Abstract
Why does weight gain commonly occur at menopause?
Longitudinal studies, including the SWAN study, which tracked over 3000 women, indicate an average annual weight gain of approximately 1.5 kg during perimenopause, culminating in an increase of around 10 kg by the time menopause is reached. 1 While ageing-related factors such as decreased energy expenditure and reduced physical activity contribute significantly to midlife weight gain, hormonal changes during menopause also play a key role in altering fat distribution, leading to increased central adiposity. 2
These body composition changes are not merely aesthetic concerns – they carry significant health implications, including an increased risk of cardiometabolic diseases, osteoarthritis, cancer, cognitive decline, mental health challenges, and exacerbation of menopausal symptoms. Given that weight gain in midlife results from the complex interplay of ageing, hormonal shifts, and lifestyle factors, clinical practice should emphasise early counselling and anticipatory guidance. Educating women on the importance of dietary modifications and regular physical activity before substantial weight gain occurs can help mitigate these changes.3,4
For many women, severe vasomotor symptoms (e.g. hot flushes), sleep disturbances, anxiety, and chronic fatigue can make it difficult to prioritise healthy lifestyle habits. Addressing these symptoms through medical, psychological, or alternative interventions can facilitate the adoption of sustainable dietary and exercise behaviours. 5 When communicated effectively, this approach ensures that women are both physically and emotionally prepared to make meaningful lifestyle adjustments.4,6,7
What dietary advice should we give?
A Mediterranean-style diet during menopause not only supports weight control but also has a role in optimising health concerns such as bone density and cardiovascular health. 8
Key principles of the Mediterranean diet
• Plant-based protein intake
Protein is essential for preserving skeletal muscle, which is crucial for metabolic health during menopause. 9 Additionally, adequate protein intake supports bone health by preventing muscle loss, 10 which is associated with reduced bone density. Current recommendations of 0.8 g protein/kg body weight have been questioned as sufficient for maintaining skeletal muscle mass, particularly when combined with resistance exercise. 10 Higher intakes, between 1 and 1.4 g/kg body weight daily, are suggested to better support muscle retention, satiety, and weight management. 10
In line with Mediterranean diet principles, protein sources should prioritise legumes, nuts, tofu, and other plant-based proteins such as soya. Lean meats, poultry, fish, and eggs are included but in moderation, typically once or twice a week.
For a 75 kg woman, protein requirements would range from 75g to 105g per day. Below are the protein contents of some common plant-based and animal-based foods
11
: • 1 medium egg (50 g): ∼6 g protein • 40 g walnuts: ∼5 g protein • 75 g cooked soybeans: ∼12 g protein • 125 g cooked salmon: ∼27 g protein • 150 g cooked chicken breast: ∼45 g protein • 80 g cooked chickpeas: ∼7 g protein • 140 g cooked fillet steak: ∼36 g protein
• Healthy fats
Omega-3 polyunsaturated fatty acids (PUFAs), specifically alpha-linolenic acid (ALA) and docosahexaenoic acid (DHA), play a key role in cardiovascular and cognitive health along with eicosapentaenoic acid EPA. DHA and EPA is predominantly found in oily fish, while ALA is abundant in olive oil, canola oil, nuts, seeds, and dark leafy greens such as spinach and kale. These fatty acids possess anti-inflammatory, and antioxidant properties, which may contribute to the mitigation of metabolic changes during the menopausal transition which contribute to an acceleration in neurocognitive and cardiovascular decline. 12
Practical dietary advice should emphasise reducing saturated fat intake, such as butter, coconut oil, and full-fat dairy, while increasing sources of unsaturated fats. However, it is important to note that all fats – saturated or unsaturated – provide 9 kcal/g, making fat the most energy-dense macronutrient. In contrast, carbohydrates and proteins contain 4 kcal/g. 11
• Calcium and vitamin D
With the acceleration of bone loss during menopause, calcium and vitamin D are essential for osteoporosis prevention. The British Menopause Society and Women’s health Concern recommends a daily calcium intake of 1000 mg and 1000iu vitamin D calcium for optimal osteoporosis risk management. 13 Calcium intakes, where possible should be met by food sources. 13
