What’s Causing Menopause Belly—And How Do I Get Rid of It?

The hallmark symptom of menopause is hot flashes, so hot and sweaty may be the adjectives most commonly associated with people smack-dab in the middle of this transition. Turns out, bloated and blown-up also deserve a place on that list. That’s because perimenopause and the menopause transition bring on a slew of lower-abdominal symptoms that are collectively known as menopause belly. If you’ve been wondering how to get rid of menopause belly, it’s helpful to understand what’s causing it. 

Menopause belly, or “meno belly,” is a colloquial term for the abdominal pouch below the belly button that can develop leading up to and during menopause. It’s not technically a medical term, says board-certified endocrinologist and obesity medicine physician, Scott Isaacs, M.D.

While it can be frustrating to watch your favorite jeans become your “skinny” jeans, it’s important to understand that menopause, and its accompanying symptoms—swollen stomach, hot flashes, mood changes—are all normal, Isaacs says (1). 

“Menopause is not a problem, but a natural and healthy process that all women will eventually go through,” he says. “It just happens to be a process that leads to symptoms.” Some 85 percent of women report experiencing symptoms at some point during menopause (2). 

But just because these symptoms are normal doesn’t mean you have to suffer through them. There are a number of lifestyle and medical interventions you can take to curb their severity. Identifying the root cause(s) of the swelling can help you minimize the expansion of your belly. 

About the Experts  

Scott Isaacs M.D., F.A.C.P., is board-certified in endocrinology, diabetes, metabolism, and obesity medicine. He founded the Atlanta Endocrine Associates in Georgia in 2000. 

Michael O. McKinney, M.D., is an expert who specializes in both women’s health and weight loss. He currently works at Healthy Outlook Weight Loss Clinic in Jacksonville, Florida. 

Kecia Gaither, M.D., M.P.H., FACOG, is double board certified in obstetrics-gynecology and maternal-fetal medicine. She is currently the Director of Perinatal Services at NYC Health + Hospitals/Lincoln in the Bronx, New York. 

Varsha Khatri R.D.N., is a registered dietitian, nutritionist, and Ayurvedic specialist who primarily works with people with digestive issues. She currently works as a remote wellness coach with Prowise Healthcare. 

Lisa Richards C.N.C., is a nutritionist from Alberta, Canada, as well as founder of The Candida Diet, a platform dedicated to helping people with gut issues and Candida imbalances.

What Causes Menopause Belly?

The main culprit of menopause bloat? Loss of estrogen. By definition, the menopausal period is a time when the ovaries—the parts of the reproductive system that store eggs and pump out hormones—slowly cease to function (3). During perimenopause, usually around your mid-40s, as this element of the baby factory slowly shuts down service, estrogen levels fluctuate dramatically. They eventually bottom out in menopause, which happens on average around age 51 (4). 

By the time of menopause (which is technically a year after your last period), the ovaries are no longer pumping out any estrogen. Before menopause, normal estrogen levels are 30 to 400 pg/mL, while after menopause, they are 0 to 30 pg/mL) (5). 
Estrogen may be best known for its role in the development of female sex characteristics (widening of the hips and enlargement of the breasts) and sexual functioning (menstrual cycle regulation, vaginal lubrication, and desire) (6). But, the hormone also plays a role in the health of the urinary tract, gastrointestinal tract, heart and blood vessels, bones, skin, hair, brain, pelvic muscles, and endocrine system as a whole (7, 8). When estrogen levels plummet, people can experience changes to any of these organs and body parts, which leads to a range of menopause symptoms, including menopause belly.

Menopause weight gain

The most common cause of an enlarging tummy during menopause is weight gain, with most women putting on an average of one to one and a half pounds per year during this transition. For this, keep your finger pointed right at waning estrogen levels (9, 10). 

Lower estrogen levels lead the body to become more insulin resistant, Isaacs says (11). As a refresher: The primary role of the hormone insulin is to transport glucose (sugar) from the bloodstream to organs and muscles to use for energy. When the body becomes insulin resistant, rather than getting used for energy, sugar stays in the bloodstream. This forces the body to store sugar as fat, leading to increased fat mass and weight gain. 

Insulin resistance isn’t the only potential cause of weight gain during menopause. In the event that you’re one of the 60 percent of people who experience sleep disturbances during this time, poor quality sleep could also be to blame (12). One of the underrated roles of estrogen is working with the hypothalamus to help regulate body temperature. When estrogen levels roller-coaster, the hypothalamus can’t balance that internal thermostat as efficiently. 

