Menopause and Weight Gain

By Joanne Rinker MS, RD, CDE, LDN and Dr. Edward J. Williams, FACOG, NCMP, MHA

One of the most common complaints of menopausal women is weight gain. While their lifestyles, eating habits and exercise levels have not changed, they cannot seem to keep weight off. Often, what has worked in the past doesn’t work in this stage of life. Although weight gain in general cannot be blamed on menopause alone, the hormonal changes can be linked to a change in how – and where – we store fat.

The best way to describe menopause is as a hormonal imbalance. This involves the key hormone players: estrogen, progesterone, insulin, cortisol and, at times, thyroid hormones. Imbalances with these hormones can cause an increase in body fat, especially belly fat.

Often, female hormone levels go down and insulin and cortisol levels go up. This “tips the scales” for weight control in menopausal women. There is a 15% increase in overweight women post-menopausal and a women’s metabolic rate declines 5% per decade. This all adds up when a women reaches menopause. So it is of no surprise that the combo of decreasing hormones, lower metabolism and less exercise ability, works against a menopausal women’s ability to lose weight.

Two of the most powerful hormones that keep weight stable, are insulin and cortisol. When these are out of balance in menopause, it can cause weight gain and fat storage.

Estrogen increases a menopausal women’s sensitivity to insulin which works to a women’s advantage when it comes to weight management. Increased insulin sensitivity helps women regulate calorie burning and control where fat is stored. The less estrogen is made in the body, the more insulin becomes resistant to promoting weight control. Due to the decrease in estrogen, the body starts to convert most calorie intake to belly fat. Also, estrogen helps regulate the effects of cortisol, which at abnormal levels will affect a women’s ability to lose weight. The higher the cortisol levels the greater the tendency to store abdominal fat. So, elevated cortisol and a decrease in estrogen is a double whammy against weight control. If cortisol levels are high, both estrogen and progesterone have been shown in combination to control the bad effects of cortisol on fat storage.

In summary, the longer a women continues to have low levels of certain hormones, the greater the effect on insulin and cortisol, and the harder to manage weight. So when calories are high, fat storage is also high because calorie burning and the effect of insulin are low.

You may be wondering about the risks associated with Hormone Replacement Therapy. Opinions on side effects and risks have been extremely conflicting over the past decades. Most of the risk potential surrounding hormone replacement therapy includes those associated with stroke, heart disease, gynecological cancers and liver disease.

Many experts agree that in the appropriately screened patient benefits may outweigh the risks especially when quality of life issues are taken into account. Most medical organizations devoted to the health of menopausal women agree that treatment is patient specific and tailored to the appropriately screened patient population and appears to be much safer now with the availability of improved medications and more advanced treatment options. With the availability of topical creams, for areas including the groin, armpit and inner thigh, this eliminates the risks that the pill form once posed, because there is no metabolism by the liver or exposure that could lead to gynecological cancers. Current follow up studies continue to report conflicting results from earlier studies and have reported heart protective effects from specific hormone therapies and decreased risks for cancer.

Current follow up studies continue to report conflicting results from earlier studies and have reported heart protective effects from specific hormone therapies and decreased risks for cancer.

This is probably not what you want to hear, but you must be aware that diet and exercise are the keys to success! Also, the RIGHT diet and exercise regimen is even more important.

So, what can we do? First, realize that the hormone imbalances during menopause tend to make women far more sensitive to carbohydrate and stress – especially if the decreased hormone production promotes insulin resistance and the body to make more cortisol.

Of course, if you are stressed and on a low-fat diet, your body will struggle to keep all these balls in the air and refuse to let go of extra body fat. The most effective diets for menopausal women tend to focus strongly on low “glycemic index” because of the impact insulin has on burning calories and storing fat. Limit starchy fruits and vegetables, those with a glycemic index of 50 or less, with more vegetables from the cruciferous (broccoli, cauliflower, etc.) category. Cruciferous vegetables have been shown to promote healthy estrogen balance in menopausal women. Cruciferous vegetables include broccoli, cauliflower, cabbage, kale, brussel sprouts, and mustard or turnip greens. Overall, increased central belly fat appears to be a direct result of the menopause and can be prevented by hormone replacement therapy and balance.

Focus on the basics!

  • Eat a healthy diet
  • Emphasize plant-based foods, less starchy fruits, vegetables and whole grains
  • Eat several servings of cruciferous vegetables a day
  • Use the glycemic index
  • Choose lean sources of protein and low-fat dairy products
  • Limit saturated fat
  • Choose moderate amounts of monounsaturated and polyunsaturated fats — found in fish, nuts and certain vegetable oils
  • Keep portion sizes in check, at home and in restaurants
  • Exercise 30-60 minutes daily
  • Engage in less intense less duration exercise (leisure walking with light weights, restorative yoga, swimming) that reduces cortisol production and promotes a healthy hormone balance that burns fat and helps maintain muscle.
  • More intense long duration exercise such as jogging, interval training and high impact aerobics may be more favorable when one is in transition into menopause- the pre-menopausal period.

Use menopause as one of life’s “sticky notes” to help you develop a personal outline of your healthcare so that you can create a snapshot of what your overall health will look like as you move forward and be committed to being as proactive as possible.


(2 Articles)

Joanne Rinker, MS, RD, CDE, LDN is a Master’s level dietitian. She has her BS and MS in Human Nutrition from West Virginia University. Joanne is currently in her thirteenth year as a Registered Dietitian and eleventh year as a certified diabetes educator. She has worked in Public Health with the North Carolina Diabetes Prevention and Control Program from May 2007 until July 2013. During those six years, she worked on the implementation and facilitation of the North Carolina Diabetes Education Recognition Program.

Joanne recently was named AADE 2013 Diabetes Educator of the Year and has used that opportunity to spread the word about the relationship between diabetes, hearing loss and depression.

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