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How to Lose Your Menopause Belly

Understand the causes of menopausal weight gain, and learn ways to fight back

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As you hit your mid-to-late 40s, besides battling the occasional hot flash or mood swing, you may notice your favorite black go-to pants are starting to feel more snug. You can blame the dryer for shrinking them only so many times before you admit you may be gaining weight in your belly.

Postmenopausal women are particularly affected by the obesity epidemic and have higher rates of severe obesity compared with their male counterparts, according to the journal Menopause, leaving them at increased risk of obesity-related health conditions. Women gain an average of 5 pounds during menopause, though this weight isn’t directly related to menopause.

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“The weight gain that midlife women experience is largely attributed to the aging process,” says Stephanie Faubion, M.D., director of the Mayo Clinic Center for Women’s Health and medical director of The Menopause Society. “Both men and women gain weight in midlife, and women gain about a pound and a half a year during midlife. This is primarily related to age-related loss in lean muscle mass.”

We lose about 0.8 percent of muscle mass every year starting in midlife, Faubion says, which impacts our weight because muscle burns more calories than fat. “Even when we’re at the gym, we’re burning fewer calories than we did before. But we’re also burning fewer calories when we’re sitting. Overall, our metabolic rate slows, but often we don’t compensate by reducing our caloric intake. The result is that there’s a net weight gain during midlife.”  

What leads to belly fat during menopause?

As you glide through the big M, you may notice something else: Even if the number on the scale is not rising considerably, any weight you do gain accumulates around your abdomen, leaving you with what sure looks like someone else’s beer belly.

Menopause is responsible for a greater redistribution of fat from the periphery to the midsection because your ovaries stop producing estrogen. “We preferentially deposit fat in the middle after we lose estrogen,” Faubion says.  “And that’s related to the effect of estrogen on fat metabolism. So it doesn’t often change the scale … but it changes where the fat goes.”

Health risks of belly fat

This type of fat in the abdomen is toxic. “It produces hormones such as the stress hormone cortisol, as well as inflammatory proteins known as cytokines,” explains Pamela Peeke, M.D., assistant professor of family and community medicine at the University of Maryland School of Medicine 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 sets you up to develop insulin resistance, a factor in the development of heart disease and type 2 diabetes.

Belly fat is associated with a much higher risk of cardiovascular disease, Faubion says. A study released in 2019 showed that having belly fat, even when women’s overall weight was within a normal range, put them at a higher risk for heart attack, stroke and other cardiovascular diseases. “We call that ‘normal weight’ obesity because they have belly fat but they’re still in the normal BMI [body mass index] range,” Faubion says. “[The study] reinforced that carrying belly fat, even if you’re not overweight or obese, is a risk for heart disease.”

How do I get rid of my menopause belly? 

Sounds daunting, but there are proven ways to reverse your scale’s, and your waistline’s, upward spiral. Here’s how:

Exercises for menopause belly

Unfortunately, you can’t solely exercise your way out of the weight gain at midlife because we don’t typically lose weight through physical activity alone, Faubion says. However, it can help you avoid additional gain and maintain your weight. Dietary changes will likely be needed to ensure weight loss during and after menopause. Exercise has numerous other health benefits, including increasing your muscle mass, balance and stamina, which are incredibly important to our health as we age.

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Crank up your workout. If you’re sedentary, starting an exercise program could help not only with weight maintenance but also relieve menopausal symptoms such as hot flashes, according to another study published in Menopause. If you’re already active, you’ll need to push things up a notch.

One way to do this is through a short duration of high-intensity interval training (HIIT), in which 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, such as brisk walking, according to a University of Scranton study. “This doesn’t have to be a lot — it can just be tweaking your morning walk to throw in some hills,” Peeke says.

Add 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 the metabolism-wrecking muscle loss that occurs naturally with age. A 2016 study of postmenopausal 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 with 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 2017 German review that looked at 13 studies concluded that yoga helps relieve menopausal symptoms, including hot flashes.

What should I eat to lose belly fat during menopause? 

There’s no “menopause diet” despite numerous advertisements to the contrary, Faubion says. “Women need to really be careful about simple carbohydrates.” Watch your consumption of bread, rice, pasta and alcohol. “Try to really focus on fruits, vegetables and lean proteins,” Faubion says. She also recommends sticking with healthy fats from olive oil, avocados and nuts, and avoiding animal-derived fats.

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. 

Diet tips to lose belly fat during menopause 

Stop eating after 7 p.m. “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,” Peeke says. “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. 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 with 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,” Peeke says. 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 in which you’re taught behavioral techniques to help promote sleep. Menopausal and postmenopausal women who used this technique showed a significant reduction of insomnia two to three months later, according to a study published in the medical journal Sleep.

Will taking estrogen reduce belly fat? 

Hormone replacement therapy (HRT) will help to control the deposition of fat to your midsection, Faubion says, but it’s not a weight loss drug. Estrogen influences fat metabolism in the abdomen through an effect on the enzyme lipoprotein lipase, but as Faubion explains, HRT isn’t used for this purpose. Taking estrogen will not lead to a change on the scale either up or down. You may get added weight management benefits if you’re on hormones for other reasons, but it’s not recommended to take HRT for weight loss.

Weight loss drugs and menopause 

New weight loss drugs are gaining in popularity, particularly GLP-1 medications, which slow digestion and tell your brain you’re full. Faubion says these drugs may also help menopausal women manage hot flashes, but studies are needed. The Women’s Health Initiative observational study showed that women who lost weight had fewer hot flashes, but the theory needs to be studied further for these newer drugs. 

Editor’s note: This story, originally published July 30, 2018, has been updated to include new information.

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