When Hormones Change, Bodies Change: Managing Menopausal Belly Fat

You may have noticed another unwelcome symptom of perimenopause and/or menopause: additional weight around your midsection or abdomen. Despite trying the latest abdominal exercises and diet to trim belly fat, nothing seems to work. It’s incredibly frustrating but it is common during midlife and with normal aging. Declining estrogen levels affect where fat is located and disrupts your digestive system, causing more abdominal or belly fat and gas during perimenopause and menopause.It's a perfect storm of hormonal fluid retention, sluggish digestion, and a fundamental shift in how your body stores fat.

Beyond the appearance of your abdomen or weight gain, the shift in weight to your midsection can result in the accumulation of visceral fat which can trigger changes that have a negative impact on your long term health. 

Bloat or Menopausal Belly Fat: How to Tell the Difference

Slower Digestion

During the day, the combination of eating, swallowing air while talking or chewing introduces gas into the digestive tract. When you factor in sluggish digestion associated with menopause, gas and food tend to sit longer in your digestive tract, giving bacteria more time to produce gas. Each meal adds to the previous one, and by evening, your stomach can look distended. The distention may improve by the morning because overnight, your digestive system gets a much-needed break. During sleep, gas has time to dissipate, and your body can process the previous day's meals without the constant addition of new food.

Aside from hormonal changes, increased stress levels can also impact digestion resulting in bloating. As stress builds, your brain responds by releasing hormones, particularly cortisol, slowing down the movement in your digestive system and causing a build-up of gas.

The Estrogen–Bile Loop

Many women do not realize the role that estrogen plays in the digestive tract. With the midlife transition, many women experience stomach upset with foods they used to be able to enjoy without stomach discomfort. As estrogen levels decline, there is a reduction in the amount of bile produced by the liver.  Bile is essential for breaking down fats and keeping things moving smoothly through your intestines. When bile production decreases, your body struggles to digest fatty foods, leading to more gas and bloat.

Water Retention

Fluctuating levels of estrogen and progesterone during the menopause transition can lead to water retention. When estrogen levels are high the body can retain water. Progesterone on the other hand causes the retention of sodium and water. Unlike gas, water retention can create a tight or heavy sensation in your abdomen. You may  even  notice increased puffiness in your hands, feet, face, and abdomen

Sudden New Food Sensitivities

It is not unusual to develop new food sensitivities as estrogen levels decline especially to dairy and gluten. This is because hormonal changes that occur in perimenopause can affect the gut microbiome, which can change  how food moves through your intestines. Common culprits include dairy, gluten, and certain fruits, vegetables, and grains that can ferment in your gut.

Why Visceral Fat is Different and Why it Matters

Abdominal Fat

The development of “new” abdominal fat is typically what is referred to as menopause belly fat. Declining estrogen and aging can cause increased weight gain and fat during perimenopause and menopause. This extra weight can cause more subcutaneous fat in the abdomen, or fat just beneath the skin that you can pinch. Extra weight can also stimulate deposition of visceral fat, or fat around your liver, pancreas, and intestines. This visceral fat is stubborn and different from temporary bloating or subcutaneous fat. Visceral fat is proinflammatory and associated with an increased risk of diabetes, cardiovascular disease, non-alcoholic fatty liver disease, hypertension, stroke, cancer, and overall increased mortality. 

Treating Visceral Fat: Evidence, Not Myths

Healthy Diet

• Focus on a diet of lean proteins like fish, chicken, and low fat dairy products

• Incorporate a diet high in plant based foods like vegetables, legumes, fruit and whole grains

• Avoid or eliminate processed meats and foods that are high in saturated fats

• Include some monounsaturated and polyunsaturated fats that are present in fish and nuts

• Watch portion sizes especially when eating at restaurants where portion sizes can be larger

• Avoid or eliminate sugary drinks and replace with water or low calorie beverages

