Why Does Menopause Belly Happen?
Putting on weight seems inevitable as we age. What's more frustrating for midlife women is that eating less and exercising more often has little effect on weight that tends to accumulate around the midsection. There's a name for it: menopause belly, or meno belly.
"Menopause belly refers to the accumulation of excess fat around the abdomen, particularly visceral fat, which surrounds the internal organs," explained Professor Yong Eu Leong, emeritus consultant at the Division of Benign Gynaecology, Department of Obstetrics & Gynaecology at National University Hospital (NUH). He added that during the menopausal transition, many women shift from a pear-shaped body, where fat is stored around the hips, thighs and buttocks, to a more apple-shaped body, where fat concentrates around the waist. On average, women gain about 2-3kg during this period.
Declining Oestrogen and Muscle Loss
Associate Professor Rukshini Puvanendran, co-director of the KK Menopause Centre at KK Women's and Children's Hospital (KKH), said declining oestrogen levels are associated with a shift in where the body stores fat. These changes can begin during perimenopause.
Age-related muscle loss is another factor. Because muscle burns more calories than fat even at rest, having less muscle slows metabolism, making it easier to gain fat and harder to lose weight.
Poor Sleep: A Vicious Cycle
Hormonal fluctuations can also disrupt sleep, creating a vicious cycle where poor sleep drives weight gain and weight gain drives poorer sleep. When sleep is disrupted, key hormones fall out of balance:
- Ghrelin (the hunger hormone) rises
- Leptin (the hormone that keeps you full) drops
- Cortisol (the stress hormone) stays high
- Melatonin (the sleep-regulating hormone) is thrown off
These hormonal changes can make the body less responsive to insulin, affecting blood sugar regulation and making it easier to store excess fat around the abdomen. Poor sleep can also increase cravings for sugary and fatty foods, while fatigue makes exercising harder.
Why Asian Women Are More Prone to Visceral Fat
Asian women may be particularly susceptible to carrying visceral fat even when they appear slim or have a healthy body mass index (BMI). "As Asian women naturally store less fat just under the skin, they can potentially appear slim and register a healthy BMI, while quietly accumulating visceral fat around their organs," said Assoc Prof Rukshini.
A 2021 National University of Singapore study comparing post-menopausal Chinese women in Singapore with German Caucasian women found that, among women with similar BMI, Chinese women tended to have higher levels of abdominal fat. Similar findings emerged from the Integrated Women's Health Programme by NUH and NUS Medicine. The study of 1,201 Chinese, Malay and Indian women in Singapore found increased visceral fat, along with loss of muscle and strength, lower energy expenditure and reduced fat-burning capacity.
These findings place Asian women at greater risk of gaining fat around the abdomen and upper body during perimenopause and menopause, as well as metabolic complications such as diabetes, hypertension and cardiovascular disease, said Prof Yong.
Same Weight, More Fat
A long-term American study, the Study of Women's Health Across the Nation (SWAN), found that women gained fat while losing lean mass as they went through perimenopause and menopause. The study of 1,246 women found a 3.6 per cent cumulative increase in fat mass and a 1.9 per cent decline in lean mass.
That means a woman may weigh roughly the same before and after menopause but have a higher proportion of body fat and less lean muscle. The study discovered that the rate of fat gain doubled and lean mass started to decline about two years before the final menstrual period. These changes stabilised about two years after the final period. However, the tendency to store fat around the abdomen may still persist due to continued low oestrogen levels and age-related metabolic changes.
The Dangers of Menopause Belly
"Abdominal or visceral fat is not merely a cosmetic concern," said Prof Yong. Unlike pinchable fat just under the skin, visceral fat lies deep inside the abdomen, surrounding the internal organs. It is biologically active and functions almost like a hormone-producing organ.
As visceral fat increases, it releases chemical signals that promote low-grade inflammation throughout the body. This inflammation can make the body's cells less responsive to insulin, resulting in insulin resistance. The body then needs to produce more insulin to keep blood sugar levels under control, which can make it easier to store additional fat, particularly around the abdomen, creating a cycle in which increased visceral fat and insulin resistance reinforce one another.
Excess visceral fat is associated with a higher risk of conditions such as Type 2 diabetes, hypertension and cardiovascular disease.
Strength Training to Combat Menopause Belly
"You can't burn fat from one spot, so crunches alone won't flatten your belly," said Danielle van der Leest, founder of Active Women SG and a menopause fitness coach. Instead, she recommends strength training complemented with mobility work. Strength training can help counter the effects of declining oestrogen on bone density and muscle mass, making it a key strategy for managing weight and body composition during menopause.
Want to track your weight, body fat, sleep and blood pressure more scientifically? The Xiaoshu Health App can sync with Apple Health to help you monitor menopausal health changes over time.