“It felt like the weight gain appeared overnight, all around my middle, and nothing seemed to shift it even when I tried eating less and spending even longer at the gym”

Sound familiar? You’re not alone.

Menopause related weight gain is such a common struggle, leaving many women frustrated and confused.  Suddenly your body isn’t behaving the way it used to, and that can be daunting.

When I first meet clients, they often blame themselves for their weight gain. They think they lack the willpower or they don’t have what it takes to make a difference.

When we’re frustrated and uncertain, it’s easy to slip into self-blame, thinking others have it all figured out or we can fall prey to the latest diet trends that promise quick fixes.

However, the truth is, it’s not your fault. And it’s not about trying harder or having more willpower.

There are additional reasons during menopause that can explain what’s happening. It is normal for our body to change during midlife but understanding why can be helpful as it can move us away from self-blame and empower us to focus on a mindset and actions that can make a difference.

How common is weight gain during perimenopause and menopause?

Around 70% of women experience weight gain during the menopause transition and cite this as one of their main concerns.

Research shows the rate of fat gain doubles during perimenopause, often coinciding with muscle loss. On average, women gain about 1 lb per year during this time which can add up over the duration of the menopause transition. For many women, this rate of fat gain slows down post-menopause, although this isn’t always the case.

Why Does it Happen?

There isn’t a single reason for weight gain during menopause, or at any other time in our lifespan, and each woman’s experience is unique.

Factors such as health background, medical conditions, lifestyle, stress levels, medications and genetics all play a role. Plus, we are living in a world where the healthier choices are the more challenging.

Midlife can also be a time of specific emotional and/or practical challenges; caring for elderly relatives, children leaving home or relationship difficulties, which occur alongside hormonal changes and can make managing weight difficult leaving us with little time or energy for self-care.

No one’s situation is the same. Some women may never have struggled with weight before perimenopause, while others may have faced challenges for years which are now heightened.

Despite all these different factors there are some reasons specific to menopause that its helpful to consider. Let’s explore these in more detail.

1. Hormone shifts and declining oestrogen

As we know oestrogen levels fluctuate during perimenopause and it is this chaoti pattern that triggers many of our symptoms.

One of oestrogens jobs in the body is to tell it where to store fat. In our younger years it’s directed to our thighs and hips, which is a healthy storage place. But as our hormones change and oestrogen drops more fat is stored around the stomach.

This shift in where fat is stored can be very frustrating when our clothes don’t fit as they used to but also because deep abdominal fat (visceral fat) is linked to poor insulin sensitivity (see below) and higher risks of conditions like type 2 diabetes, fatty liver disease, and heart disease.

2. Insulin sensitivity and blood sugar control

For some women lower oestrogen levels can also make the body less sensitive to insulin’s action and may lead to insulin resistance.

One of insulin’s jobs in the body is to move sugar out of the blood and into the cells where it’s needed to make energy. When we’re insulin resistant the cells stops listening to this message so we make more and more insulin so the message is louder and sugar is forced out of the blood and into the muscles.

These high insulin levels can lead to more fat storage and weight gain and a viscous cycle can develop. Insulin resistance drives weight gain and weight gain leads to more insulin resistance unless we focus specifically on how to increase insulin sensitivity in the body.

It is also thought that too much fat around our middle makes substances that contribute to chronic inflammation this adds to insulin resistance as well.

Eventually (usually after years) the body can’t keep up with the need to make more and more insulin and so blood sugar levels rise and this is the start of type 2 diabetes.

Understanding the link between storing fat around the middle and insulin resistance is important because it helps us focus on the lifestyle choices that help to increase the bodies sensitivity to insulin.

Fat stored in the liver and pancreas

Fat stored under the skin is called subcutaneous fat. It’s the stuff we can pinch between our fingers and it’s the healthy place to store it.

In recent years we’ve come to understand that everyone has their own ‘personal fat threshold’ which is the level of fat in the body that can be healthily stored under the skin. If we go above this threshold, fat begins to be stored in and around organs like the liver and pancreas and interferes with how they work. Too much fat in the liver and pancreas increases the likelihood of insulin resistance and eventually of developing fatty liver and type 2 diabetes.

3. Hormone Hunger
Oestrogen helps regulate appetite, and as oestrogen drops, many women experience increased hunger and cravings. Disrupted sleep, a common menopause symptom, can exacerbate this by increasing hunger hormones and cravings, particularly for sugary or high-carbohydrate foods.

4. Loss of muscle tissue
As we age, we naturally lose muscle at a rate of 1-2% per year. We may notice these changes as we move through perimenopause. Maybe we’re not as strong as we used to be, we don’t have the same muscle definition, or we can’t do activities in the way we used to.

