Got Meno-gut? How to Lose the Belly Menopause Brings

As you hit your mid-to-late 40s, you may notice that besides battling the occasional hot flash or mood swing, your favorite black go-to pants are starting to feel noticeably more snug. This time it's not your imagination.

The average woman gains about four-and-a-half pounds as she starts the transition to menopause in her 40s, according to a landmark study. And it's a trend that doesn't slow down, either: Women continue to put on about a pound and a half each year in their 50s and 60s, according to a new review published in the journal Mayo Clinic Proceedings.

"The main reason is the natural loss of muscle mass that occurs with age," explains Jo Ann Pinkerton, M.D., executive director of the North American Menopause Society and professor of obstetrics and gynecology at the University of Virginia Health System. "Since muscle burns more calories than fat, your metabolism slows down, causing you to put on weight." Starting at age 30, research shows that you lose on average about a half pound of muscle each year; and that number rises to almost a full pound once you hit 50.

But as you glide through the big M, you may also notice something else: Even if the number on the scale is not rising considerably, any weight you do gain ends up accumulating around your abdomen, leaving you with what sure looks like someone else's beer belly. "After menopause, your ovaries stop producing estrogen, and the only place where it can be generated is in your abdominal fat cells," explains Deborah Clegg, M.D., a professor of internal medicine at the Diabetes and Obesity Research Institute at Cedars-Sinai Medical Center in Los Angeles. As a result, "your body naturally gravitates towards storing fat in that area, in an effort to get estrogen," says Clegg, who notes that the stomach's been called "the third ovary."

But this type of fat, known as visceral fat, is toxic. "It produces hormones such as the stress hormone cortisol as well as inflammatory proteins known as cytokines," explains Pamela Peeke, M.D., professor of medicine at the University of Maryland and author of The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction. These chemicals force your body to churn out more insulin, which not only ramps up appetite, but also increases the storage of fat in fat cells. This, in turn, causes you to put on even more belly weight and also sets you up to develop insulin resistance, a key factor in the development of heart disease and type 2 diabetes.

Sounds daunting, but there are expert-approved ways to reverse your scale's upward spiral. Here's how: 

Crank it up. If you're sedentary, starting an exercise program will help you shed pounds as well as relieve menopausal symptoms such as hot flashes, according to a study published last year in the medical journal Menopause. But if you're already active, you'll need to crank things up a notch. The best way to do this is through a short duration of high-intensity interval training (HIIT), where you alternate brief periods of intense physical activity with more relaxed recovery periods. Obese postmenopausal women who did 10 minutes of HIIT five times a week lost twice as much weight as those who did more traditional endurance exercises, like brisk walking, according to a University of Scranton study published last October in Menopause. "This doesn't have to be a lot — it can just be tweaking your morning walk to throw in some hills," says Peeke.

Add in resistance training. "In order to remove weight as you get older, you have to lift weights," stresses Peeke, who notes it's key to reversing that metabolism-wrecking muscle loss that occurs naturally with age. A 2016 study of post-menopausal women in their late 50s and 60s found that those who did an hour of strength training twice a week for eight weeks not only significantly reduced their body fat compared to a control group, they also reported less physical pain and felt better overall. If you're resistant to pumping iron, consider yoga. It has the same kind of weight-bearing benefits, and a 2016 German review that looked at 13 studies concluded that yoga also helps relieve menopausal symptoms, including hot flashes.

Watch what you eat. In a study of 17,000 postmenopausal women ages 50 to 79, researchers found that those who followed a low-fat diet that included five servings of fruits and veggies and six servings of whole grains were three times more likely to lose weight than those in a control group. "In general, we recommend that women going through menopause try to keep their fat intake under 20 percent, with most of it coming from good-for-you fats such as olive oil, fish or avocados," says Pinkerton. One suggestion: Start your meal with veggies and protein and eat your starch last. This significantly reduces your body's blood sugar and insulin levels, which will help keep you feeling fuller longer, according to a 2015 study published in the medical journal Diabetes Care.

Stop eating after 7 p.m. Research shows that intermittent or alternate day fasting, where you eat normally for a day and restrict calories dramatically the next, can work. People who slashed their calories to between 750 and 1,100 for five days a month for three months lost significantly more abdominal fat — and improved blood pressure, cholesterol and blood sugar levels — than those who didn't, according to a University of Southern California study published last year. But since that's hard to stick to, "I generally recommend that my patients only eat during a 12-hour window each day — for example, from 7 a.m. to 7 p.m., and then put the kitchen on lockdown after that," says Peeke. "They’ll get some of the health benefits of intermittent fasting without the hassle or excessive hunger."

Get enough shut-eye. Not catching enough zzz's doesn't just feel awful, it leads to weight gain over time. One study showed that women who slept less than five hours a night had a 30 percent higher risk of gaining 30 pounds over a 16-year period, compared to those who got a full seven hours. "Lack of sleep causes your hunger hormones to go haywire: It lowers the levels of leptin, which suppresses appetite, and increases ghrelin, which stimulates your appetite," says Peeke. If getting the rest you need is made challenging by, say, menopausal hot flashes, one option to consider is a short course of cognitive behavior therapy, a type of counseling where you're taught new behavioral techniques to help promote sleep. Both menopausal and postmenopausal women who used this technique showed a significant reduction of insomnia two to three months later, according to a study published this past January in the medical journal Sleep. Hormone replacement therapy, certain antidepressants such as low-dose paroxetine (Brisdelle), venlafaxine (Effexor), or escitalopram (Lexapro), or the migraine drug gabapentin (Neurontin) are all also options to discuss with your doctor, says Pinkerton.