Why Visceral Fat Targets Your Heart After Menopause

So many things change after menopause. From hair thickness and energy levels to vaginal moisture and even fat distribution. It’s true: even without major changes on the scale, you may notice your pants fit a bit more snugly than they did before. You may see your belly protrude more than it used to—often referred to colloquially as menopause (or meno) belly. This shift can feel confusing and disheartening, especially if you haven’t changed your diet or exercise routine. 

It’s very important to understand that it’s not your fault. And thankfully, there are effective and proven ways to combat this unwanted accumulation of visceral fat.  

"One other important thing to know: the type of fat that accumulates around your midsection is visceral fat, and it’s more than a cosmetic annoyance. It wraps around your internal organs, which can significantly increase your cardiovascular disease risk." - Dr. Barreiro

What Is Visceral Fat and Why Does It Matter?

Put bluntly, visceral fat is not your friend. Not all body fat behaves the same way. Some mostly store energy, while some actively influence your hormones and metabolism. There are two main types:

Subcutaneous fat sits just underneath your skin. If you pinch a bit of your belly, that’s subcutaneous fat. Visceral fat, on the other hand, lies deeper in the abdomen and surrounds key organs, including the liver, pancreas, and intestines.

Visceral fat isn’t just stored energy. Research suggests it behaves like an organ in the body. Unlike subcutaneous fat, it releases fatty acids and inflammatory hormones directly into the bloodstream, where they can affect your liver and metabolism. That’s why higher visceral fat is closely linked to insulin resistance, unhealthy cholesterol levels, and metabolic syndrome — all of which can increase your risk of heart disease and cardiac events like heart attack. 

While 60-70% of women experience some weight gain during menopause, averaging about 1.5 pounds per year between ages 50 and 60, visceral fat isn’t always obvious from your body weight alone. You can have a BMI in the normal range but still carry too much visceral fat, sometimes called normal-weight central obesity, and this still carries elevated cardiometabolic risk.

Recent menopause-focused research shows that the transition to menopause itself is strongly associated with increased abdominal and visceral fat, even when total body weight only slightly changes. On average, visceral fat rises from about 5-8% of total body fat before menopause to roughly 15-20% after menopause.

How Menopause Triggers Visceral Fat Gain

Estrogen helps regulate where fat is stored in your body. It promotes a more “gynoid” fat distribution pattern, more commonly known as pear-shaped. In other words, estrogen encourages fat storage in areas that fill out your natural curves, like the hips, butt, and thighs, rather than around the belly. But as estrogen levels bottom out after menopause, that pattern shifts. 

Relative androgen activity increases when estrogen levels drop, changing the hormone balance. As a result, testosterone’s effects can become more pronounced, which can contribute to visceral fat accumulation.

You may also notice changes in muscle mass during menopause, as this life stage is associated with accelerated muscle loss (also known as sarcopenia). Because muscle burns more calories than fat, losing it lowers your resting metabolic rate, making fat gain easier even if your habits haven’t changed (ugh!). Energy regulation also shifts. Hormonal changes during menopause affect how your body manages hunger cues, satiety, and fuel use. Lower estrogen is associated with reduced insulin sensitivity, meaning your body doesn’t process blood sugar as efficiently. This can promote greater fat storage, particularly in the abdominal area. Changes in estrogen (and other hormones) can also influence your appetite signals, plus how efficiently your body burns fat for energy. 

So even though the number on the scale may remain relatively stable, you may notice your waistline is thicker or your body shape has changed. 

It’s important to state this very clearly: a lot of this is outside your control. Research shows that increases in abdominal fat, which includes visceral fat, are partly independent of age and BMI. What this means? Menopause itself is a core driver behind these changes. Perimenopause is now considered a “sensitive window” for metabolic change, where hormonal shifts make visceral fat gain more likely and cardiovascular risk begins to climb.

Why Visceral Fat Raises Heart Disease Risk After Menopause

Visceral fat doesn’t just sit quietly in the abdomen—it actively influences your cardiovascular health. Because it functions like metabolically active tissue, it releases inflammatory and hormonal signals that act like a megaphone, amplifying their effects on your blood vessels, cholesterol levels, blood sugar, and blood pressure. These effects include:

Increases plaque build-up in arteries

One major pathway is inflammation. Visceral fat produces inflammatory cytokines, or chemical messengers that can irritate blood vessel walls over time. This makes it easier for plaque to form inside arteries, which is one of the underlying drivers of heart disease. 

Your cholesterol levels can change as well. Higher visceral fat is often associated with increased triglycerides and LDL (bad) cholesterol and lower HDL (good) cholesterol—a lethal combination that can increase your risk of atherosclerosis (hardening of arteries from plaque buildup).

Promotes insulin resistance

Visceral fat is also linked to insulin resistance. As visceral fat increases, the body becomes less responsive to insulin, raising blood sugar levels and increasing the risk of type 2 diabetes. And diabetes, as you likely already know, is a well-established cardiovascular risk factor.

Together, inflammation and insulin resistance place more strain on your cardiovascular system, making hypertension (high blood pressure) more likely over time as your heart has to work harder to pump blood through stiffened, less flexible blood vessels.

Not to mention, menopause itself—irrespective of visceral fat—changes how your cardiovascular system functions. Before menopause, estrogen helps keep blood vessels more flexible, supports healthier cholesterol patterns, improves insulin sensitivity, and has natural anti-inflammatory effects.

Research suggests that central obesity is one of the strongest drivers of metabolic syndrome risk during and after the menopausal transition. Data also show that rates of atherosclerotic cardiovascular disease are higher after menopause than before.

How to Recognize and Measure Visceral Fat

Because visceral fat sits so deep in your abdomen, you can’t measure it directly at home. But, you can estimate your risk. Measuring your waist circumference is one of the most useful screening tools. Specifically, a waist measurement that exceeds 35 inches (88 cm) suggests increased cardiometabolic risk.

