Body changes in menopause: why they happen and healthy habits

It is common, but not inevitable. Muscle mass decreases with age and energy expenditure declines, so the same diet may result in a small calorie surplus. Sleep disturbances, stress, hot flushes and lower levels of daily activity can also play a role.

Ageing appears to be the main factor responsible for weight gain, while menopause particularly favours the redistribution of fat towards the abdominal area. The Menopause Society

Estimates vary considerably. Prospective studies commonly report an average increase of approximately 0.5–0.7 kg per year during midlife. One five-year study found a mean total weight gain of 2.1 kg, although there was considerable individual variation. Prospective study on PubMed

Not all women gain weight. In addition, body weight may change very little while body fat increases and muscle mass decreases. The SWAN study showed that fat gain accelerates approximately two years before the final menstrual period and continues until around two years afterwards. SWAN study, funded by the NIH

Declining oestrogen levels favour a shift from predominantly subcutaneous fat storage — around the hips and thighs — towards greater abdominal and visceral fat accumulation.

Other contributing factors include:

• Loss of muscle mass and lower energy expenditure.
• Reduced physical activity.
• Sleep disturbances.
• Stress and changes in mood.
• Insulin resistance and age-related metabolic changes.

Visceral fat is of greater clinical relevance because it is associated with type 2 diabetes, changes in cholesterol levels, high blood pressure and fatty liver disease.

The best overall approach is to combine:

• Aerobic exercise: at least 150 minutes per week at moderate intensity, such as brisk walking, swimming or cycling.
• Strength training: two or more days per week, working the major muscle groups.
• Daily activity: walking, taking the stairs and reducing the amount of time spent sitting.

Aerobic exercise is particularly helpful for reducing body fat and waist circumference, while strength training helps maintain or increase muscle mass, strength and energy expenditure. Combining both provides greater overall benefits than relying on a single type of exercise. Scientific document from the International Menopause Society

For weight loss, exercise generally needs to be combined with a moderate and sustainable reduction in energy intake.

A restrictive diet is not necessarily required, but it can be helpful to adapt its composition and energy density:

• Approximately 1–1.2 g/kg/day of protein, unless medically contraindicated.
• Vegetables, fruit, pulses, nuts and whole grains as sources of fibre.
• A Mediterranean dietary pattern as the foundation.
• Adequate calcium and vitamin D.
• Fewer sugar-sweetened drinks, alcoholic beverages, processed meats and ultra-processed foods.
• Avoid extreme calorie restriction that may promote muscle loss.

The International Menopause Society considers perimenopause an appropriate stage of life for early intervention in diet, exercise and body composition. Official IMS recommendations

Yes. Menopause does not prevent weight loss. It may be somewhat more difficult because of lower muscle mass, reduced energy expenditure and sleep problems, but body fat and abdominal fat can respond to sustained changes in diet and physical activity.

The most effective approach usually includes:

1. A moderate, personalised calorie deficit.
2. Strength training to preserve muscle mass.
3. Aerobic activity and regular daily movement.
4. Adequate protein and fibre-rich foods.
5. Seeking medical advice for insomnia, sleep apnoea or menopausal symptoms where appropriate.

HRT may modestly influence body fat distribution in some women, but it is not recommended solely for weight loss. If weight gain is rapid or unexplained, it is advisable to rule out hypothyroidism, sleep apnoea, diabetes, medication-related effects or other medical causes.

Follow the directions for use on the label and do not exceed the recommended daily intake. Food supplements should not be used as a substitute for a varied and balanced diet and a healthy lifestyle. If you are taking medication or have a health condition, speak to a healthcare professional before starting any food supplement.