Why Does Belly Fat Increase During Menopause?

One of the most common complaints in my practice is weight gain during menopause. This is no surprise, as 60% to 70% of menopausal women experience weight gain¹. Women typically gain about 1.5 pounds per year during their 50s, regardless of their baseline weight or ethnicity².
More frustratingly, unlike pre-menopause when excess weight tends to accumulate around the thighs and hips, menopause often brings weight gain around the waistline—the so-dreaded belly fat. Also called visceral fat, belly fat can increase from up to 8% of total body fat in the premenopausal years to as much as 20% post-menopause².
In this blog post, I explore why this happens and what you can do to mitigate it. Let’s dive in and find ways to manage these changes together.

Why does belly fat increase during menopause?

HORMONAL CHANGES

Drop in oestrogen

• Oestrogen controls adiposity and promotes excess fat to be stored subcutaneously (under the skin) . During menopause, oestrogen levels drop substantially, facilitating fat storage around the waist as opposed to subcutaneously.³
• Oestrogen plays a role in regulating the hormones ghrelin and leptin, which are crucial for appetite control and energy balance.
  • Ghrelin, often referred to as the “hunger hormone,” is produced primarily in the stomach and stimulates appetite, increasing food intake and promoting fat storage. Oestrogen has been shown to suppress ghrelin levels. During periods of high oestrogen, such as in the follicular phase of the menstrual cycle or during pregnancy, ghrelin levels are typically lower, which helps in reducing appetite.
  • Leptin, known as the “satiety hormone,” is produced by adipose (fat) tissue and helps regulate energy balance by inhibiting hunger, thus promoting weight maintenance. Oestrogen increases the sensitivity of the brain to leptin. This means that when oestrogen levels are high, the body is more responsive to leptin’s signals of satiety, helping to control food intake and maintain body weight.⁴
  • Lower oestrogen levels during menopause mean higher levels of ghrelin , increasing appetite and potentially leading to weight gain and lower leptin sensitivity, making it harder to feel full and satisfied after eating.

Higher circulating testosterone

• The decline in oestrogen disrupts the balance between oestrogen and testosterone. While the absolute levels of testosterone may not significantly increase, the ratio of testosterone to oestrogen becomes higher because of the substantial drop in oestrogen levels.
• Reduced Sex Hormone-Binding Globulin (SHBG) , a protein that binds to sex hormones and regulates their availability in the body, which means more free (unbound) testosterone is available in the bloodstream.
• The body continues to produce androgens (precursors to testosterone) from the adrenal glands and ovaries. In postmenopausal women, these androgens can be converted to testosterone, further contributing to higher circulating levels.
• Testosterone is associated with fat accumulation around the waist⁵.

Higher levels of cortisol

Menopause is often accompanied by increased physical and emotional stress due to hormonal changes, sleep disturbances, and life transitions. In response to stress, the adrenal glands produce more cortisol. Chronic stress leads to consistently high levels of cortisol in the bloodstream.

• Cortisol influences the storage of fat, especially in the abdominal area. This is because visceral fat cells have a higher concentration of cortisol receptors compared to subcutaneous fat cells.⁶
• High cortisol levels can lead to insulin resistance, a condition where cells become less responsive to insulin. Insulin resistance is associated with higher blood sugar levels and increased fat storage, particularly in the visceral region.⁷ Insulin resistance can create a vicious cycle, where increased visceral fat further exacerbates insulin resistance and high cortisol levels, leading to even more fat accumulation.
• Cortisol can increase appetite and cravings for high-calorie, high-fat, and sugary foods. This is partly due to its effect on other hormones, such as ghrelin and leptin.⁸
• Stress-induced eating behaviours are often exacerbated during menopause, contributing to weight gain and accumulation of visceral fat.⁹

Decreased metabolism paired with lower physical activity levels

• Metabolism tends to slow down with age, and this is often accelerated during menopause. Aging and lower levels of physical activity during menopause contribute to the loss of muscle mass. Since muscle tissue burns more calories than fat tissue, losing muscle mass can further decrease metabolic rate and increase fat accumulation.
• Many women become less physically active during middle age due to various reasons, including increased responsibilities, health issues, or lack of motivation. Reduced physical activity contributes to weight gain and increased abdominal fat.¹⁰

Poorer sleep quality

Poor sleep quality during menopause is a common issue driven by hormonal changes, psychological factors, physical discomforts, sleep disorders, and lifestyle habits. A night of poor sleep often results in food cravings, usually for foods high in fat and sugar. Furthermore, lack of sleep results in a lack of energy to practice physical activity, all contributing to weight gain and visceral fat accumulation.

What are the health risks of belly fat

Contrary to subcutaneous fat, visceral or belly fat is located deep within the abdominal cavity, surrounding important internal organs such as the liver, pancreas, and intestines. This close proximity allows visceral fat to directly affect the functioning of these organs. Visceral fat has higher metabolic activity, contributing to chronic inflammation, insulin resistance, cardiovascular disease, non-alcoholic fatty liver disease, and increased risk of type 2 diabetes.¹¹

A study by Gambacciani et al. found that an 8 to 20-pound increase in body weight in women aged between 34 and 59 increased the risk of cardiovascular disease by 27% compared with women who maintained their baseline weight.¹²

How to mitigate weight and belly fat gain during menopause?

