Conventional wisdom suggests you can't lose weight after menopause. Research says otherwise.
Advertisement
women bike riding

You've likely heard that weight loss becomes harder the older you get. There is some truth to this. For example, the metabolism of an average 25-year-old is typically higher than that of a 55-year-old. Likewise, a 30-year-old may be able to exercise longer (and thus burn more calories) than a 60-year-old.

When the physical changes from aging are coupled with the hormonal changes brought about by menopause, it may feel like losing weight after menopause is impossible.

"Weight gain is a problem for many women, despite maintaining the same diet and exercise routines that they've had for years," says JoAnn Pinkerton, M.D., executive director of the North American Menopause Society. "Even if the number on the scale doesn't change, women complain of a shift in fat to the midsection after menopause."

Sound familiar? You're not alone.

Here's how to help your body adjust to changes brought about by menopause so that you can keep weight off—and maybe lose a few pounds too.

Menopause and Weight Gain

Most females will gain about five pounds during the menopausal transition, says Pinkerton. While it might not seem like a lot, these five pounds may be compounded by future weight gain or previous weight gain you've been trying to lose.

However, most of these causes are related to aging, not menopause. It just so happens these events all occur at the same time. That's why menopause often gets the blame.

Here are some factors that contribute to weight gain during midlife and menopause.

Body Mass Changes

Your lean body mass, which includes muscle, tends to decrease with age as a result of changes in hormones. This is true for both males and females—and leaves your body without the highly efficient calorie-burning engine of your younger years.

"Because we lose muscle mass with age, we burn fewer calories at rest and also when we exercise," says Pinkerton.

But the decrease in age-related muscle mass, known as sarcopenia, doesn't happen overnight and there are things you can do about it (discussed below). According to a 2020 review in the Journal of Cachexia, Sarcopenia and Muscle, researchers state that muscle mass tends to decline by about 1-2% per year in people over 50. With the loss of muscle mass comes the loss of muscle strength, which tends to decline at a rate of 1.5% between the ages of 50 and 60, and 3% thereafter.

Looking at specifically how menopause affects body composition, a 2022 review in the International Journal of Women's Health suggests that during the menopausal transition, lean body mass decreases by about 0.5%, while fat mass increases by approximately 1.7% per year. Researchers also state that the risk of sarcopenia increases with age, from 1.4% in the 60 to 69-year-old group up to 12.5% in the over-80 group.

Metabolism Slows

Midlife tends to bring a slower metabolism, which means your resting energy usage slips. In other words, the number of calories you burn just while resting is lower after postmenopause than before. "Changes in metabolism after menopause make it more difficult than before menopause to lose weight," says Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women's Health at NYU Langone Health.

While a slower metabolism does come with age, it's not as much as was previously thought, according to a large 2021 review published in Science that included 6,400 participants. Researchers analyzed the energy used during rest, as well as during all types of activity—including planned exercise and activities of daily living—and found that from the ages of about 20 to 60, the metabolism stays fairly consistent. And while metabolism begins to decline after the age of 60, it's still only about 0.7% per year. According to these researchers and the studies they reviewed, the physiological changes—including weight gain—that most people experience as they age is more about lifestyle and body composition changes than a naturally slowing metabolism.

Decreased Estrogen and Higher Levels of Insulin

Insulin is your body's fat-storing hormone. The more insulin you have, the more fat your body retains. Estrogen helps combat spikes in insulin, but when estrogen levels fall, such as before and during menopause, your body has fewer resources to prevent the surge in insulin—and higher levels of insulin can lead to greater fat retention.

In a 2020 review published in Nutrients, researchers looked at 20 years' worth of studies that involved olive oil as a possible benefit to menopause-associated metabolic syndrome, which can happen as a result of the increased insulin levels that occur with menopause. These researchers concluded that the Mediterranean diet, which includes plenty of olive oil, might be a natural way to combat metabolic syndrome that occurs as a result of menopause.