Calcium content of common foods
• 120 mL semi-skimmed milk: 150 mg • 50 g cheddar cheese: 400–420 mg • 125 g plain low-fat yogurt: 200–260 mg • 120 mL calcium-enriched soy milk: 120–180 mg (varies by brand) • 28 g almonds: 76 mg • 85 g canned sardines (with bones): 325 mg
For vitamin D, sunlight exposure is the primary source, 11 but supplementation of 1000iu daily is recommended between October and early March, particularly in regions with limited sunlight, to support calcium absorption and bone health.13,14
• Dietary fibre
Dietary fibre consists of plant-based compounds that are not fully digested in the human gut. Insoluble fibres (cellulose, hemicellulose, lignin) aid digestion, while soluble fibres (pectins, β-glucan, hydrocolloids) support heart health and blood sugar regulation. 10
The UK’s recommended daily fibre intake is 30g, yet only 4% of women meet this target. 15 Currently, the average fibre intake is 17g for women and 21g for men, highlighting a significant gap in dietary habits. Systematic reviews support the higher fibre recommendation for health benefits, including weight management and cardiovascular protection. 15
Fibre content of common foods
• Medium banana: 3 g • Pear with skin: 6 g • 80 g cooked carrots: 2 g • 80 g cooked peas: 4.5 g • 120 g cooked chickpeas: 12 g • 150 g baked beans: 10 g • 1 slice wholemeal bread: 2 g • 150 g cooked wholewheat pasta: 6 g • 90 g oats: 4 g • 30 g chia seeds: 10 g • 28 g pistachios: 3 g
Encouraging menopausal women to incorporate more whole grains, 11 legumes, nuts, and seeds can improve fibre intake and help regulate appetite, digestion, and metabolic health.16,17
• Antioxidants and bioactives
Antioxidants from fruits and vegetables protect cells from oxidative stress and support cardiovascular health. 8 Encouraging women to consume a variety of at least 30 different servings of colourful fruits and vegetables as well as other plant-based foods such as nuts, seeds, herbs and spices weekly provides a broad spectrum of phytonutrients, vitamins, and minerals. 18
Phytoestrogen-rich foods, such as soy, may also help alleviate menopausal symptoms and provide cardiovascular benefits.8,10 However, according to the National Diet and Nutrition Survey (NDNS) (2016/2017–2018/2019), the average fruit and vegetable intake among UK women is below the recommended five portions per day, with women aged 19–64 consuming only 3.7 portions daily.
• Alcohol Consumption
Alcohol intake among women in the UK increases with age, peaking in the 55–64 age group. 19 The Health Survey for England (2022) reported that 23% of women in this age range exceed the UK’s recommended alcohol limit of 14 units per week. 20
While the relationship between alcohol and menopause is complex, from a weight perspective, alcohol is a significant contributor to energy intake, providing 7 kcal/g. Alcohol calories are often overlooked, yet they can meaningfully impact weight management.
Approximate alcohol content and energy values of common drinks
• Wine (12% ABV) ○ 125 ml (small glass): 12 g alcohol (∼84 kcal) (1.5 units alcohol) ○ 175 ml (medium glass): 16.8 g alcohol (∼118 kcal) (2.1 units alcohol) ○ 250 ml (large glass): 24 g alcohol (∼133 kcal) (3 units alcohol) • Beer/Lager (4% ABV) ○ Half pint (284 ml): 9 g alcohol (∼64 kcal) (1.1 units alcohol) ○ Pint (568 ml): 18 g alcohol (∼126 kcal) (2.3 units alcohol) • Strong Beer/Lager (6% ABV) ○ Half pint (284 ml): 13.6 g alcohol (∼95 kcal) (1.7 units alcohol) ○ Pint (568 ml): 27.2 g alcohol (∼189 kcal) (3.4 units alcohol) • Cider (4.5% ABV) ○ Half pint (284 ml): 10.2 g alcohol (∼73 kcal) (1.3 units alcohol) ○ Pint (568 ml): 20.4 g alcohol (∼143 kcal) (2.6 units alcohol) • Spirits (Vodka, Gin, Whisky, 40% ABV) ○ 25 ml (single measure): 10 g alcohol (∼70 kcal) (1unit alcohol) ○ 50 ml (double measure): 20 g alcohol (∼140 kcal) (2 units alcohol) • Alcopops (5% ABV, 275 mL bottle): 11 g alcohol (∼77 kcal) (1.4 units alcohol)
Summary
A balanced Mediterranean-style diet for menopausal women should prioritise whole, nutrient-dense foods that support bone and heart health while aiding weight management. This dietary approach helps to address common risks associated with menopause, such as osteoporosis and cardiovascular disease, while promoting sustainable lifestyle habits when combined with regular physical activity.3,21
What advice about physical activity should we give?