Follow these tips to get the most accurate measurement:

• Place a tape measure around your abdomen at belly-button level

• Measure after a normal exhale

• Keep the tape snug, not tight

Your waist-to-hip ratio may also be a helpful indicator. Usually, a higher ratio means you have more fat stored centrally, or around your belly. 

Imaging tests, such as DEXA, CT scan, and MRI, are the most accurate way to get a snapshot of what type of fat you have in your body and where. 

Lifestyle Strategies to Reduce Visceral Fat and Protect Your Heart

You have more agency than you may think. Remember how we said visceral fat is metabolically active? That means it often responds well to consistent lifestyle changes. Even small tweaks in your daily routine can improve both your metabolic and heart health over time. While menopause fatigue is very much a thing, making simple changes to your lifestyle can help boost your energy levels as well.

Exercise works best when you combine strength and cardio. Strength training a few times per week helps preserve muscle, support metabolism, and improve insulin sensitivity. Cardio-based workouts can help reduce visceral fat, strengthen your heart, and lower blood pressure and triglycerides. Current guidelines suggest strength training two to three times weekly, in addition to incorporating about 150 minutes of moderate aerobic activity (or 75 minutes of vigorous exercise) per week. 

Your overall eating pattern matters more than strict dieting. Mediterranean and plant-forward styles of eating are consistently linked to lower cardiometabolic risk. This includes fiber-rich options, including vegetables, fruits, legumes, and whole grains. It also calls for healthy fats (like olive oil) and satiating lean proteins, such as fish and chicken. Keeping your fiber intake high supports blood sugar and cholesterol control, whereas getting enough protein in your diet helps you maintain your current muscle mass.

Sleep and stress are part of the metabolic picture, too. Not getting enough sleep and ongoing stress can raise cortisol levels, which may promote visceral fat. Aim for seven to nine hours of quality sleep each night when you can. Going to bed a bit earlier, building a calming wind-down routine, or practicing deep breathing can all help you fall—and stay—asleep.

Medical Options: When Lifestyle Isn’t Enough

For some women, making the above lifestyle changes isn’t enough to reduce visceral fat or cardiometabolic risk, and that’s completely okay. There are several medical options you can turn to, including menopause hormone therapy and GLP-1s.

Menopause Hormone Therapy (MHT)

Menopause hormone therapy (MHT) may offer metabolic benefits in addition to symptom relief for some women. Starting MHT around the time of menopause has been linked to less visceral fat gain and better insulin sensitivity, with some evidence suggesting lower diabetes risk as well. MHT isn’t right for everyone, but for eligible women, it can provide benefits beyond symptom control. A menopause-informed clinician can help you decide whether it’s a good fit based on your health history and other risk factors.

GLP-1s

GLP-1–based medications, such as liraglutide, semaglutide, and tirzepatide, can support weight loss, visceral fat reduction, and improvements in blood sugar and other cardiometabolic markers. These medications can be used on their own or, in some cases, alongside menopause hormone therapy with clinical guidance and monitoring. Talk to your healthcare provider to see if GLP-1s are appropriate for you. 

When to Talk to Your Doctor About Visceral Fat and Heart Risk

You don’t have to wait for a major medical diagnosis to start the conversation with your care team. Think of it this way: earlier evaluation can help you take preventive steps sooner.

It’s worth checking in with a clinician if you have:

• Weight gain specifically around your belly—and you can’t seem to lose it

• High blood pressure 

• Elevated cholesterol or triglycerides

• Prediabetes or diabetes

• A family history of heart disease or stroke

During your visit with your doctor, you can ask about cardiovascular risk screening, waist and metabolic assessment, menopause hormone therapy options, weight management medications, and personalized nutrition and exercise guidance.

Working with a menopause-trained provider supports shared decision-making and care that’s tailored to your health history and goals.

Frequently Asked Questions

What is visceral fat, and why is it considered more dangerous than other types of body fat?

Visceral fat is a type of fat that lies deep within the abdomen, wrapping around internal organs like the liver and pancreas. Unlike subcutaneous fat, which sits just under the skin, visceral fat behaves like an active organ. It releases inflammatory hormones and fatty acids directly into the bloodstream, which can lead to insulin resistance, unhealthy cholesterol levels, and a significantly higher risk of cardiovascular disease.

Why do women often notice an increase in abdominal fat during menopause, even without changes in diet or exercise?

The transition to menopause causes estrogen levels to drop, which shifts how the body stores fat. Estrogen typically promotes fat storage in the hips and thighs, but as it declines, the body moves toward a "central" storage pattern around the belly. Additionally, the loss of muscle mass (sarcopenia) during this stage lowers the resting metabolic rate, and reduced insulin sensitivity makes it harder for the body to process blood sugar efficiently, promoting fat accumulation.

How can I accurately measure or screen for visceral fat at home?

While imaging tests like DEXA or CT scans are the most accurate, you can estimate your risk by measuring your waist circumference at the belly-button level. A measurement exceeding 35 inches (88 cm) suggests an increased cardiometabolic risk. For the best accuracy, keep the tape snug but not tight, and take the measurement after a normal exhale.

What medical options are available if lifestyle changes alone aren't reducing "meno belly"?

If lifestyle adjustments aren't enough, medical interventions like Menopause Hormone Therapy (MHT) or GLP-1 medications may be considered. MHT has been linked to less visceral fat gain and improved insulin sensitivity when started around the time of menopause. GLP-1 medications, such as semaglutide or tirzepatide, can also support visceral fat reduction and improve blood sugar markers. It is recommended to discuss these options with a menopause-informed clinician to determine the best fit for your health history.