The truth about menopause and weight gain

For many women, midlife weight gain feels almost unavoidable. While menopause is often blamed, the answer is more nuanced. Hormonal changes, aging, sleep patterns and lifestyle can all influence weight, health and how women feel during perimenopause, the transitional time leading up to menopause.

“Once perimenopause begins, many women notice changes in their weight,” says Nebraska Medicine OB-GYN Marcela Pineda, MD. “On average, women gain about a pound and a half per year during this stage. Over just a few years, that can easily add up to five to 10 pounds.”

Why the body changes

The most significant changes usually happen during the first year of menopause. This is when fat distribution changes and moves away from the hips and thighs and settles around the abdomen and organs.

“That type of fat is concerning because it increases cardiovascular risk,” says Dr. Pineda. 

At the same time, women often lose lean muscle mass, flexibility and strength. These changes make it easier to gain weight and harder to stay active unless there’s an emphasis on exercise and mobility.

The impact of sleep and mood

Another hidden factor is sleep. Poor or disrupted sleep is common during perimenopause and menopause, and it can have a major impact on appetite and food choices. 

“When we don’t sleep well, it’s almost like our brains say, ‘I deserve to eat whatever I want because I’m exhausted,’” says Dr. Pineda.

Good sleep also helps regulate hormones that tell the body when it’s full. Without it, women may feel hungrier and less satisfied after meals. When mood changes such as anxiety and depression come in, it’s easy to see why lifestyle habits can shift during this time.

Recognizing the signs

Menopause is diagnosed after 12 consecutive months without a menstrual period, but symptoms often begin years earlier. 

“Menopause is a retrospective diagnosis,” explains Dr. Pineda. “You’re considered menopausal after your period stops, but that doesn’t mean symptoms weren’t happening earlier.”

Early signs may include:

• Fatigue.
• Soreness.
• Sleep changes.
• Decreased hearing.
• Irregular periods.
• Mood shifts like anxiety and depression.

“It’s easy to blame some of these symptoms on busy lifestyles, like raising kids or stressful jobs, but many are tied to perimenopause,” says Dr. Pineda.

Hot flashes and vaginal dryness were once thought to be early indicators but are now recognized as later symptoms.

“Some women go through menopause earlier, while others continue to have periods into their 50s,” says Dr. Pineda. “Both are normal.”

Supporting long-term health

Nutrition and exercise play critical roles during this transition. Calcium and vitamin D needs increase during menopause, making bone health a top priority. Diets rich in fiber, lean protein, plant protein and unprocessed foods can help maintain energy and support overall health.

Exercise is equally important. “This is the time to think ahead to who we want to be in our 60s, 70s and 80s,” explains Dr. Pineda. “Exercise helps prevent frailty, keeps bones strong and supports independence later in life.”

Strength training can counter muscle loss while boosting metabolism. Pairing it with mobility and cardio exercises creates a well-rounded approach. 

Medications and menopause

With the popularity of GLP-1 medications (such as semaglutide and Mounjaro®) for weight management, some women wonder if they’re helpful during menopause. Dr. Pineda explains that this research is still limited. 

“The goal isn’t aggressive weight loss,” she says. “It’s about preventing excessive weight gain, maintaining muscle and protecting bone strength.”

A new phase

The most important takeaway is shifting the mindset around menopause. Menopause is about adapting to a new stage of life.

“Just like when we go through puberty, we don’t expect to keep our prepubescent bodies forever,” says Dr. Pineda. “In the same way, we need to acknowledge that menopause changes us, but we’re still the same women – just in a new phase.”

Weight gain during menopause is common but not inevitable. By focusing on diet, consistent exercise, good sleep and long-term bone health, women can feel empowered during this new stage.