I stand in front of the mirror and squeeze myself into pants that no longer button. I turn to the side and notice soft, soft rolls of fat, a new stomach and thin legs. Who is this person staring at me?
I go to the gym at least three times a week, eat a mostly Mediterranean diet, and walk everywhere. Why did I suddenly gain the pounds? And where do these chicken legs come from?
As a middle-aged, menopausal woman, I knew wrinkles were inevitable. I was prepared for brain fog and hot flashes, but the weight gain around my stomach? Nobody had warned me. I tried to gain some confidence about my body but I couldn’t find any. Maybe it was hiding under all that new belly fat.
I did what any other Gen X woman would do and searched the internet for answers. On TikTok, a chiropractor blamed belly fat on miscarriages, and a fitness guru suggested doing endless crunches on Instagram. A doctor on FB swore that magnesium was the answer to my problems. Soon my feeds were flooded with ads for supplements and hacks. There was so much conflicting information that I didn’t know who or what to believe.
So I logged off social media and started doing scientific studies. I’ve found that an increase in visceral fat is fairly common during menopause. According to the SWAN study, the majority of midlife women gain between 4 and 5 pounds over a three-year period.
Curious to find out more, I turned to the experts to learn why this happens and what, if anything, I can do to slow down my stomach rolling.
Where does belly fat come from during menopause?
“Menopausal belly is determined by a decline in estrogen and an increase in follicle stimulating hormone (FSH),” said Dr. Sara Szal, gynecologist and author of Women, Food, and Hormones. When your estrogen levels drop during menopause, you begin to lose muscle mass and gain fat. This creates subcutaneous fat – the soft, jiggly muffin top right under your skin. Visceral fat also develops – deeper fat that surrounds your internal organs such as your liver, stomach and intestines. Along with a drop in estrogen, high levels of FSH – a reproductive hormone – increase fat storage and slow metabolism. This makes it much more difficult to lose weight in midlife.
As estrogen levels continue to decline, your fat is redistributed from other parts of your body and is deposited in your stomach. A meta-analysis of over a million women found that waist circumference increased by 4.6 cm and trunk fat increased by 5.5%, while leg fat decreased significantly by 3.2%. “This is why the legs look thinner as the midsection increases,” Salz said. That explained my chicken thighs.
But that’s only part of the story. According to menopause expert Mary Claire Haver, MD, when you don’t get enough sleep during menopause (and who does?), ghrelin, your hunger hormone, increases. A drop in estrogen levels also reduces leptin, the hormone that tells you when you are full. So not only are you hungrier, but your body isn’t signaling when you’ve eaten enough.
Stress is another culprit. Salt said chronic stress increases the stress hormone cortisol, which contributes to visceral fat, insulin resistance and metabolic syndrome. When you’re stressed, you’re also more likely to make poor meal choices or eat sugary foods. This all leads to inflammation in your body. Inflammation contributes to more belly fat, brain fog, and muscle pain.
And this isn’t just a vanity concern. It’s not just about us gaining a few pounds or going up a few pant sizes. “Visceral fat is dangerous fat,” Salz said. It can increase the risk of breast cancer, dementia, diabetes, heart disease and even sudden death.
How to get rid of belly during menopause
Fortunately, there are steps you can take to shrink your belly during menopause. Forget the hacks you see online and follow these well-researched guidelines from Salz and Haver.
Follow a Mediterranean diet
Why it works: A Mediterranean diet rich in fruits and vegetables, whole grains, nuts, fish and olive oil helps reduce weight and inflammation.
Eat protein
Why it works: Protein maintains muscle, improves bone density and helps satisfy your hunger. Aim for 30 grams of protein per meal.
Add fiber to your diet
Why it works: Fiber is the hidden superpower for the stomach during menopause. It improves insulin sensitivity, reduces inflammation and helps control your appetite. Aim for 25-40 grams of whole plant-based foods daily, including berries, beans, whole grain oats, and legumes.
Avoid sugar
Why it works: Sugar causes inflammation and contributes to the storage of visceral fat. Aim for less than 25 grams of added sugar per day.
Exercise
Why it works: Salt said combining high-intensity interval training (HIIT) with resistance training is the most effective way to improve body composition in postmenopausal women. You need at least 150 minutes a week of moderate-intensity aerobic activity and muscle-strengthening activities twice a week.
Less stress
Why it works: By reducing stress, your cortisol levels decrease. Make sleep a priority, drink less alcohol—it can raise your cortisol levels and affect your sleep—and consider cognitive behavioral therapy. Journaling, meditation, yoga and breathing exercises can also be helpful.
Look into hormone therapy
Why it works: Hormone therapy (HT) increases estrogen levels in your body, which helps redistribute visceral abdominal fat. HT may also improve the vasomotor symptoms of menopause (hot flashes and night sweats), sleep quality, and your mood, which may help you have more energy for consistent exercise.
Debunking the myths
Now that we know what causes menopause belly and what we can do about it, let’s hear what Salt has to say about these menopause belly myths.
Myth 1: Crunches and abdominal exercises reduce belly fat. A selective reduction is not possible. No amount of abdominal work will burn fat.
Myth 2: Eat less, do more cardio and your stomach will loosen. Aggressive calorie restriction in midlife destroys muscle mass and worsens the underlying problem.
Myth 3: Hormone therapy causes weight gain. The evidence shows the opposite: hormone therapy can favorably influence body fat distribution.
Myth 4: It’s just aging – menopause has nothing to do with it. Weight gain is largely age-related, but fat redistribution is particularly driven by menopause.
Myth 5: Nothing you do really works. INCORRECT. Strength training, aerobics, HIIT, Mediterranean diet, sleep and (where indicated) HT, work.
It’s time to change your attitude towards the menopause belly
I’m implementing many of these guidelines and starting to see results, although I’m still unsure of my center. But weight gain during menopause is nothing to be ashamed of. It’s biological, which means it’s not your fault.
“Shame is not a useful lever, nor is longing for the body you had at 30. You won’t lose yourself in it, and you shouldn’t want to,” Salz said.
Your menopausal belly represents everything you’ve been through to get where you are today. And if you have to buy new pants to accommodate all of these life experiences, it’s worth it.
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