One of the most common (and frustrating) changes women notice in midlife is weight gain—especially around the midsection. I know this firsthand: when I entered perimenopause, I was shocked at how quickly weight started to gather in my belly, even though my habits hadn’t really changed. Losing it has been far more difficult than I expected, and that frustration is something I hear echoed by other women. This isn’t just about aesthetics; it’s rooted in biology and has important health implications.
Hormonal Changes Drive Redistribution of Fat
Estrogen decline: Estrogen plays a key role in regulating fat distribution. Before menopause, women tend to store fat in the hips and thighs. As estrogen levels drop in perimenopause and menopause, fat storage shifts toward the abdominal area.
Studies confirm that the drop in estrogen during the menopausal transition plays a central role in shifting fat storage from the hips and thighs to the abdominal region, specifically increasing visceral fat. Unlike subcutaneous fat, visceral fat is metabolically active and strongly associated with inflammation, insulin resistance, and higher cardiovascular risk. A longitudinal study found that women who transitioned into menopause had a significant rise in visceral abdominal fat, directly correlated with declining estradiol levels (Lovejoy et al., 2008). A 2019 meta-analysis of 11 studies confirmed these findings, reporting a consistent and significant increase in visceral fat area during and after menopause (Ambikairajah, et al., 2019).
Changes in Muscle Mass and Metabolism
From the mid-30s onward, women naturally lose muscle mass—a process called sarcopenia. This accelerates during menopause due to lower estrogen and growth hormone levels.
Muscle is metabolically active, so with less lean mass, resting metabolic rate decreases—meaning women burn fewer calories at rest (Lovejoy, 2009). Without adjustments in nutrition or activity, this naturally leads to weight gain.
Insulin Resistance and Blood Sugar Changes
Menopause is associated with an increased risk of insulin resistance, which makes it harder for the body to regulate blood sugar.
Recent research shows that the decline in estrogen during menopause drives fat storage toward the abdominal region, and this central adiposity is strongly associated with higher risks of insulin resistance, type 2 diabetes, and metabolic syndrome (Ambikairajah, et al., 2019).
Stress, Cortisol, and Sleep Disruption
Many women experience sleep disturbances (night sweats, insomnia) and heightened stress during menopause. Cortisol not only encourages fat storage in the belly, but also increases cravings for high-calorie, high-sugar foods.
Lifestyle and Aging Factors
Reduced physical activity, changes in diet, and the natural slowing of metabolism with age all contribute. Women in midlife often juggle career, caregiving, and family responsibilities—leaving less time for structured exercise or recovery, which further compounds weight gain.
What Can Help?
Strength Training: Preserves lean muscle mass and boosts metabolism. Studies show resistance training significantly reduces abdominal fat in postmenopausal women.
Protein Intake: Higher protein diets help preserve muscle and regulate appetite.
Aerobic Exercise + HIIT: Improves insulin sensitivity and helps reduce visceral fat.
Stress & Sleep Management: Prioritizing sleep and using stress-reduction tools (like the Calm app) can help regulate cortisol.
Balanced Nutrition: Emphasizing whole foods, fiber, and reduced refined carbs supports metabolic health.
Midsection weight gain in perimenopause and menopause isn’t about “willpower”—it’s the result of complex hormonal, metabolic, and lifestyle changes. Understanding the science behind it helps remove blame and empowers women to take evidence-based steps to protect their health. With the right strategies, it’s possible not just to manage weight, but to build strength, resilience, and long-term wellness in midlife.
If you want more information about Menopause, check out my post Menopause 101: What to Expect and How to Prepare.
Resources:
Ambikairajah, A., Walsh, E., Tabatabaei-Jafari, H., & Cherbuin, N. (2019). Fat mass changes during menopause: a metaanalysis. American journal of obstetrics and gynecology, 221(5), 393–409.e50. https://doi.org/10.1016/j.ajog.2019.04.023
Lovejoy, J. C., Champagne, C. M., de Jonge, L., Xie, H., & Smith, S. R. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. International journal of obesity (2005), 32(6), 949–958. https://doi.org/10.1038/ijo.2008.25
