life, if you will, where you are finally being done with menstruation and fertility worries. It is having the opportunity to be clear on what you want, what you no longer need, and how you can focus on your nourishment, recovery, health, and peace.[22]^{, [23], [24]}

Dr. Kim Abog, ND

Dr. Kim Abog is a registered naturopathic doctor and doula based in Toronto, Ontario. She has a special interest in fertility and reproductive health. She helps people by facilitating health-management plans with them, connecting them to evidence-informed integrative health solutions, and helping them thrive.

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