What is menopause belly?

It can take many women in their 40s and 50s by surprise: You’re eating the same way you’ve always eaten, exercising just as much as you have for years, and yet you start to notice your pants are fitting a little tighter around your midsection. This frustrating realization isn’t all in your head — it’s commonly referred to as “menopause belly” and is a result of the changes your hormones are going through as well as natural aging. We asked the experts why this accumulation of belly fat happens, how much you can expect to gain, and if there’s anything you can do about it.

What is menopause belly?

Though it’s not a medical diagnosis, menopause belly — an increase in belly fat that occurs in the years leading up to and following menopause — is a real thing that can happen as your reproductive system winds down and your hormones go haywire.

First, a note on belly fat. There are two kinds: subcutaneous and visceral. Subcutaneous fat is the pinchable kind that lies just below the surface of the skin. Visceral fat is stored deep within the abdominal cavity, surrounding vital organs such as the liver and pancreas. Too much visceral fat is strongly associated with a higher risk for cardiovascular disease, type-2 diabetes, and heart disease.

During perimenopause and menopause, women can gain both kinds of fat in their midsection. But they tend to accumulate more visceral fat in particular, says Dr. Shamsah Amersi, M.D., an OB-GYN in Santa Monica, California, who specializes in hormone health. In fact, visceral fat increases from between 5 and 8 percent of total body fat in premenopausal women to 15 to 20 percent in postmenopausal women.

What causes menopause belly?

As they age, both men and women tend to gain weight all over for reasons that have nothing to do with menopause. One big reason: Many people become less active as they get older — even time spent doing light activity like walking goes down. You also lose muscle mass through midlife, and since muscle burns more calories at rest than fat does, your metabolism ticks slower and slower.

For women, however, hormones also play a role. Before menopause, normal levels of estradiol, the primary form of estrogen in your body, have a range that tops out at around 300 picograms per milliliter (pg/mL); after menopause, those levels drop to less than 10 pg/mL. This decline in estrogen, in addition to natural aging and lifestyle changes, can contribute to overall weight gain — helping explain why women gain an average of 1.5 pounds per year during the menopausal transition. One reason: Lower estrogen levels can cause sleep-disrupting night sweats, which may impact your hunger hormones and increase your appetite, says Dr. Liz Lyster, M.D., a women’s midlife health specialist and OB-GYN in Foster City, California. Some studies have shown that poor sleep leads to an increase in the hunger hormone ghrelin and a decrease in leptin, which helps regulate appetite (though the research on this is mixed).

Declining estrogen can also impact exactly where you pack on those extra pounds. “During perimenopause and menopause, a significant hormonal shift — primarily the decline of estrogen — profoundly affects fat distribution in women,” says Amersi. She explains that up until menopause, estrogen promotes a more “gynoid” distribution of fat, which is fat on the hips and thighs. As estrogen declines, fat shifts away from the hips and thighs to the midsection, meaning that even if your weight stays the same, where you carry it can change.

Other hormones also impact belly fat. “Women in this phase of life are incredibly busy and often muscling through fatigue, which makes the adrenals produce more cortisol,” says Lyster. (Research has found that cortisol levels significantly increase during the menopause transition.) This doesn’t just impact your mental well-being: “Elevated cortisol levels promote visceral fat accumulation,” says Amersi. Cortisol activates your body’s “fight or flight” response, and in response, your body starts storing fat as visceral fat, which is easier to use as energy than the subcutaneous variety.

What can you do about menopause belly?

You can’t stop aging or avoid menopause’s disruption to your hormones, but there are steps you can take to minimize — and even reverse — stubborn abdominal fat.

Prioritize protein

To build muscle and reduce visceral belly fat, research shows increasing your intake of lean protein (like chicken, turkey, tofu, and nonfat Greek yogurt) while slightly reducing your overall calories can be the perfect approach. Though the Dietary Guidelines for Americans advise that adults should consume at least 0.8 grams of protein per kilogram of bodyweight each day, your protein requirements may be higher during the menopause transition. Working with a registered dietitian (WeightWatchers members have access to one-on-one sessions with nutritionists) can help you zero in on your exact needs.

Strength train

Regular weightlifting and resistance exercises help build muscle mass, which burns more energy (i.e., calories) than fat does. “This helps offset the loss of metabolism caused by aging and decreased estrogen,” says Amersi. And in turn, this helps slow or even reverse weight gain and belly fat. If you aren’t already doing it, try strength-training at least twice a week. This doesn’t have to mean lifting heavy weights; you can use resistance bands or do bodyweight exercises, such as squats and knee push-ups.

Pick up the pace

Cardio is great for your heart health and for keeping your weight in check, but instead of going a steady pace, try adding in some bursts of speed on your walk or run. “High-intensity interval training, or HIIT, is helpful for metabolism,” says Lyster, speeding it up for hours afterward. Characterized by high-intensity bursts of cardio followed by short bouts of rest, HIIT is also a great way to pack a big activity punch into a small amount of time.

Chill out

To keep cortisol-driven visceral fat at bay, Amersi suggests stress-management techniques such as yoga or mindfulness, as well as logging seven to nine hours of sleep per night. “Sleep is foundational,” concurs Lyster. If you can’t improve sleep on your own, talk with your healthcare provider to find out if there’s an underlying physical cause that could be improved with medication.

Can medications help with menopause belly?

Though hormone-replacement therapy (HRT), also known as menopause hormone therapy (MHT), is not prescribed for weight loss, there is some evidence that it can help with menopause belly: Swiss researchers found that women taking hormones had significantly less visceral fat than those that had never taken hormones. Beyond HRT, the group of weight-loss medications called GLP-1 agonists, which include Wegovy (semaglutide) and Zepbound (tirzepatide), have demonstrated significant efficacy in reducing visceral fat. Your doctor will be able to talk through your medication options — both HRT and weight-loss drugs — to see if one might be a good fit.