Menopause Weight Gain: Why Muscle Matters

The short version

Around menopause, falling oestrogen shifts where the body stores fat, with more stored around the middle and less on the hips and thighs (Juppi et al., Seminars in Reproductive Medicine, 2025).

Midlife weight gain rarely has a single cause. Hormonal change, ageing, stress and less time for exercise or healthy eating all play a part (Davis et al., Climacteric, 2012).

Muscle mass and strength decline with age, and falling oestrogen speeds up bone loss after menopause (Seeman, Journal of Applied Physiology, 2003).

Muscle and bone work as a team: muscles pulling on bones during movement is one of the main signals that keeps bone strong.

When you lose weight, some of what you lose is lean mass rather than fat. Studies put this at around 25% to 39% of weight lost with GLP-1 medications (Eisa and Barood, Diabetes, Obesity and Metabolism, 2026).

In the same analysis, adding resistance training to lifestyle changes cut the share of weight lost as lean mass to around 17.5% (Eisa and Barood, 2026).

A useful protein reference point is at least 1.0 to 1.2 g per kg of body weight a day, spread across your meals (Deutz et al., Clinical Nutrition, 2014).

Calcium is needed for the maintenance of normal bones, and vitamin D contributes to normal bones and normal muscle function. The NHS advises everyone to consider 10 micrograms of vitamin D a day in autumn and winter (NHS).

HRT reduces menopause-related bone loss, but it is not a weight-loss treatment (Anagnostis et al., Hormones, 2021).

The links between hormone changes and weight gain are constantly talked about, especially in the conversation around perimenopause and menopause.

Maybe you've experienced it yourself: you haven't changed what you eat, but your waist has disappeared and your weight seems to go up no matter how carefully you eat.

But more important than the number on the scale is what that number is made of. We need to shift the focus and think about overall body composition at this time of life. When oestrogen levels drop at menopause, it affects our whole body. Yes, fat distribution changes, so we see more fat stored around our middle, but we are also likely to lose bone density and strength, as well as muscle mass, which is often overlooked in our eagerness to drop weight (Juppi et al., Seminars in Reproductive Medicine, 2025).

So, this piece looks at body composition rather than body weight: why it changes around menopause, why muscle and bone matter so much at this stage of life, what you may really be losing when the scales go down (including if you're taking a GLP-1 medication), and how to eat and move to keep both strong.

Why does weight change around perimenopause and menopause?

Changes in weight and body composition at menopause are often put down to falling levels of oestrogen alone.

When oestrogen is in good supply before perimenopause, it influences fat storage towards areas like the hips, thighs and buttocks. This oestrogen comes from the ovaries. But as we move into menopause, ovarian oestrogen becomes scarcer and fat storage is redirected to the abdomen, including the deeper visceral fat around the organs. This is the 'menopause belly fat' so many women notice, even when their weight barely changes (Juppi et al., 2025).

But this is only part of the picture. A review for the International Menopause Society concluded that weight gain itself cannot be blamed on the menopause transition alone, even though the hormonal shift is linked with more total and abdominal fat (Davis et al., Climacteric, 2012). Most women experience perimenopause in their mid to late 40s. It's not uncommon for this to be prime juggling time: raising a family, juggling a career, and possibly looking after ageing parents.

All of this can contribute to changes in stress levels, bringing other hormones into the equation. Chronic stress and alterations in cortisol activity have also been associated with abdominal fat accumulation, although the relationship is complex and the research is not entirely consistent (Bose, Oliván and Laferrère, Current Opinion in Endocrinology, Diabetes and Obesity, 2009).

Add into this a lack of time to exercise regularly or prioritise healthy nutrition, and you have 'the perfect storm'.

So we're looking at several lifestyle factors, as well as the effect of decreasing oestrogen levels on the body, as possible reasons for weight gain in midlife women.

What happens to muscle and bone during menopause?

Muscle mass and strength gradually decline with age, making it increasingly important to consider the factors that help maintain strong bones and healthy muscle tissue. Among the factors we can change, low physical activity and low protein intake are the biggest contributors to muscle loss after menopause (Maltais, Desroches and Dionne, Journal of Musculoskeletal and Neuronal Interactions, 2009).

This loss of strength and skeletal muscle is known as sarcopenia, and it often goes hand in hand with bone-related conditions like osteopenia and osteoporosis (Lu and Tian, Journal of Endocrinology, 2023).

How does oestrogen affect your bones?

Again, loss of oestrogen plays a significant role in our bone health. Your skeleton is constantly being renewed: old bone tissue is broken down and removed, and new bone is laid down in its place. This bone 'turnover' is important to maintain healthy, strong bones, and oestrogen helps keep the two sides of it in balance. When oestrogen falls at menopause, turnover speeds up and more bone is removed than is replaced, so we're more likely to experience brittle bones, or more frequent fractures due to poor bone quality (Seeman, Journal of Applied Physiology, 2003).

We need to remember that bones are more than just the framework holding us upright. They're living tissue that responds to hormone signals, diet quality, movement and lifestyle factors.

Why do muscle and bone depend on each other?

The loss of muscle becomes significant in this equation due to its function as a stabiliser and strengthener of bones. Muscle and bone sit side by side and even signal to one another (Lu and Tian, 2023).

Muscle contractions and weight-bearing activity place mechanical load on bones, providing an important stimulus for maintaining bone strength. That is why the UK consensus statement on exercise for bone health, developed with the Royal Osteoporosis Society, recommends resistance and impact exercise to maximise bone strength (Brooke-Wavell et al., British Journal of Sports Medicine, 2022). So where muscle mass is lost, bone strength can suffer, leading to increased risk of fractures.