The role of physical activity in menopause
Physical activity is one of the most powerful tools for improving health and managing weight during menopause, addressing both physical and psychological challenges. 21 Regular exercise helps counteract age-related muscle loss, maintain bone density, enhance cardiovascular fitness, and improve mental well-being. Additionally, it can help mitigate menopause-related symptoms, such as sleep disturbances and mood swings. 22
Types of exercise and their benefits
• Aerobic Exercise: Activities such as brisk walking, swimming, or cycling enhance cardiovascular health, support weight management, and reduce the risk of hypertension and type 2 diabetes. Current guidelines recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous activity per week.
23
• Resistance Training: Strength training using weights or resistance bands is particularly effective in preserving muscle mass and bone density, both of which decline due to ageing and hormonal changes. A meta-analysis found that postmenopausal women engaging in resistance training twice weekly significantly reduced their risk of fractures and osteoporosis.
23
Additionally, a 2% increase in bone mineral density has been observed in women who incorporate resistance training over 1 year.
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• Flexibility and Balance Training: Activities such as yoga, Pilates, and tai chi enhance flexibility, reduce stress, and improve balance, helping to prevent falls as women age.
Exercise has also been shown to alleviate vasomotor symptoms, such as hot flushes and night sweats. Studies indicate that women who engage in regular physical activity report a 40% reduction in symptom severity after 12 weeks. 25
Addressing barriers to physical activity
Despite understanding the benefits of exercise, many women face barriers such as lack of time, fatigue, or limited access to facilities. Healthcare professionals can support women in overcoming these challenges by emphasising the importance of reducing sedentary time, such as incorporating short activity breaks during prolonged sitting. 23
Encouraging small, manageable lifestyle adjustments – such as walking during lunch breaks, taking the stairs, or following home-based exercise programmes – can help integrate physical activity into daily routines.
Motivation and adherence
Social support plays a crucial role in maintaining physical activity levels. 23 Encouraging participation in group activities, such as fitness classes or walking groups, can provide accountability and develop a sense of community.
Additionally, setting achievable goals, such as a daily step target, can help women track progress and remain engaged in long-term physical activity habits.
Practical strategies for weight management
Regular meal patterns
Skipping meals can disrupt energy balance and lead to compensatory overeating later in the day. Encouraging structured eating patterns – such as three balanced meals with healthy snacks – can help maintain steady energy levels and regulate appetite. Failure to eat regularly, or to regularly skip meals makes it difficult to meet daily nutritional requirements.
Appropriate portion sizes
Many women report consuming similar portion sizes to their male partners or teenage sons, which can contribute to unintentional overconsumption. A simple yet effective strategy for creating a calorie deficit is adjusting portion sizes to reflect individual energy needs.
Behavioural support
Behavioural tools such as food diaries or smartphone tracking apps can help women assess their food intake and identify areas for improvement. Group-based programmes or behavioural counselling can further enhance accountability and long-term adherence.
Weight management is not solely about achieving an ideal BMI but rather about improving metabolic health and reducing disease risk. The emphasis should be on gradual, sustainable changes rather than rapid weight loss, which is often difficult to maintain.
Healthy weight recommendations
• Aim for a body mass index (BMIkg/m2) of 18.5 to 24.9 and a waist circumference below 80 cm.