Protecting and preserving our muscles is extremely important when we’re thinking about managing weight and health but also because of how it shapes our future risk of frailty and quality of life in later years.

Muscle is metabolically active tissue, meaning it burns more energy (calories) than fat, even at rest. So the higher our muscle mass the higher the body’s metabolic rate and the more energy (calories) the body will burn at rest which clearly is helpful for our body composition and weight.

Improved muscle health also improves insulin sensitivity so we can limit the risk of insulin resistance and all the downstream effects this can have (type 2 diabetes, fatty liver and cardiovascular disease).

So when we’re thinking about managing weight, where muscle loss can be an unintended consequence, we need to consider strategies that will optimise muscle health and preserve and build muscle. This is why combining dietary changes like optimising protein intake, ensuring adequate fibre together with resistance training and aerobic activity is so important.

5. Poor Sleep
Insufficient sleep (generally 7 hours or less) and/or poor quality sleep, often experienced during the menopause transition, are linked with weight gain and poor metabolic health.

Sleep deprivation increases hunger hormones, decreases insulin sensitivity and reduces activity the next day. Poor sleep is linked with less healthy food choices and increased cravings for sugary and salty snacks.

We all know that feeling after tossing and turning all night when only a sugary snack and a strong coffee seems to hit the mark.

And the science shows its not all in our heads. We’re less likely to opt for fruits, vegetables and high fibre foods and more likely to turn to sugary and salty foods in part due to changes in hormones that control appetite.

Recognising the link between poor sleep and how it affects our eating and activity habits is important but improving sleep quality and quantity can be particularly difficult for some women during the menopause transition.

Focusing on our sleep hygiene can be a helpful first step (check our this website for help with all aspects of sleep) but if sleep continues to be elusive and its impacting your health and progress its worth having a conversation with your doctor.

It’s also helpful to think through how we’re responding to tiredness and low energy and whether some of our coping strategies might be making sleep less likely going forward. The amount and timing of caffeine and alcohol can be a useful starting point to consider.

6. Stress and Cortisol
Midlife often brings new stressors—whether it’s managing a challenging career, caring for aging parents, children leaving home or other life difficulties.

Stress has been linked to weight gain with increases in hunger hormones and changes to what we eat with higher amounts of ‘comfort’ foods. The effects of stress on eating and weight seem to differ depending on the type of stress and how long it lasts.

We may lose our appetite during bouts of acute stress but long term stress encourages us to want and seek out highly palatable foods which may be due to higher levels of the stress hormone Cortisol. This hormone has also been linked with increased insulin resistance and fat storage although this is complex and not fully understood.

Using relaxation techniques to help manage chronic stress has been shown to improve weight loss as well as mood and anxiety.

Steps That Will Make a Difference

We’ve explored the importance of protecting our muscles and their health, the role of insulin resistance, the value of maximising sleep quality and quantity as well as managing the stress in our lives.

So what can we do to get started on changing these:

To protect muscle health

• Focus on Protein-Rich Meal

Protein helps preserve our muscles as we lose weight, which is essential for a healthy metabolism and it also dampens down our hunger so we feel fuller for longer. Include lean proteins like chicken, fish, tofu, tempeh, pulses/beans, and eggs in every meal to support muscle maintenance and satiety.

• Incorporate Activity & Strength Training

Strength training is one of the most effective ways to combat muscle loss during menopause. Incorporating resistance exercises, whether through weights, bodyweight exercises, or resistance bands, can help maintain muscle mass, boost metabolism, and prevent weight gain. Physical activity can also quickly improve insulin sensitivity and a short 10-15 minute walk after meals can be a particularly helpful strategy.

To improve insulin sensitivity

• Eat Plenty of High Fibre Foods

Fiber-rich foods like vegetables, fruits, whole grains, and beans (pulses) keep your microbiome happy and help control blood sugar levels, improve digestion, and keep you feeling full longer.

• Limit Refined Carbs and Sugar

Eating less refined starchy and sugary foods helps manage insulin sensitivity and prevent fat storage around the middle. Opt for whole grain starchy foods where possible.

• Prioritize Sleep and Stress Management

Quality sleep and stress management are just as important as food choices and activity so prioritising a healthy sleep routine, practice mindfulness or meditation, and trying activities that bring pleasure and relaxation are key.

The Bottom Line

Although changes in weight and shape are common in menopause there are many things we can do to make a difference to how we feel now and in the future. While some of these can be challenging the right support can make all the difference.