Why am I not losing weight after menopause?

You’re going to the same spin class and being meticulous with your portion sizes. So, why are your favourite jeans suddenly feeling tighter? And why does the weight seem to be gathering around your middle?

If this sounds familiar, menopause could be part of the picture. As your hormone levels shift, so can your body’s composition. Add disrupted sleep, hot flushes, and mood changes, and it’s little wonder that losing weight can start to feel like an uphill battle.

But how much of this is down to menopause, and how much is simply getting older? More importantly, what can you do about it? Thankfully, you’ve not got to start running ultramarathons or living off rice cakes to see a difference.

In this article, we cover:

• Why does menopause make it harder to lose weight?
• Why do you gain belly fat during menopause?
• Could something else be stopping you losing weight?
• When should you see your GP?
• How to lose weight during menopause
• What are the best exercises for weight loss during menopause?
• Does HRT help with weight loss?
• What if you’re doing everything right and still not losing weight?
• Do weight-loss injections work during menopause?
   

Why does menopause make it harder to lose weight?

Here’s something you’ve probably heard countless times: your metabolism slows down as you get older. But is that really why it’s harder to lose weight?

Perhaps not in the way you’d expect. In a study following more than 6,400 people, researchers found that the rate of metabolism remains remarkably stable between the ages of 20 and 60, once differences in body size and muscle mass are taken into account. Only after 60 does energy expenditure (burnt calories) start to drop, by roughly 0.7% a year [1].

So, if your metabolism hasn’t suddenly hit the brakes, what’s changed?

1. Lower oestrogen affects body composition

Menopause can change your body shape, even if your weight barely changes. In one major study, the rate at which women gained fat doubled during the menopause transition, while lean mass began to decline [2]. This shift can affect how many calories your body needs, while falling oestrogen levels also encourage fat to accumulate around your waist. Ageing-related changes also play a part.

2. Your sleep takes a hit

Perimenopause isn’t famous for restful nights. Hot flushes and night sweats can leave you tossing and turning, and poor sleep may make losing weight that much harder. In a study following more than 68,000 middle-aged women, those sleeping five hours or less were 32% more likely to gain at least 15kg than those getting seven hours [3]. While the study can’t prove that poor sleep causes weight gain, other research suggests that too little sleep can increase hunger, encourage us to eat more, and may make staying active feel harder [4].

3. You may move less

When you’re exhausted, achy, or feeling low, that evening spin class can suddenly seem much less appealing. One study found that women with more severe menopause symptoms reported doing less exercise in their free time [5]. And when you’re moving less, you’re burning fewer calories.
 

Why do you gain belly fat during menopause?

Before menopause, oestrogen tends to steer fat towards the hips, thighs, and buttocks. As oestrogen levels fall, this pattern starts to change. More fat accumulates around your middle.

But some of this fat sits deeper around the organs, known as visceral fat. Even though you can’t see it, it’s particularly important for your health. Too much can contribute to insulin resistance, making it harder for your body to control blood sugar. It can also promote inflammation and increase your risk of conditions like type 2 diabetes, heart disease, and fatty liver disease [6].

The good news is that visceral fat isn’t fixed. A review involving 5,697 postmenopausal women found that regular exercise reduced body fat, including visceral fat [7]. And don’t fall into the trap of doing endless crunches to shift it. The key is a combination of aerobic exercise and strength training – these can help reduce overall fat while preserving muscle.

Why your waist measurement matters more than you think

Use a tape measure and measure around your middle, halfway between your lowest rib and the top of your hip bone. A handy rule of thumb is to keep your waist below half your height [8]. For example, if you’re 160cm, keep your waist under 80 cm. It’s a simple way to catch changes the scales can sometimes miss.

A result over 0.5 suggests increased fat around your middle, putting you at increased risk of conditions like type 2 diabetes, heart disease, and high blood pressure [8].
 

Could something else be stopping you losing weight?

Menopause might be part of the picture, but it’s not always the whole story. Other health conditions, medications, and everyday habits can also make the weight harder to shift.

Other factors that make weight loss harder:

• An underactive thyroid (hypothyroidism) – Thyroid problems become more common with age, especially in women. Because symptoms of thyroid problems and menopause can overlap, it’s easy to mistake one for the other.
• Certain medications – Some antidepressants, steroids, and diabetes treatments can make weight harder to shift. If you suspect a medication is playing a part, speak to your prescriber rather than stopping it yourself.
• Dietary habits – Larger portions, frequent snacking, sugary drinks, and calorie-dense convenience foods can make it easier to consume more calories than you realise. Stress and disrupted sleep make these foods harder to resist.
• Less everyday movement - Walking to the shops, taking the stairs, and housework all burn energy. If you’re spending more time sitting down, you can end up burning fewer calories than you realise.

Our Weight Loss Blood Test can help identify some underlying conditions that might be affecting your progress, like thyroid disease, diabetes, and hormone imbalances. 
 

When should you see your GP?

If you’re gaining weight unexpectedly, struggling to lose weight despite making changes, or experiencing persistent or concerning symptoms, it’s worth speaking to your GP. Alternatively, you can also opt to see a private menopause specialist. My Menopause Centre is a CQC 'Outstanding' rated clinic with a team of experts ready to help. They can review your symptoms and medications, as well as check for underlying conditions if it’s appropriate.
 