1. Focus on a Balanced Diet

• Eat More Protein: Protein helps preserve muscle mass and increases feelings of fullness. Include lean meats, fish, beans, tofu and legumes in your diet.
• Increase fibre Intake: Fibre-rich foods like vegetables, fruits, whole grains, and legumes can help control appetite and improve digestion.
• Eat Healthy Fats: Incorporate healthy fats from sources like avocados, salmon, mackerel, sardines, nuts, seeds, and olive oil. These fats can help reduce inflammation and support cardiovascular health.
• Strive for 30 plant foods per week: Eating a diverse array of 30 different plant foods weekly can provide essential nutrients, balance hormones, support bone and heart health, manage weight, enhance digestion, and improve mood and cognitive function during menopause. This approach not only helps alleviate menopausal symptoms but also promotes overall health and vitality. These can include fruits, vegetables, nuts and seeds, grains and legumes.
• Eat more phytoestrogens: Phytoestrogens are plant compounds that mimic the effects of oestrogen in the body, potentially helping to alleviate menopausal symptoms. Phytoestrgens are found in soy products (Tofu, tempeh, edamame, and soy milk), flaxseeds, and legumes (Chickpeas, lentils, and beans).
• Reduce Sugar and Refined Carbs: Limit intake of sugary foods and beverages, as well as refined carbohydrates like white bread and pasta, which can spike blood sugar levels.
• Stop drinking alcohol and limit caffeine consumption: alcohol is high in calories and alongside caffeine, disturbs sleep, hence may promote weight gain.
• Eat more Antioxidant-rich and anti-inflammatory Foods: Antioxidants help combat oxidative stress and inflammation. Fruits, vegetables, nuts and seeds, herbs and spices, green and white teas all contain powerful antioxidants.

2. Stay Physically Active

• Cardiovascular Exercise: Engage in regular aerobic activities like walking, jogging, swimming, or cycling to improve heart health.
• Strength Training: Incorporate resistance exercises to build and maintain muscle mass, which helps boost metabolism. Aim for at least two strength-training sessions per week.
• Flexibility and Balance: Activities like yoga and Pilates can improve flexibility, balance, and core strength, which are essential for overall fitness and well-being.

3. Manage Stress

• Mindfulness and Meditation: Practice mindfulness, meditation, or deep-breathing exercises to reduce stress and lower cortisol levels.
• Adequate Sleep: Ensure you get 7-9 hours of quality sleep per night. Poor sleep can disrupt hormones that regulate hunger and appetite.

4. Hormone Therapy

Where symptoms are persistent, it is worth discussing with your doctor the potential benefits and risks of hormone replacement therapy (HRT), which may help manage menopausal symptoms for some women.

Disclaimer: this article is for educational purposes only and should not replace medical advice.

References:

1. Baker, F. C., Lampio, L., Saaresranta, T., & Polo-Kantola, P. (2018). Sleep and sleep disorders in the menopausal transition. Sleep medicine clinics, 13(3), 443-456.
2. Karvonen-Gutierrez, C. and Kim, C., 2016, July. Association of mid-life changes in body size, body composition and obesity status with the menopausal transition. In Healthcare (Vol. 4, No. 3, p. 42). MDPI.
3. Brown, L.M. and Clegg, D.J., 2010. Central effects of estradiol in the regulation of food intake, body weight, and adiposity. The Journal of steroid biochemistry and molecular biology, 122(1-3), pp.65-73.
4. Smith, A., Woodside, B., & Abizaid, A. (2022). Ghrelin and the Control of Energy Balance in Females. Frontiers in endocrinology, 13, 904754. https://doi.org/10.3389/fendo.2022.904754
5. Janssen, I. et al. (2010) Testosterone and Visceral Fat in Midlife Women: The Study of Women’s Health Across the Nation (SWAN) Fat Patterning Study. Obesity (Silver Spring, Md.). [Online] 18 (3), 604–610.
6. van der Valk et al., (2018). Stress and Obesity: Are There More Susceptible Individuals?. Current obesity reports, 7(2), 193–203. https://doi.org/10.1007/s13679-018-0306-y
7. Adam, T. C., et al (2010). Cortisol is negatively associated with insulin sensitivity in overweight Latino youth. The Journal of clinical endocrinology and metabolism, 95(10), 4729–4735. https://doi.org/10.1210/jc.2010-0322
8. Chao, A. M., et al (2017). Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring, Md.), 25(4), 713–720. https://doi.org/10.1002/oby.21790
9. Yau, Y. H., & Potenza, M. N. (2013). Stress and eating behaviors. Minerva endocrinologica, 38(3), 255–267.
10. Dąbrowska, J., et al., (2015). The role of physical activity in preventing obesity in midlife women. Przeglad menopauzalny = Menopause review, 14(1), 13–19. https://doi.org/10.5114/pm.2015.49252
11. Mitrovic, B. et al. (2023) Non-alcoholic fatty liver disease, metabolic syndrome, and type 2 diabetes mellitus: where do we stand today? Archives of medical science. [Online] 19 (4), 884–894.
12. Gambacciani, M., et al., (1997). Body weight, body fat distribution, and hormonal replacement therapy in early postmenopausal women. The Journal of Clinical Endocrinology & Metabolism, 82(2), pp.414-417.