Does my weight and metabolism change during menopause?

During menopause, body composition changes dramatically, even when the scales often fail to show it. The rate at which fat mass increases doubles at the start of menopause and continues until roughly two years after the last menstrual period, after which the pace drops back to zero. At the same time, the body loses muscle mass. Because both processes largely cancel each other out on the scales, weight appears barely to change. Weight gain in midlife itself is largely a consequence of ageing and lifestyle, not of menopause alone.

Where fat is stored does shift noticeably. As oestrogen levels fall, the body stores more fat around the abdomen (visceral fat, the fat deep inside the abdominal cavity) rather than on the hips and buttocks. This is a consistent finding from multiple studies and is relevant because visceral fat raises the risk of cardiovascular disease and metabolic disorders. This abdominal fat effect is considered likely to be caused by the hormonal change itself.

The loss of oestrogen also impairs fat metabolism. Visceral fat releases more free fatty acids that the liver and muscles are less able to burn, because the genes responsible for fat oxidation become less active. This can lead to insulin resistance and an increased risk of type 2 diabetes. The precise mechanism is reasonably well described, but the magnitude of this effect in individual women has not been precisely quantified in the available studies.

Weight gain in midlife is therefore the result of three interacting factors: menopause itself (hormonal change), the normal ageing process that reduces energy expenditure, and lifestyle factors such as reduced physical activity. This distinction matters in practice: it means that a healthy diet and sufficient exercise can make a measurable difference during and after menopause, precisely because lifestyle makes an independent contribution.

There is evidence that oestrogen therapy (hormone therapy) can partly counteract menopause-related changes in body composition: studies show less abdominal fat, less total fat mass and a lower risk of type 2 diabetes in women who use it. Starting early, preferably before the age of sixty, appears to be relevant in this regard. Hormone therapy is not without risks, however, and is not suitable for every woman. Whether and when this is an option for you requires a personal conversation with a doctor.