Exercise

• High intensity interval training is considered a good way to trim belly fat

• Add strength and resistance training to your work out regimen 2-3 times a week

• Find ways to incorporate more movement in your daily life beyond structured exercise (i.e. parking farther away from the entrance of a building, taking the stairs, a quick walk outside during a break)

Sleep

• Get 7-8 hours of sleep each night

• Treat sleep apnea 

• Create a sleep routine (i.e. establish a typical bed time, make your bedroom a relaxing environment, read or meditate before going to bed)

• Limit screen time before bedtime

• Avoid alcohol, caffeine and large meals close to bed time

Since visceral fat can be stubborn and is associated with chronic health conditions, if you are still struggling to reduce abdominal fat despite making significant lifestyle changes you may want to consider a GLP-1 medication to  help with weight loss. Alloy’s personalized weight care program is led by menopause-expert physicians who evaluate your health history and help determine if a GLP-1 is right for you.

When Menopause Related Bloating Warrants Evaluation

Sometimes bloating can indicate other problems, like:

• Bloating that doesn't go away after sleeping or bowel movements

• Feeling full after just a few bites of food

• Pelvic or abdominal pain

• Changes in urinary frequency or urgency

• Nausea and vomiting

How to Beat Menopause Bloating: Evidence-Based Relief Strategies

Dietary Changes

Reduce or eliminate foods notorious for producing gas like beans, cruciferous vegetables (broccoli, cauliflower, brussels sprouts), carbonated drinks, and artificial sweeteners. If your symptoms are extremely bothersome a temporary elimination diet can be a good way to identify food sensitivities. Start by identifying the foods most likely responsible for your symptoms and remove them completely for 2-3 weeks. After 2-3 weeks of eliminating your trigger foods slowly reintroduce them one at a time to see which food your body can tolerate without uncomfortable bloating.

Drink Up 

This might sound counterintuitive, but if you're retaining water, the solution is to drink more water, not less. If you're bloated with water retention, upping your water intake will help balance your system and flush out excess fluids. Once that happens, your body will release the water it's been retaining.

Get Moving

Movement is an easy way to improve the bloating associated with a more sluggish digestive system that is common in perimenopause and menopause. Studies have shown that as little as 20 minutes of aerobic exercise three times a week can reduce the bloating caused by fluctuating hormones. Taking walks after meals or doing yoga poses like seated spinal twists or supine twists can offer relief whenyou're uncomfortable due to gas and bloating.

Natural Remedies

Natural remedies like peppermint and chamomile tea can help relax the muscles in your digestive tract. If the gas and bloating causes mild nausea, ginger capsules or tea can be helpful in reducing nausea associated with bloating. Enzymes that help digest carbohydrates in dairy, beans, and cruciferous vegetables are available over the counter and can be very helpful in relieving symptoms associated with eating those foods.

Frequently Asked Questions

What causes menopause belly fat during perimenopause and menopause?

Fluctuating hormone levels alters digestion and fluid balance which results in more bloating. Additionally, declines in estrogen shift fat distribution more to the midsection which contributes to weight gain in the abdominal area. In the absence of healthy lifestyle changes the shift in fat and weight to the midsection can lead to increased visceral fat. This is a more dangerous type of fat that raises the risk of diabetes, cardiovascular disease, and fatty liver among other conditions.

Why is bloating worse at night during menopause?

The accumulation of food, swallowed air, and slower digestion can make bloating worse at night. Hormonal shifts also contribute to more fluid retention throughout the day resulting in abdominal distention. Lastly, chronic stress can also cause an increase in cortisol levels which also can slow the digestive tract.

How can I tell if my bloating is water, gas, or fat?

Water retention often feels tight and puffy, where gas causes pressure and discomfort that often changes throughout the day.  Visceral fat creates an overall increase in abdominal size that remains over time unless you lose weight with lifestyle changes or weight loss medication support..

When should bloating be evaluated by a doctor?

Persistent bloating, early satiety, persistent nausea and vomiting, pelvic pain, or urinary concerns should be medically evaluated.