Weight gain and increased abdominal (belly) fat is common among women at midlife.
However, research suggests that menopause alone does not result in significant weight gain. Weight gain in women at midlife is primarily the result of physical changes that come with ageing, and the lifestyle changes that often accompany them.
These changes can be further influenced by menopausal symptoms such as hot flushes, night sweats, sleep disturbances and mood disorders.
A review published by the Mayo Clinic shows women can prevent weight gain at midlife by adopting healthy lifestyle measures and addressing symptoms associated with menopause.
The review – by the Women's Health Clinic Division of General Internal Medicine and Division of Endocrinology, Diabetes and Nutrition – also recommends that doctors support women by educating them on weight management strategies, offering psychological support and advice on lifestyle and behaviour change.
Jean Hailes endocrinologist Sonia Davison says that while weight gain is common around the time of menopause, "there are many contributing factors".
"We notice that weight gain also tends to occur around the central, or abdominal region, and this can increase the risk of illnesses such as cardiovascular disease, type 2 diabetes, and cancer," Dr Davison says.
Women tend to gain weight as they age, whether they are in menopause or not. On average, women gain about 1kg per year during midlife, regardless of their initial body weight.
This is due to physical changes. Ageing causes a decrease in lean body mass, which slows down the metabolism. This means the rate at which a woman burns calories slows down, so her energy (food) needs decrease.
The decrease in energy needs is often coupled with a decrease in physical activity, so unless a woman not only eats less, but also maintains physical activity, she will gain weight.
"Women often comment to me that they haven't noticed any change in their diet or exercise patterns, but will still put weight on around the time of the menopause, which they find distressing," says Dr Davison.
"At every life stage, we need to make adjustments to ensure our health is on the right track, and menopause is no exception."
Although menopause itself does not seem to cause weight gain, it does influence where the fat is stored.
Postmenopausal women tend to have a greater percentage of body fat around the abdominal area. In fact, belly fat in postmenopausal women accounts for between 15% to 20% of the total body fat, compared with 5% to 8% at premenopause.
Increased abdominal fat in women not only increases the risk of cardiovascular and other diseases, but also increases the occurrence of menopausal symptoms such as hot flushes.
Dr Davison says that alongside the weight gain many women experience around menopause, a woman may also be dealing with bothersome symptoms such as sleep disturbance, mood fluctuations and hot flushes/sweats. Chronic sleep deprivation can lead to reduced physical activity and, in turn, increased weight gain.
As a result, she says, "women may not feel like their 'normal' selves and may struggle to adopt good routines in terms of physical activity and healthy eating".
Dr Davison says there is "no single strategy to tackle the weight gain associated with menopause".
"However, physical activity, and healthy eating, and treating bothersome symptoms will help women on the right path," she says.
"Doing some form of brisk activity on most days of the week will be useful for weight loss and prevent further weight gain; the current recommendations are that women do 150 minutes of brisk activity on a weekly basis."
Weight management around menopause and beyond is about behaviour change; setting up new habits that will help a woman to enjoy a healthy lifestyle. This includes overcoming barriers, problem solving and goal setting. Identifying and addressing any potential non-physical health issues, such as depression and anxiety, is also a critical part of weight management.
Dr Davison encourages women to eat healthily and mindfully. Eating less food, but eating more often, can also help.
"Lowering portion sizes, eating small but frequent meals to maintain metabolic rate, lowering carbohydrate and caloric intake and reducing alcohol intake can all be effective for weight loss," she says.
Find more information on healthy living and weight management at midlife.