November 04, 2025
3 min read
Key takeaways:
- Menopause itself may not trigger weight gain, but rather the aging process.
- Hormonal changes during menopause can cause the body to redistribute this extra weight.
- Management requires a patient-centered approach.
The menopausal transition is a pivotal time in women’s health, bringing about profound hormonal, metabolic and physiologic changes.
For many women, this stage of life raises new concerns about weight regulation, cardiometabolic health and overall well-being. Understanding how menopause influences these factors is essential for both patients and providers.
Hormonal shifts and metabolic health
A decline of estrogen, particularly 17 beta-estradiol, has the greatest impact on weight regulation and cardiometabolic risk. Loss of estrogen contributes to increased insulin resistance, greater central adiposity and lower energy expenditure.
Estrogen has both central and peripheral effects. Centrally, estrogen regulates satiety and energy expenditure, and loss of estrogen results in increased appetite and decreased energy expenditure. Peripherally, estrogen deficiency promotes insulin resistance and impairs lipid metabolism.
With the hormonal changes that occur in menopause, we also see a redistribution of body fat, with the greatest increases in body fat centrally. This increase in abdominal fat is also associated with cardiometabolic risk. Recently, there has been evidence that menopause itself may not trigger weight gain but rather the aging process causes weight gain and menopause leads to a change in the distribution of this increased body fat.
The impact of timing
The age at which menopause occurs also has lasting implications. Women who experience menopause earlier in life face greater risks for cardiovascular disease and type 2 diabetes compared with those who enter menopause later. Regardless of timing, however, menopause accelerates age-related weight gain and shifts in body fat distribution, leading to increased central adiposity.
Strategies for health after menopause
While there is not one specific dietary approach recommended for postmenopausal women, there is literature that supports a Mediterranean diet. Plant-based eating patterns, especially those rich in soy, may also help alleviate vasomotor symptoms such as hot flashes. Nutrition, however, is only part of the equation.
Physical activity is essential for postmenopausal women and should include a combination of weight-bearing aerobic exercise and resistance training. Resistance training helps to support bone mineral density and muscle strength and decrease fall risk, while weight-bearing aerobic exercise has been shown to improve cardiovascular health and prevent weight gain.
Patient-centered communication
Equally important to treatment strategies is how providers communicate with patients. Using person-first, non-stigmatizing language can make a significant difference in how women experience their care.
When discussing body weight, it is important to avoid labeling patients as “obese” or “overweight.” Instead use patient-first language such as “a patient with obesity.” Many women feel their concerns regarding menopausal symptoms are dismissed. Understanding a patient’s motivation and goals can help to align your treatment with their desired outcome.
Menopause is also often accompanied by challenges beyond weight, such as sleep disturbances, mood changes and stress. These symptoms deserve careful attention in every patient, regardless of BMI. Hormone therapy can be effective for hot flash-related sleep problems, while cognitive behavioral therapy and selective serotonin reuptake inhibitors may help address mood and stress concerns.
Emerging research and therapies
Recent studies highlight promising developments in the treatment of obesity during menopause. GLP-1 receptor agonists, such as semaglutide (Ozempic/Wegovy, Novo Nordisk) and tirzepatide (Mounjaro/Zepbound, Eli Lilly), have proven highly effective for weight loss and improving insulin resistance. New research presented at the Endocrine Society’s annual meeting in July showed improved weight loss outcomes in women treated with both tirzepatide and hormone therapy compared with tirzepatide alone. Similar findings have been seen with semaglutide and hormone therapy in the past.
Another key insight from ongoing research is the recognition that aging itself drives overall weight gain, while menopause influences where fat is stored — specifically increasing central adiposity.
A holistic approach
The most important takeaway for providers is that managing obesity in menopausal women requires an individualized, patient-centered approach. Education, support and validation are just as vital as medical interventions. By focusing on each woman’s unique symptoms, goals and experiences, clinicians can help improve not only metabolic health but also quality of life during and after the menopausal transition.
For more information:
Samantha Flanagan, DO, is a board-certified obesity medicine physician practicing in Philadelphia at Temple University Lewis Katz School of Medicine, where she is an assistant professor of family and community medicine. She can be reached at primarycare@healio.com.
Sources/Disclosures
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Disclosures: Flanagan reports no relevant financial disclosures.
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