Another way to combat the increase in insulin levels with menopause may be with menopausal hormone therapy. A large 2022 study in The Lancet showed that menopausal hormone therapy helped improve postprandial (after eating) blood glucose levels, as well as belly fat in menopausal females. Hormone therapy isn't for everyone, however, so talk to your healthcare provider to see if you're a good candidate for it.

Menopause Symptoms Worsen Weight Problems

"During the menopause transition, night sweats, sleep disturbances and problems with mood are common and may affect a woman's ability to adhere to a healthy diet and regular exercise program," says Pinkerton. "Whether you are just trying to stay awake or combat a low mood, the candy bar (instead of an apple or a bag of carrots) may seem like a great energy booster."

Similarly, Pinkerton says that an exercise class may be a bit too daunting after a night of not sleeping well. The combination of poor food choices and lack of movement can lead to a gain around your midsection.

Not sleeping well, combined with a poor diet and a lack of physical activity (and everything else that comes with menopause) can also increase stress levels. And chronic stress has also been shown to increase fat around the middle, per a 2018 review in Current Obesity Reports.

Medications Can Lead to Weight Gain

Some medications have also been shown to promote weight gain. For example, in a large 2018 population cohort published in BMJ that followed people for 10 years, researchers found that antidepressants were linked with an increase in the risk of weight gain. According to Pinkerton, antidepressants are a common drug prescribed to females during menopause to help with changes in mood that occur as a result of fluctuating hormones.

Is It Really Harder to Lose Weight after Menopause?

containers

Featured Recipe: Black Bean-Quinoa Bowl

It's possible to lose weight after menopause, but the same tried-and-true techniques of your younger years may no longer work.

"The reality is that weight gain during midlife is common, and about two-thirds of women ages 40 to 59 and nearly three-quarters of women older than 60 are overweight," says Pinkerton. "On average, midlife women gain 1.5 pounds per year. Although this may not sound like much, it adds up over time."

To lose weight post-menopause, it helps to eat fewer calories because your baseline calorie burn has shifted down.

"Postmenopausal women often eat as many calories as when they were younger, as they have long-standing habits that are harder to break," says Julie Upton, M.S., RD, C.S.S.D. "If post-menopausal women cut back on calories and up the intensity of their exercise, they lose weight and tone up, just like younger women. It may be a bit slower, but it happens. It requires long-term adherence as well."

Pinkerton suggests aiming for a 400- to 600-calorie daily deficit. However, Pinkerton adds that calorie-cutting alone likely isn't enough to help you see the results you want. And this is backed up by science.

In a 2017 review in Perspectives on Psychological Science, researchers looked at how reducing calorie intake affected weight loss or gain and concluded that only reducing calories is not the best solution for long-term weight management—and may just induce weight-cycling (aka the weight loss and regain cycle that comes with yo-yo dieting).

One solution? You may also have to increase how much you move. "It's important for midlife women to understand that the rules change in terms of what it will take, not only to avoid weight gain but also to lose weight as we get older," says Pinkerton. "A daily caloric deficit, regular physical activity, low fat intake, consumption of fruits and vegetables, and ongoing behavior support all have been associated with sustained weight loss."

Increasing Exercise May Be a Key to Success

The old adage of eating less and moving more certainly applies to weight loss after menopause, but the ratios may have to shift to see results.

"Cutting calories is necessary for weight loss, but increasing exercise will help sustain weight loss, prevent weight gain and lead to favorable changes in body composition," says Pinkerton. "The general recommendation is 30 minutes of moderate-intensity exercise most days per week."

And you don't have to get that all in one session each day, adds Pinkerton. You can divide it up over two 15-minute high-powered sessions if that helps fit it into your day more easily.

While 30 minutes of moderate exercise a day is a general recommendation, to lose weight and keep it off, the American College of Sports Medicine (ACSM) recommends a little more movement each week than the general recommendation. In their most recent (2009) position statement in Medicine & Science in Sports & Exercise regarding weight loss and regain prevention in older adults, the ACSM states that they recommend 150-250 (or more) minutes a week of moderate-intensity physical activity combined with a moderate reduction in caloric intake (but not a severe restriction in calories) for weight loss. And the same amount of physical activity is recommended to prevent weight regain. You can reduce how long you exercise by increasing the intensity.

