Here's what a weight management doctor has to say about maintaining a healthy weight—and losing weight—after menopause.

Hot flashes, trouble sleeping and mood swings. Welcome to menopause. But what's up with the weight gain? Do you feel like you eat healthfully and workout but now there's a layer of fat around your stomach that wasn't there before? You aren't alone.

Menopause weight gain is fairly common, and while some of it is hormonal or related to genetics, there are lifestyle factors you can control to help stop the gain and lose the weight. We spoke to Dr. Richa Mittal, MD, founder and medical director of Radiant Health, to learn why women gain weight during menopause and how to lose it.

Why do women gain weight during menopause?

Not everyone gains weight during menopause, but most women notice a redistribution of weight, says Dr. Mittal. "Due to hormonal changes that occur during this time, a reduction in estrogen, progesterone and testosterone, there is an increase of fat deposition in the mid-section/abdominal area," she says. This is the not-so-healthy fat called visceral fat. Dr. Mittal explains, "An increase in visceral fat is associated with increased inflammation, including development of insulin resistance, which can lead to increased risk for heart disease and type 2 diabetes, high-blood pressure and even certain cancers, like endometrial and post-menopausal breast cancer."

"In addition to hormonal changes, with age, there is a natural reduction in the basal metabolic rate and in muscle mass, leading to weight gain and increased body fat percentage," says Dr. Mittal. According to studies, muscle mass decreases about 3 to 8% per decade after age 30, and the rate of muscle loss is even higher after age 60. Muscle is metabolically active, meaning that it burns calories (even if you're sitting all day). When you lose muscle, the number of calories you burn at rest decreases. "If food intake and physical activity remain the same, women can notice weight gain," Dr. Mittal explains.

Finally, along with hormonal changes and loss of muscle, changes to eating patterns and reduced physical activity can lead to menopause weight gain, especially weight gain in the stomach area, says Dr. Mittal.

Mature woman working out outside
Credit: Getty Images / adamkaz

How to prevent menopause weight gain and lose the menopause weight

While you can't control genetics or hormones, per se, you do have control over lifestyle factors including diet, exercise, stress and sleep. Dr. Mittal breaks them down here.

1. Eat more whole foods while cutting back on ultra processed items

"It is important to focus on including an abundance of fruits and vegetables, lean proteins and plant-based protein sources like tofu, beans and lentils and small amounts of heart-healthy unsaturated fats like nuts, seeds and olive oil," says Dr. Mittal. And while some processed foods are okay, it's best to limit ones that don't add much value to your day. "Limit ultra-processed foods that provide convenience, but most of the time do not offer much nutritional value but pack a lot of calories. Frequently, sugar-sweetened beverages, yes even that favorite treat from your local drive through coffee shop, are sources of added sugar, often leading to exceeding the World Health Organization (WHO) recommendation of limiting added sugar for women to 25 grams daily."

2. Prioritize exercise—including strength training

"To counteract the decrease in lean body muscle mass, it is important to include weight training two days per week, in addition to meeting minimum guidelines for moderate physical activity of 150 minutes per week. The increase in muscle mass not only helps with appearance, it helps to maintain metabolic rate and help improve insulin sensitivity, reducing risk for type 2 diabetes," says Dr. Mittal.

Lifting weights will not make you bulky but instead will increase the number of calories burned at rest, which will make losing and maintaining weight loss much easier. Cardio exercise alone could lead to loss of muscle. If you don't use it, you lose it.

3. Try to stress less

"Stress and sleep are very important factors that affect a multitude of hormones that affect metabolism—cortisol, insulin, ghrelin and leptin, just to name a few!" says Dr. Mittal. "Stress not only affects hormones that can lead to weight gain, but can also make us cope by turning to 'comfort foods' that are calorie-dense and lead to weight gain. Medications like steroids, beta-blockers, certain medications used for depression and other mood disorders, as well as diabetes medications like insulin, can contribute to weight gain. It is important to not stop medications on your own, but to work with your healthcare provider to find weight-neutral options if this is an issue."

Breathing, meditation and exercise can help lower stress, as well as delegating tasks in your personal or work life and setting boundaries.

4. Get 7 to 8 hours of sleep a night

"From observational data, less than 6 hours of sleep is associated with an increased body mass index (BMI) and 7 hours appears to be the goal to hit," explains Dr. Mittal. Lack of sleep can increase ghrelin (the hormone that tells you you're hungry) and decrease leptin (the hormone that tells you that you're full). This is why you may find yourself snacking more when you are tired.

Aim to get 7 to 8 hours of sleep per night and if it's proving difficult to do so, set systems in place to help like charging your phone outside the bedroom, getting an alarm clock and turning off screens after a certain time.

Bottom line

During menopause, hormone levels change, which can lead to weight gain. Prioritize balanced meals, sleeping 7 to 8 hours per night, managing stress and incorporating strength training into your exercise routine to help halt the menopause weight gain and lose belly fat.