The Menopause 'Meno-Potbelly' — Myth or Fact?
Or: What’s happening to my belly and what can be done about it? A mortified health writer investigates.
Editor’s note: In honor of Menopause Awareness Month, we are running a series of stories about menopause. Our goal is to illuminate a topic that is sometimes shrouded in misinformation and shame. We hope to change that.
What am I doing wrong?!
At 61, I'm fitter than ever in my adulthood. I work out most days — a mix of strength-training, cardio, HIIT (high intensity interval training), flexibility and balance. I count macros, eat "clean and green." My weight falls in the normal range, with body fat hovering around 22%.
But a recent companion never leaves my side — er, my belly. A poochy, uninvited, most unwanted guest.
The Internet dubs it a "meno-potbelly"— the potbelly that shows up after menopause. I'm not plagued by hot flashes, dryness, insomnia or mood swings. This shape change, on the other hand, has remade my sanity along with my midsection.
Friends can't stop obsessing about their meno-pots, either. "Just yesterday, my daughter said, 'I saw you doing that again!'" noted mom-of-four Cherie Spino, who's 57 and lives in Toledo. We share the same tic: Turn, side-eye the mirror and check whether (ahem, how much) you're rounding out.
"You lose fat in some places — like the face, the vulva and the fat pads of your foot — and you gain in others, and we don't know why."
"It's annoying," says Barbara Wilson, 55, of suburban Philadelphia. She wore the same lean size for 20 years. "Just in the last year, I can no longer fasten the button on my favorite jeans. I now understand why 'women of a certain age' start wearing long tunics and shift dresses!"
We trade theories: Metabolism? Gravity? Weak core? Genetics (mom was round in her later years)? Delayed after-effects of long-bygone pregnancies?
One friend wondered if maybe it were an optical illusion: Her belly was only looking bigger as her breasts seemed to shrink.
No, no, no and no to all that, "although optical illusion would be nice," chuckled Dr. Stephanie Faubion author of "The Menopause Solution." She's director of the Mayo Clinic's Center for Women's Health and medical director of the North American Menopause Society.
And she totally got our midriff malaise. Her patients complain about it every day. A 57-year-old former ballerina, Faubion now finds it "irritating," "frustrating" and "a helluva lot of work" to maintain her own silhouette.
So, What's Going On?
Above all, blame the very real double whammy of age plus menopause.
Around 50, both men and women lose 0.8% of muscle mass per year, Faubion says — it's part of the natural aging process. Muscle burns energy. Muscle-melt can translate to a 1.7-pound weight gain a year, starting in midlife. "That might not sound like much, but over a few years it adds up," she says.
But I do strength-training, I whined.
Women have much less lean muscle mass relative to men to begin with, Faubion explained. More lean tissue is largely why your husband drops pounds faster than you can say, "All you did was drink less beer!" Then our loss of estrogen amps up the challenge.
For physiological reasons that (amazingly) remain unclear to scientists, the menopausal transition really coincides with proven shape changes — less pear, more apple — even if weight stays the same.
"You lose fat in some places — like the face, the vulva, and the fat pads of your foot — and you gain in others, and we don't know why," Faubion says.
Funny how I view all those changes as annoying but my meno-belly as moral failure.
"Unfavorable changes in regional fat distribution" is how an analysis out earlier this year puts it. The Study of Women's Health Across the Nation (SWAN), which has tracked a large group of the same women since 1994, was the first, in 2019, to definitively tie changes in overall body composition to the 3.5 year menopause transition (a phase bracketing the final menstrual period). Starting a few years before that last period, women lose lean mass, and total fat mass goes up by nearly 6%.
This year's follow-up SWAN research paper pinpointed what's happening to fat within specific regions. Gynoid fat (located roughly from the hips down to the upper thigh) rises a little before the final menstrual period, then plummets — hello flat butt. Android fat (from the breasts to just below the waist, including love handles) goes up fivefold in this phase — hello meno-potbelly.
"With menopause, women's shapes become more male-like," says Dr. Gail A. Greendale, a SWAN principal investigator who is Leichtman/Levine Professor of Women's Health Research at the UCLA School of Medicine.
What Can I Do About It?
So, what can you do about it? "That's the sixty-million dollar question," Greendale says. "We have no idea how to prevent this phenomenon." Interventional studies focused on how to impact specific kinds of fat changes around menopause haven't been done yet.
What's clear is that after menopause, having the shape you want becomes more complicated.
"I feel like we all want to say it's due to menopause. But we're not being honest about how our lifestyles have changed."
Along with physiology, lifestyle often changes. We're not running after kids. More time for cocktails. Maybe caregiving stress. Night sweats and bladders can ransack sleep.
"I used to be massively active, teaching Pilates three times a week, doing it on my own, using the elliptical," says Juliann Tilley, 60, of Clawson, Mich. "Then my mom got sick, I had knee problems and work stress and my body went to heck. Now I walk fifteen minutes and get on the elliptical a couple of times a week and kid myself about how 'active' I am. I feel like we all want to say it's due to menopause. But we're not being honest about how our lifestyles have changed."