Resistance Training

Muscle is your body's energy driver. The more you have, the more energy (calories) you burn, even when you're at rest.

"Starting around age 40, we lose 10 to 15 percent muscle mass and strength every decade," says Upton. "It pays to work out to keep your muscles strong and functional."

If you're pinched for time, a 2019 study in The Journal of Strength and Conditioning Research suggests that there was no significant difference in strength gains between postmenopausal women who performed three sets of 8-12 repetitions of each exercise and those who did six sets.

High-Intensity Interval Training (HIIT)

Another way to get more meaningful physical activity when you're short on time—or if you just prefer higher-intensity exercise—is with HIIT. High-intensity interval training has been a trend that has stuck around—and it isn't just for the younger crowd. It's been shown to also help those who are young at heart.

For example, in a small 2018 pilot study in the journal Menopause, researchers found that the postmenopausal women who participated in HIIT lost twice as much weight, more inches on their bodies and more fat mass compared to those in the endurance-training group.

"Bump up the intensity of your aerobic exercise, slowly at first, until you get in better cardio shape," suggests Upton. "Think about trying high-intensity functional fitness like CrossFit or a boot camp-style workout."

Lifestyle Changes for Losing Weight after Menopause

containers

Eat Less Sugar and White Flour

White sugar and white flour are two of the biggest food culprits for insulin-level spikes. If you reduce them, you may be able to lose weight more easily after menopause and prevent fat storage around the abdomen.

"Eating a diet high in simple carbohydrates—sugar and white-flour foods—leads to weight gain," says Goldberg. "Also, remember that alcohol is sugar and leads to weight gain." Instead of a bagel for breakfast, Goldberg suggests oatmeal and berries. Instead of a grilled chicken sandwich, move that protein to a bed of greens for a salad.

Eat More Fruits and Vegetables

In a 2018 review in Nutrients, researchers found that a higher vegetable intake (greater than four servings a day) was associated with a reduced risk of weight gain.

"After the age of 50, our need for energy—calories—decreases, but we still need the vitamins, minerals and fibers from foods," says Upton. "Make your choices count by selecting nutrient-rich foods."

For example, a 2018 study in Food & Function found that eating more fruits and vegetables may reduce your risk for postmenopausal osteoporosis.

Eat More Protein

While we still need plenty of protein post-menopause to build and maintain muscle, Upton says we need more protein as we get older for other reasons, too, including staving off hunger.

"It is best for our muscles—and to keep hunger in check—if we spread protein throughout the day," says Upton. "Aim for 20 to 30 grams of protein at every meal."

Yogurt, milk, cheese, eggs, fish, poultry and meat are all good choices. And, says Upton, "don't overlook plant-based proteins like soy, nuts, beans and peas."

Menopausal Hormone Therapy for Weight Loss

Many females begin some form of hormone therapy as they near menopause. This treatment helps ease symptoms and transition you more naturally into lower levels of hormones. In addition, some females see weight-loss benefits from hormone therapy.

"Although estrogen used for management of menopause symptoms is not a weight-loss drug, it improves body composition by reducing abdominal fat," says Pinkerton.

According to a 2017 review in Endocrine Reviews, menopausal hormone therapy also delays the onset of type 2 diabetes in women. But, as Pinkerton points out, "it is not U.S. government-approved for this purpose."

For typical menopause symptoms, including night sweats, sleep disruption and hot flashes, the benefits may far outweigh the risks associated with this treatment, says Pinkerton. Lower doses or newer therapy options may be recommended, so talk with your healthcare provider.

Bottom Line

While losing weight after menopause can be more difficult, it is still possible with a little strategic planning. By reducing your total food intake by a few calories, increasing your physical activity, watching your intake of sugar and white flour and increasing your fruit and vegetable intake, you may be able to get ahead of the menopause weight gain. And if you're consistent with your changes, you might even make the second half of your life your healthiest yet.