7
• For women who may never reach a ‘healthy’ BMI Kg/m2, a modest weight loss of 10% can still give significant health benefits, including: ○ Reduced risk of type 2 diabetes ○ Improved blood pressure control ○ Better cholesterol profiles ○ Reduced joint pain and improved mobility ○ Enhanced metabolic health, reduced systemic inflammation, and improved energy levels
Given that excess weight is a risk factor for cardiovascular disease (CVD), type 2 diabetes, and osteoarthritis, even small, sustained weight losses can lead to meaningful health improvements. 26
What support do women need to make and maintain lifestyle changes?
Practical tips for implementation
1. Food Diaries: Encourage women to complete a 3–4-day food diary, then review it together to identify specific areas for improvement. 2. Meal Planning: Suggest planning meals ahead of time to ensure balanced and varied nutrition throughout the week. 3. Mindful Eating: Discuss strategies such as eating slowly and savouring food to enhance satiety and prevent overeating. 4. Realistic Expectations: Weight management during menopause should focus on overall health, well-being, and body composition, rather than achieving an arbitrary weight goal. Setting realistic timelines for change is key to managing expectations.
Nutrition education should be empowering rather than prescriptive, enabling women to feel confident in making informed choices that align with their health goals.
Effective communication in delivering care
The way information is conveyed is just as important as the content itself. A woman’s experience with healthcare professionals during menopause can strongly influence her willingness to adopt lifestyle changes and adhere to recommended interventions. Empathy, clarity, and cultural sensitivity are key elements of effective communication.
Empathy and active listening
Many women report feeling dismissed or misunderstood when discussing menopause-related concerns with healthcare providers.
25
Practicing active listening – acknowledging concerns without judgement – helps build trust and validates their experiences. Simple phrases such as: • ‘I hear how challenging this has been for you’. • ‘I understand your frustration’. can foster a more supportive and collaborative relationship.
Tailoring communication to individual needs
Not all women approach menopause with the same level of health literacy, cultural perspective, or personal priorities. Tailored communication ensures that information is accessible and relevant. • Visual aids, diagrams, or digital tools can make complex concepts, such as hormonal changes or resistance training benefits, easier to understand. • Providing written resources or online content allows women to revisit information at their own pace.
Cultural sensitivity
Cultural beliefs and practices shape how women experience and manage menopause
• Some cultures may emphasise natural remedies over medical interventions, while others may view menopause as a taboo topic. • Acknowledging these differences and offering options that are sensitive to a woman’s individual values and preferences can improve engagement and adherence.
Final thoughts
Successful weight management in menopause requires a multifaceted approach, combining practical dietary strategies, physical activity guidance, behavioural support, and effective communication. By adopting an individualised, empathetic, and evidence-based approach, healthcare professionals can help women navigate this stage of life with confidence and control, leading to long-term improvements in health and well-being. 26
Practical steps for implementing lifestyle changes
Adopting a healthier lifestyle can feel overwhelming, particularly for women managing multiple responsibilities during midlife. Breaking recommendations into small, actionable steps makes change more attainable and sustainable.
Step 1: Prioritise concerns
Begin by identifying the woman’s primary concern – whether it’s weight management, sleep disturbances, or emotional well-being. Focussing on one area first prevents overwhelm and lays the foundation for broader changes.
Step 2: Set Realistic goals
Encourage women to set SMART goals (Specific, Measurable, Achievable, Relevant, and Time-bound). For example: • ‘Walk 20 minutes every evening’ is more actionable than the vague aim ‘exercise more’.
Step 3: Provide Resources and tools
Equip women with practical tools to support their goals, such as: • Meal-planning apps or recipe guides for healthy eating. • Fitness trackers to monitor physical activity. • Guided meditation apps to improve sleep and reduce stress.
Step 4: Regular follow-up and feedback
Lifestyle changes require ongoing support. Scheduling follow-up appointments allows for reviewing progress, addressing challenges, and celebrating successes. Positive reinforcement – such as acknowledging improved energy levels or symptom relief – can help sustain motivation.
Step 5: Encourage peer support
Women often find encouragement and accountability through peer support groups. Whether in-person or online, these communities provide a valuable space to share experiences, challenges, and strategies for success.