Still, she wonders: "Is it just aspirational or can I control it if I just get my act together?"
Old Tricks Don't Work Anymore
"You can't exercise your way out of the meno-pot," Faubion says. "Exercise can help you not gain weight and keep it off. But you also have to cut calories." She added flatly: "Midlife women can't eat carbs. They just can't."
My heart sank! I've already given up desserts, fried foods and most added sugar. Now goodbye to my beloved daily Norwegian rugbrod (a dense seeded rye), chocolate, and wine, too?
Faubion clarified she's referring to simple carbs — white rice, white pasta, white bread and yes, most desserts. Beyond quickly adding calories that are harder to expend, they trip a troublemaking glucose response at a time when many women face a higher risk of insulin resistance.
"You just can't eat as much or you will gain weight," she says. "And you have to watch the wine."
What about peers still rocking washboards?, I asked (okay, whined to) Greendale. Are they just trying way, way harder?
"Maybe their hormone profiles are different to start with, maybe they're more resilient to hormonal changes," she says. Those studies have yet to be done. "But they're a rare phenotype."
She added, sympathetically: "You can tell women that it's not them. It's not some character flaw, not a diet flaw, not trying hard enough. It's that their body is no longer playing ball."
Welcome to meno-math. Do more, eat (and drink) less and you might still have measurements you don't like!
No wonder I hate math! It's enough to make me want to give up, except for this kicker:
The Real Enemy is Visceral
Cosmetics aside, a type of fat you cannot see, known as visceral fat, also increases sixfold during the menopause transition, the SWAN study showed. Visceral fat lies beneath belly fat, wrapping around inner organs. Blame (scientists think) a still-unclear interplay of changing body composition and hormones, especially one called follicle-stimulating hormone (FSH), an ovary-regulator that falls in perimenopause and is associated with visceral fat.
Visceral fat is a major risk factor for heart disease and dementia. It's inflammatory and reduces sensitivity to insulin (which regulates blood sugar, another reason simple carbs are so damning now). Even lean older women are at risk; doctors dub it TOFI: "Thin outside, fat inside."
"We need to give ourselves some grace. You probably won't be a size two with a flat belly your whole life. Will you ever get there again? Probably not, and that's okay."
Hormone replacement therapy (HRT, now known as "menopausal hormone therapy") seems to hold back some of these changes, some studies show, with users having less visceral fat and lower BMI — but only while on it.
Indeed, my own middle began to muddle as soon as I started weaning off hormones a few years ago. Intriguing as preventative applications are for future research, given a current lack of proof plus HRT downsides (like elevated cancer risks), nobody's prescribing hormone replacement therapy for meno-pots. "HRT is NOT a weight-loss drug," Faubion stressed.
Better, the experts chorused, to focus on proven ways to keep the encroaching visceral fat down, like maintaining a normal weight. "You don't even have to be at the lowest end of normal," Faubion says, and have a waist measurement below 35 inches, which is a rough proxy for visceral fat in women. (Much more accurate are devices that measure fat/muscle composition; I've used an InBody scale, available at some health centers.)
To that end, carbs do count. Exercise matters more than ever, especially strength training to hang onto muscle mass and high-intensity intervals to burn fat. Metabolism-protective sleep is under-valued.
"It's possible there's nothing you can do about the striking changes of the menopause transition — you lose muscle, gain fat and maybe mitigate it a bit with exercise. We just don't know," Greendale says. "But we do know exercise and watching your diet are good for other things, so you've got to go to bat and try."
Changing Our Own Mindset
"We need to give ourselves some grace," Faubion says. "You probably won't be a size two with a flat belly your whole life. Will you ever get there again? Probably not, and that's okay. Aging is out of our control — but the alternatives are worse."
I asked Faubion whether our generation can't stop griping because the likes of Twiggy gave us collective body dysmorphia.
"The real issue is that there's not a lot of positive messaging about older bodies," she says. True, celebrities like Gwyneth Paltrow are finally yakking up hot flashes and meno-libido (yes, that's a thing). But we still see more surgeon-sculpted torsos than nature-made meno-pots.
My friends who are amping up the HIIT and Pilates have it right. Cut back the wine and chocolate — but not out, life is short! I admit I'm flirting with Over-60 CrossFit, even as I finally ordered jeans with a sized-up waist. Working harder and easing up.
"I wouldn't say I'm fighting it OR giving up," says Wilson. "I'm coming to terms with the change, like how I had to accept going up half a shoe size after two pregnancies. As my husband likes to tell me, 'These are things that only you notice.'"
I know it's time to stop beating myself up over what I'm doing "wrong" for my belly and celebrate what I'm doing right for my heart and brain health.
If only menopause would gift me with one more big change: the maturity to be more vain about what's inside than what's outside.