Is weight gain at menopause inevitable? At menopause, I experienced a sudden and dramatic weight gain. I was healthy and exercised moderately five times a week for 30-plus years; I have always been careful about my diet, eating only healthy fresh food that I prepare myself. I am not sleep deprived. After trying various diets, I cannot get rid of this extra 15 pounds, and I've moved into the officially "overweight" category. What happened? Am I doomed to eat only lettuce in the future?

A

Many women in middle age complain about stubborn belly fat. Research suggests that this is indeed a common feature of menopause.

In a large study carried out by the International Menopause Society in 2012, scientists reviewed decades of research and concluded that the hormonal shifts of menopause change the distribution of body fat, making it more likely to accumulate in the abdomen. The drawbacks of this are more than just cosmetic: The accumulation can also increase the risk of insulin resistance and cardiovascular disease.

Last year, researchers at the Mayo Clinic took a closer look at the phenomenon by comparing fat tissue in pre- and post-menopausal women of similar ages. At the cellular level, they found that two enzymes that work to synthesize and store fat were more active in the postmenopausal women, which the researchers attributed to drops in estrogen.

Experts also say that decreases in metabolism mean that women gain an average of 10 pounds around menopause, but that they can lose weight through diet and exercise.

One study that underscored this was published in the journal Menopause in 2012. Researchers randomly assigned about 17,000 postmenopausal women who were not using hormone therapy to either a control group, or to another group that was put on a diet with increased intake of healthful foods like fruits, vegetables and whole grains. After a year, women in the diet group had fewer hot flashes and they were three times as likely to have lost weight.

In one randomized trial called the Women’s Healthy Lifestyle Project, 535 premenopausal women were followed through menopause. About half of the women were assigned to follow a low-calorie diet (about 1,300 calories daily) and burn an extra 1,000 to 1,500 calories weekly through physical activity.

After five years, the women in the diet and exercise group saw greater reductions in their waistlines, and they were more likely to have remained at or below their baseline weight.

So while weight gain is common at midlife, it's not a foregone conclusion. That said, women who want to avoid midlife weight gain will have to work harder at keeping weight off by taking in fewer calories and burning more through exercise.