What about popular diets and weight management medications?
Popular diets and the yo-yo dieting trap
Many menopausal women have spent years caught in the cycle of yo-yo dieting, experimenting with fad diets that lead to short-term weight loss followed by regain – often with an increase in body fat percentage compared to pre-diet levels. This cycle can make sustainable weight loss more challenging and negatively impact metabolism, emotional well-being, and self-esteem.3,4
Many women explore popular diets such as ketogenic, intermittent fasting, and low-carb diets for weight loss during menopause. However, research supporting their effectiveness specifically in menopausal women is limited.
A closer look at three popular diets
Ketogenic diet
A high-fat, low-carbohydrate diet, the ketogenic diet may promote initial weight loss by reducing appetite. However, long-term adherence is challenging, and nutrient deficiencies, as well as fibre, can be problematic for menopausal women, given its role in digestive and heart health. 27
Both the British Dietetic Association (BDA) and the Academy of Nutrition and Dietetics caution against ketogenic diets for weight management due to limited evidence on long-term efficacy and safety.
Intermittent fasting (IF)
Intermittent fasting (e.g. 16:8 or 5:2 fasting) has shown potential for weight management, but research specifically on menopausal women is limited. While some women may benefit, IF should be approached cautiously to ensure nutrient requirements are met during eating windows.28,29
Both the BDA and the Academy of Nutrition and Dietetics acknowledge the popularity of IF but emphasise that current scientific evidence remains limited, with many studies based on small-scale or animal models. 30 More long-term research is needed to assess its effectiveness and safety in menopause.
Continuous glucose monitoring (CGM) for weight management
Continuous glucose monitoring (CGM) is traditionally used to support blood glucose control in diabetes. More recently, CGM has been promoted as a tool for weight management in individuals without diabetes.
In one study involving 30 participants without diabetes, researchers examined 1189 glucose responses to duplicate meals from four different dietary patterns. 31 The study concluded that 67 repeated exposures to a single food would be needed for accurate blood glucose response predictions. These findings highlight the high variability in postprandial glucose responses in individuals without diabetes, suggesting that CGM-based personalised diet advice may require more reliable methodologies. 32
Breaking free from diet culture
For many women, menopause presents an opportunity to move away from restrictive dieting and adopt a lifelong, balanced approach that prioritises: • Nutrient-dense eating habits • Sustainable physical activity • Mental well-being
This consistency-over-intensity approach empowers women to manage their health without the rigid constraints of fad diets, supporting long-term well-being beyond menopause.
Weight management medications
For some women, weight-loss medications may serve as an adjunct to lifestyle interventions.
Common medications include: • Semaglutide (Ozempic) • Liraglutide (Saxenda) • Tirzepatide (Mounjaro) or 9Zepbound)
These drugs act on the GLP-1 pathway, promoting satiety and reducing caloric intake. Studies show they can facilitate significant weight loss and improve metabolic parameters, such as: • Blood glucose control • Cholesterol profiles • Blood pressure regulation
However, these medications are typically reserved for women with: • A BMI over 30 • Weight-related health risks, such as hypertension or insulin resistance
It is essential to emphasise that weight-loss medications should complement – not replace – lifestyle changes and must be prescribed and monitored by healthcare providers. 9
Conclusion
Effective weight management during menopause requires a holistic approach, integrating:
Balanced nutrition
Regular physical activity
Behavioural support
Adjunct tools and, where appropriate, medications
Menopause presents an opportunity for positive lifestyle change – a turning point to move away from the cycle of fad dieting and instead embrace a sustainable, health-focused approach.
Healthcare professionals play a key role in guiding menopausal women toward evidence-based strategies that empower them to take control of their health. By fostering a supportive, individualised approach, clinicians can help women navigate menopause with confidence and improve their overall quality of life.
Footnotes
Declaration of conflicting interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The author declared that his organization receives sponsorship and educational grants from the following organisations: Theramex, Astellas, Besins, Symprove, Linwoods, Benecol, Yes Organics.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Guarantor
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