Does my weight and metabolism change during menopause?
During menopause, the rate of fat gain doubles and you lose muscle mass, even if the scales do not show it. The fat shifts toward your abdomen, which affects your metabolism. More exercise and a healthy diet demonstrably help, and hormone therapy may be an option for some women after consulting a doctor.
During menopause, the rate at which your fat mass increases doubles. This begins at the start of menopause and continues until about two years after your last period. After that, the rate drops back to zero. At the same time, you lose muscle mass. Because these two processes cancel each other out, your weight on the scale appears to barely change.
What does change clearly is where the fat ends up. Due to falling oestrogen levels, your body stores more fat around the abdomen -- so-called visceral fat (deep inside the abdominal cavity) -- rather than on the hips and buttocks. This is a consistent finding from multiple human studies. Visceral fat increases the risk of cardiovascular disease and metabolic disorders.
The loss of oestrogen also affects your fat metabolism. Visceral fat releases more fatty acids than your liver and muscles can handle. As a result, the genes responsible for fat burning become less active. This can lead to insulin resistance and a higher risk of type 2 diabetes. How large this effect is for any given individual is something science cannot yet say precisely1,2,3,4,5.
Midlife weight gain has three simultaneous causes: hormonal changes due to menopause, normal ageing that lowers your energy expenditure, and lifestyle factors such as reduced physical activity. A healthy diet and sufficient exercise make a measurable difference both during and after menopause.
There are indications that oestrogen therapy can partly counteract the menopause-related changes. Studies show less abdominal fat, lower total fat mass and a reduced risk of type 2 diabetes, particularly when treatment is started early, before the age of sixty2,6,4. However, hormone therapy also carries risks and is not suitable for everyone. Discuss this personally with a doctor.
Based on multiple human studies, including long-running cohort studies. The findings on fat gain, muscle loss and the shift toward abdominal fat are consistent and come from several independent sources (PMID 30843880, 22978257, 38416337, 28333235, 34960109). Findings on hormone therapy are based on a smaller set of studies (PMID 22978257, 35526556, 28333235) and are somewhat less certain. No meta-analyses were used as a direct source.