How to lose weight during menopause

There’s no special ‘menopause diet’. What the evidence supports is less glamorous, but it works: build and protect muscle, get good-quality sleep, and lose weight gradually.

Strategies to lose weight through menopause:

• Aim for a modest deficit – Slow and steady is the goal. The NHS suggests 0.5-1kg (1-2 lb) a week as a safe pace [9]. Gentle weight loss, alongside adequate protein intake, helps to protect muscle.
• Prioritise protein – Aim for around 1.2g of protein per kilogram of body weight while losing weight [10]. For a 70kg woman, this is roughly 85g a day. Good sources include fish, lean meats, eggs, Greek yogurt, tofu, and legumes.
• Build meals around foods that keep you full – Fibre-rich plants, pulses, wholegrains, fish, and olive oil. A Mediterranean-style diet is well evidenced for heart and metabolic health.
• Limit refined sugars and alcohol – Cut back on added sugars, sugary drinks, ultra-processed foods, and alcohol. These can all add hidden calories you might not even notice.
• Fix your sleep – Sleep is often overlooked but could have a genuine impact. Start with whatever is wrecking your sleep, whether that’s night sweats, stress, or evening alcohol.

That’s one half. The other important factor is exercise.
 

What are the best exercises for weight loss during menopause?

A combination of cardio and strength training is your best bet.

A meta-analysis found that aerobic and combined training had the greater effects on lowering fat, while resistance training was best for building muscle [7].

Cardio

Aim for at least 150 minutes of moderate activity each week, such as brisk walking, swimming, dancing, water aerobics, rowing, or cycling [11]. If you prefer more intense exercise, 75 minutes of vigorous activity is another option. High-intensity interval training (HIIT) involves short bursts of intense activity followed by recovery periods.

Resistance training

For many women, this part gets forgotten about.

Aim for at least two strength sessions a week, working your major muscle groups. Think squats, rows, presses, and exercises using weights, resistance bands, or your own body weight. Choose a weight you can lift with good form 8-12 times. The last few repetitions should feel like hard work. Gradually increase the weight over time as you grow stronger.

During menopause, declining oestrogen levels can speed up bone loss. Strength training also helps to prevent this, alongside adequate vitamin D and calcium intake [12].

If you’re new to weights, read more about the benefits of strength training for women.
 

Does HRT help with weight loss?

The short answer is no, although HRT may help with some of the changes during menopause.

HRT also doesn’t appear to cause significant weight gain, despite this being a common concern [13].

Research suggests that HRT may help reduce some of the fat accumulation around the middle. One review of 107 trials found that HRT reduced abdominal fat by around 7% and improved insulin sensitivity [14]. However, when researchers looked at women following a six-month weight-loss programme, those taking HRT didn’t lose any more weight or abdominal fat than those taking a placebo [15].

So, what’s the verdict?

HRT is primarily prescribed to relieve menopause symptoms and, in some cases, protect bone health. If it improves your sleep and mood, you might find managing your weight easier too. But weight loss isn’t a sole reason to start HRT.

If you’re weighing up treatment, our guide explains the benefits and risks of HRT in more detail.
 

What if you’re doing everything right and still not losing weight?

If you've been making changes but the weight still isn't shifting, you don't have to keep struggling on your own. Your GP can help identify any underlying health conditions that might be affecting your progress and discuss whether additional support, such as a structured weight-loss programme, could help.

For some women, prescription weight-loss treatments, including injections and tablets, may also be an option. These can be particularly effective for people living with obesity, or those who are overweight with other weight-related health conditions. Your GP can help you explore what's appropriate for you.
 

Do weight-loss injections work during menopause?

Yes, and the evidence is encouraging. Weight-loss injections like Wegovy (semaglutide) and Mounjaro (tirzepatide) can be highly effective, even after menopause.

In an analysis, postmenopausal women taking tirzepatide (at the maximum tolerated dose) lost an average of 23% of their starting weight over 72 weeks [16]. Women before and during menopause saw similar results, suggesting that menopause doesn’t significantly reduce the effectiveness of treatment.

If you’re taking weight-loss injections during menopause:

• Protect your muscles – Some of the weight loss with these medications is lean tissue (including muscle), so make sure you’re getting enough protein and doing regular strength training.
• Let your prescriber know if you’re on HRT – These medications slow stomach emptying, which may affect the absorption of oral progestogens used in HRT [17]. If you're taking both, speak to your prescriber, as your HRT may need reviewing to ensure your womb lining remains protected.

You can read more about how weight-loss injections work in our separate guide.
 

A final thought

If losing weight feels harder than it used to, there’s good reason for that. Menopause changes where your body stores fat, muscle mass can decline, and disrupted sleep and mood changes can make shifting weight that much more challenging. What worked for you at 35 might not work quite as well now.

Fortunately, there are things that can help. Strength training, eating enough protein, and looking after your sleep can all make a difference. For some women, weight-loss medication may have a role too. HRT can also relieve symptoms that make healthy habits easier to maintain.

But perhaps the most important thing to remember? Progress isn’t always reflected on the scales. Feeling stronger, healthier, and more confident, matters too.

 

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References
 

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