What does this mean for you? Hot flashes that can leave you drenched and cause you to wake up in the middle of the night. Research published in the International Journal of Endocrinology shows that sleep disturbances have a profoundly negative impact on metabolism, which could lead to weight gain (13). 

“A lack of quality sleep can also result in higher concentrations of the hunger hormone ghrelin and reduced amounts of leptin, hormones that signal satiety,” says registered dietitian Varsha Khatri, R.D.N. “This [imbalance of hormones] can promote an increase in appetite and cravings, especially for starchy foods, leading to excessive body mass,” she says. 

Insufficient sleep can also reduce your energy levels as well as your interest in exercising, she says, increasing risk of weight gain. 

It’s also possible that the number on the scale hasn’t budged, but your body composition has changed. People lose muscle mass at a rate of three to eight percent per decade, after age 30 (14). By and large, this means that middle-aged people have less muscle and more fat than they did when they were young. Muscle is both more metabolically active and takes up less “space” per pound than body fat (15). So, it is possible for people to weigh the exact same as they did prior to menopause but experience body composition changes that lead to them look bigger in certain areas of their body.

Menopause belly bloat

Some of estrogen’s side gigs include aiding in digestion, supporting the gut microbiome, and helping the body maintain fluid balance. “The decline in estrogen levels during menopause may cause water retention and bloating,” says Khatri. The result? Meno belly.

Fluctuations in estrogen can slow down your metabolism and digestion process, she explains (16). The increased cortisol levels that often accompany the dip in estrogen from menopause have also been found to slow gastrointestinal (GI) emptying. Together, this slowdown “can lead to distension-causing bloating and constipation, as well as discomfort,” Khatri says. 

Estrogen is also thought to play a role in supporting the integrity of the stomach lining, according to OBGYN and menopause specialist Kecia Gaither, M.D., M.P.H., FACOG. One 2018 study published in Digestive Diseases and Sciences showed that estrogen supports the health and strength of the mucosal barrier in the stomach (17). So, when estrogen levels dip, the GI tract can become permeable, Gaither says. Research shows this permeability can lead to symptoms of leaky gut, which includes bloating (18). 

“Emerging research indicates that lack of estrogen might affect the gut microbiome in such a way that results in an unhealthy ratio of bacterial species within the gut,” says Khatri. “Consequently, there is more gas generation leading to GI-related symptoms like bloating.” 

One 2012 study in the journal Menopause identified a link between the estrogen changes that occur during menopause and altered gut microbiome (19). While a second study published in the International Journal of Women’s Health found that decreased estrogen levels are associated with a less diverse bacterial makeup in the gut microbiome (20). 

Estrogen also works on something called the nephron cells in the kidneys, which supports the filtration organ in its efforts to maintain a balance between fluids and electrolytes in the body (21). “Decreasing estrogen can impact the kidneys’ ability to expel sodium, further exacerbating fluid retention,” Khatri says. 

Finally, due in large part to the metabolic slowdown that happens in middle age, people are more likely to develop food intolerances, according to Isaacs. So, what you think may be menopause belly could actually be your body tipping you off to an intolerance. He suggests seeking out care from a gastroenterologist to help navigate bloating, distention, and gas, as well any other sign of food intolerance (22). 

MORE MENOPAUSE

8 Signs You Might Need Menopause Hormone Therapy

5 Vitamins & Supplements That Ease Perimenopause Symptoms

How to Get Rid of Menopause Belly

Whether it’s a result of weight gain or bloat, menopause belly is both a normal and common symptom. But the good news is that if it’s causing discomfort or otherwise altering your self-image, there are steps you can take to manage (and combat) it. 

Practice patience

No doubt, this might be the most annoying tip ever. But research has found that both weight gain and gastric issues level off after menopause. 

Case in point: The additional weight gain each year may sound like a lot, but the average total gain at the end of menopause is just two to five pounds in total (23). Also, one 2024 study found that perimenopausal women have slower gastric emptying compared to postmenopausal women. This finding suggests that it’s the fluctuations in estrogen that occur in perimenopause that have a more significant effect on GI movement than hormone levels that are low, but steady (24). 
So, while you’re in the throes of the menopause symptoms (like belly bloat), just remember that it does get better. 

