Menopause isn't the boss of your scale.
Credit: Illustration: Sarah Wilkins

Menopausal weight gain is like a chubby bogeyman lurking in the dark closet of women's lives. On top of the hormonal free-for-all of hot flashes and night sweats, most women—thin, healthy weight, and overweight alike—can expect to gain an average of 10 to 15 pounds before, during, and after menopause.

But those climbing scale numbers may not be the fault of menopause. "It's not 100% clear whether women's midlife weight gain is related to the hormonal changes of menopause or whether it's related to the aging process itself," says Bette Caan, DrPH, a senior research scientist with Kaiser Permanente. In fact, research shows that both men and women are likely to put on pounds in midlife. For both genders, that creeping weight gain is associated with a loss in muscle mass, particularly bad news because less muscle means a slower metabolism.

Fortunately, whether the weight gain is the result of menopause or midlife, it's not dark magic. It's only pounds, and pounds can be shed. Caan recalls a study of menopausal women that she worked on decades ago: "We weren't trying to help them lose weight. Our focus was on decreasing fat in the diet to try to decrease breast cancer risk." The diet included increased fruits and vegetables and whole grains, "but this was the ′90s," she notes, "and our big focus was cutting fat, so we didn't really pay attention to what we were substituting for the fat, and our diet was very high in refined carbohydrates—it might have included fat-free cookies and pudding with whipped topping. It's not a diet we'd pick today." But even on this less than ideal regimen, the women on the diet were three times more likely to drop weight than control subjects.

And they lost that weight without the added boost of exercise. Midlife pounds can be slightly more stubborn (thanks, slowed metabolism), so it may take the one-two punch of healthy diet plus exercise to budge them. Bonus: While it's burning calories, exercise also builds muscle and strengthens bones.

Finally, Caan notes that overweight women report more hot flashes and night sweats than their leaner peers. "More research needs to be done before anyone can definitively say that weight loss is an effective treatment for hot flashes, but there's a growing body of evidence that suggests that losing weight may decrease menopausal symptoms."