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Since the menopause I have put weight on, how can I lose it?

Since I started the menopause I have put weight just round my middle. I exercise every day, go swimming twice a week and eat healthily, but cannot lose any pounds. I am also starting to have palpitations and feel anxious. Is this normal?

20 March 2021

When women reach the age of 45 to 55 years old, they usually start the menopause. This is when you stop having the monthly menstrual periods.

Your periods usually start to change over a few months (or even years) before the menopause. They could become more or less frequent, or heavier or lighter. In some cases, they can just stop.

The menopause is officially diagnosed once you have no menstrual periods for 12 months.

The NHS estimates that one in every 100 women will experience the menopause before the age of 40. There is often no obvious cause for this, but some surgeries, breast cancer treatments and other conditions (such as Down’s syndrome) can play a part.

During the menopause the body stops making regular amounts of oestrogen. This means that the amount of oestrogen in the body reduces considerably which triggers menopause symptoms.

The severity and occurrence of symptoms differ for every woman, but commons symptoms of the menopause include:

  • Hot flushes
  • Night sweats
  • Palpitations (a sudden racing of the heartbeat, a flutter or a jumping feeling within the chest) are common in the first few months
  • Changes to your vagina – including dryness and thinning of the walls which can make sex uncomfortable
  • Reduced libido
  • Low mood or anxiety
  • Memory issues
  • Frequent headaches
  • Urinary tract infections, such as cystitis
  • Sleeping difficulties
  • Aches and pains in your joints
  • Loss of muscle
  • Greater risk of osteoporosis.

These can start months or years before your menopause and last for a while after. Most women are symptom-free after four years, but it is much longer for others.

The menopause and weight gain

It is common to gain weight during the menopausal years and this usually sits in different places compared with your pre-menopausal years (it’s usually seen as a loss of definition around the waist and an increase in abdominal fat). It’s not just the lack of oestrogen and progesterone that causes this, but an alteration in the balance of androgens (sometimes referred to as male type hormones). As a result, fat is deposited in a more male-like distribution around the abdomen and less on the bottom, hips, thighs and breasts.

Menopausal mood changes and low self-esteem may also make you over-eat and, in some cases, insulin resistance plays a part. It is important to stick to a healthy, balanced diet and exercise regularly, not only to maintain ideal body weight but also to elevate mood.

Menopause treatment

If your symptoms are troubling you, you can go to the doctor. They will confirm whether it is the menopause and may do a blood test to make sure, especially if you are quite young.

Many women turn to HRT (hormone replacement therapy) where you take oestrogen to ease your symptoms. This is available as tablets, skin patches, a gel or implants. It is extremely effective, but does come with some risks. You will need regular checks and monitoring to get your dose right and ensure you are getting on ok.

There are other ways to relieve menopause symptoms:

Stay cool

Wearing light clothing and keeping rooms cool, especially at night, can help you manage hot flushes and night sweats. It is particularly helpful to try and get a good night’s sleep as this can ease your low mood. Taking a cooling shower, a cold drink or fan can also help.

Maintain a healthy diet

Avoiding spicy food can help with hot flushes and night sweats, as can stopping smoking, avoiding alcohol and cutting back on caffeine. All this can also help stave off osteoporosis, as can taking calcium or vitamin D supplements.

Exercise regularly

If you’ve overweight, hot flushes and night sweats, can be worse so maintain a healthy weight. Exercise is also a great way of managing low mood or anxiety – exercises such as yoga are great for your body and can boost your mental health too. These weight-bearing and resistance type of exercises are also good for preventing the onset of osteoporosis.

Cognitive behavioural therapy

This is a talking therapy that can help support your low mood. You could also try anti-depressants (some of which are also reported to help with hot flushes) but do bear in mind that these can have significant side effects. If your low mood becomes persistent then it’s important to discuss this with your GP. Evidence shows that oestrogen plays a role in maintaining mood and a sense of wellbeing - and declining levels of oestrogen in the blood have been shown to affect overall mood in some women. Treatment is then aimed at managing this loss of oestrogen and for some women a short course of HRT to address oestrogen imbalance is all that’s required.

If you lose your libido, HRT can help. Your doctor could also prescribe you some testosterone, the male sex hormone. This is not yet licensed for women but doctors can use it if they think it would help, though it can have side effects such as acne and hair growth.

Creams, pessaries and a vaginal ring can all help to ease vaginal discomfort – standard lubricants or vaginal moisturisers might also help. You can use these alongside HRT indefinitely as side effects are very rare.

Natural ways to relieve the menopause

There are a variety of natural remedies aimed to reduce menopausal symptoms such as soya-based products which have a weak oestrogenic-like action, black cohosh and red clover – to name a few.

That said, the NHS does not recommend taking natural remedies as it is not clear how safe or effective they are.

Answered by the Health at Hand team.

Further reading

Menopause symptoms, self-help and treatment - AXA Health

How hormones affect mood - AXA Health

Osteoporosis and bone health - AXA Health

How to lose weight well - AXA Health

Weight training for women - AXA Health

Menopause - NHS factsheet


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