Exercise

Interrupted sleep during menopause begins with a series of unfortunate events, Khatri notes. The lack of sleep leads to hormone imbalance that leads to less interest in exercise, she explains. However, one of the best ways to combat fat accumulation and keep the GI tract moving is to move your body. 

“Regular exercise with both cardio and strength training will go a long way in supporting efficient metabolism and muscle mass preservation,” says physician Michael O. McKinney, M.D. Logging 150 minutes of moderate-intensity cardio and getting in two strength sessions per week, which is what’s recommended by the Physical Activity Guidelines for Americans, is a good jumping off point, he says (25). 

If you’ve never stepped foot in a weight room, you might be inclined to skip the latter portion of that suggestion, so McKinney suggests hiring a certified trainer or checking out some weight-training videos online and powering through. In addition to aiding with body recomposition, resistance training can help postmenopausal women maintain and increase bone density, according to research in the Journal of Mid-Life Health (26). 

Prioritize nutrient-dense foods

A balanced diet is critical to combating menopause belly, says nutritionist Lisa Richards, C.N.C. Your plate should almost always consist of lean proteins, fruits, and vegetables. Consider following a Mediterranean-style meal plan that emphasizes healthy fats, lean proteins, and whole grains, she says. One 2014 review found that adherence to the Mediterranean diet can have beneficial effects on menopausal women’s health (27). Why? The researchers note that the diet helped aid in weight loss, support healthy blood pressure, and lower total cholesterol levels.

Implement stress reduction

Cortisol often rises in response to declining estrogen levels, McKinney explains (28). So you’ll want to start managing your stress. “Incorporating stress management techniques can manage spiked cortisol levels, which are associated with abdominal fat deposition,” he says. “Yoga, meditation, or mindfulness, in particular, can help manage stress levels. 

The findings from a 2018 study revealed that people going through menopause who incorporated mindfulness techniques experienced a reduction of stress, anxiety, and depression (29). The North American Menopause Society says that practicing deep breathing, positive thinking, hypnosis, and meditation can be helpful, as can pampering yourself with things like massages, manicures, and soothing baths (30). “Aromatherapy and acupuncture can also serve as stress reducers,” Gaither says.

Prioritize sleep hygiene

During menopause, you might wake up drenched in the middle of the night, thanks to night sweats. The chain of events that follow—lack of sleep, increased cravings, reduced energy for exercise, etc—can all contribute to weight gain, Isaacs says. 
To get better Z’s, McKinney recommends improving your general sleep hygiene (31). “To start, maintain a regular sleep and wake schedule and create a dark and cool environment conducive for sleeping,” he says. Doing things to keep you and your bedroom cool, like dressing your body and mattress in cotton, keeping a cool drink by your bed, and blasting fans can also help, according to the National Council on Aging (32).

Talk to your doc about weight loss meds

Weight loss medications won’t be prescribed to treat menopause belly directly. However, if you are one of the 50 percent of menopausal women with obesity, your healthcare provider may suggest a drug like Wegovy (33). “Weight loss medications are approved for obesity at any life stage; they can be used before menopause, as well as in menopause,” Isaacs says. As such, they might be prescribed for someone in menopause who has weight-related comorbidities, he adds. For these folks, weight loss medication can effectively help alleviate menopause belly caused by weight gain all over—including in the lower abdominal area.

Hormone Therapy for Menopause Belly

Hormone replacement therapy, which can consist of both estrogen and progesterone, can help minimize myriad symptoms associated with perimenopause and menopause. 

“Experiencing symptoms during menopause indicates that you might be a good candidate for hormone replacement therapy,” Isaacs says. 

There are a number of ways to administer estrogen, like any other hormone being supplemented, he says, including injections, oral pills, vaginal suppositories, topical creams, and medicinal patches. The best method will vary by person, he says.  

By off-setting symptoms such as hot flashes, low energy, and GI distress, hormone replacement therapy subsequently eases symptoms of bloating and weight gain that are exacerbated during the menopause transition. The research is currently limited, but one older study found that hormone replacement therapy can help prevent increased body fat mass or fat redistribution in postmenopausal women (34).

If you think you’re a good candidate for hormone replacement therapy (or a weight loss drug), talk to your provider, suggests McKinney. “Any treatment must be individualized based on a person’s overall health status, risk factors, and lifestyle,” he says.