And this is a two-way street. If you're unlucky enough to suffer a fracture, you may be immobilised and unable to walk or exercise, meaning that you're less able to maintain muscle mass.

Losing weight in midlife: what are you actually losing?

You'll see, then, that the number on the scale isn't the be-all and end-all. If the number is going down, you need to be sure that you're losing what you want: fat mass, not muscle mass or bone mass. So, when we weigh ourselves, it's worth using body composition monitoring scales to find out what our weight comprises. It's not just fat.

This is true for everyone. A 2026 meta-analysis of 20 randomised controlled trials found that around a quarter of the weight lost through diet and lifestyle changes alone was lean mass (Eisa and Barood, Diabetes, Obesity and Metabolism, 2026). Lean mass refers to muscle plus water and other tissues that aren't fat.

What about muscle loss on GLP-1 medications like Mounjaro?

If you're taking a GLP-1 medication (Wegovy, Ozempic or Mounjaro, for example), it's worth planning your nutrition and exercise with this in mind. These medications work by reducing appetite, so while you're eating less, and the food noise has quietened down, it's important to ensure that you are still focusing on the right foods for your muscle and bone health in the meals that you eat.

A recent meta-analysis found that lean mass accounted for around 25% of weight lost with GLP-1 receptor agonists (Karakasis et al., Metabolism, 2025). More recent evidence suggests that lean mass may account for approximately 25% to 39% of weight lost with different incretin-based medications, although the proportion varies considerably (Eisa and Barood, 2026).

Here's the encouraging part. In that same 2026 analysis, people who combined lifestyle changes with resistance training lost the smallest share of lean mass, at around 17.5% of the weight they lost (Eisa and Barood, 2026). So understanding how to maintain muscle while losing fat is important, and professional advice to help you make suitable dietary choices alongside your weight-loss medication can help you confidently reach your goals.

How can you preserve muscle while losing weight in midlife?

Given that loss of lean mass is a risk during weight loss, it's important to pay attention to muscle growth and strength. The more muscle we have, the more ability we have to stay active and thrive in life as we get older.

Not only will a nutrient-rich diet give your body the tools it needs, but regular exercise matters too. The NHS recommends regular exercise during perimenopause and menopause, including weight-bearing activities such as walking, running or dancing, and resistance exercises such as using weights (NHS, Menopause and perimenopause: things you can do). Resistance and strength-based exercise, such as weight training, Pilates or yoga, stimulates muscle adaptation and, alongside weight-bearing activity, plays an important role in maintaining muscle strength and bone health.

What should you eat for healthy bones and muscles during menopause?

The biggest mistake to make if you want to lose weight is to just eat less. Instead, the focus needs to be on the nutritional value of what you eat: make every mouthful count. If your appetite is suppressed by a GLP-1 medication, this still applies. You will be eating smaller portions, but you can still make every meal a powerhouse of nutrition.

Protein

Protein provides the amino acids (building blocks) needed to maintain and repair muscle and build bone. Protein contributes to the maintenance of muscle mass and to the maintenance of normal bones. It's used for so many reactions in the body that it's important to ensure you're eating enough so there's plenty for these two vital areas.

A useful starting point is at least 1.0 to 1.2 g of protein per kg of body weight each day, spread across your meals, although individual requirements vary (Deutz et al., ESPEN Expert Group, Clinical Nutrition, 2014). That recommendation was written for healthy older adults, but it's a helpful reference point through midlife too. For a woman weighing 70 kg, it works out at roughly 70 to 84 g of protein a day.

Choose from eggs, fish, chicken, dairy, tofu, tempeh, beans, lentils, nuts or another protein source that works for you.

Calcium and vitamin D

Your bones need more than protein. Calcium is needed for the maintenance of normal bones, and the NHS suggests eating calcium-rich foods such as milk, yoghurt and kale during perimenopause and menopause (NHS, Menopause and perimenopause: things you can do). Vitamin D contributes to the maintenance of normal bones and to normal muscle function, so it matters for both halves of this story. In autumn and winter the sun in the UK is not strong enough for your skin to make vitamin D, which is why the NHS advises everyone to consider a daily supplement containing 10 micrograms of vitamin D during those months (NHS, Vitamin D).

Fibre

Fibre is another important part of the picture, keeping the digestive system working and eliminating well. It also feeds the microbiome, so focus on variety: vegetables, fruit, beans, lentils, wholegrains, nuts and seeds all provide fibre, as well as a range of vitamins, minerals and plant compounds.

If you are increasing your fibre intake, do it gradually and make sure you're drinking plenty of water. Suddenly doubling your fibre intake without sufficient water is unlikely to make your gut particularly happy.

If you're taking GLP-1 medication, be cautious. You may be experiencing delayed gastric emptying, which can cause digestive upsets (Marathe et al., Experimental Diabetes Research, 2011). In this case, increase fibre gradually to feel more comfortable.

Hydration

Again, if you're taking medication that reduces your appetite, you may find that you also drink less water. Stay hydrated by drinking water and herbal teas throughout the day. This helps your digestive system maintain its motility, helping to avoid constipation, and is essential when you're eating more fibre.

Micronutrients and nutrient density

As already mentioned, making your food work for you is essential. If you're eating smaller amounts of food, or managing the general symptoms around midlife or menopause, weight loss still needs nutrient-rich choices rather than nutrient-poor, calorie-dense foods.

Always prioritise protein, and then add a good portion of vegetables for vitamins and minerals, healthy fats and wholegrains. If you snack, combine protein (such as nuts) with a piece of fruit for added nutrients.

If you're looking for nutritional support alongside a balanced diet, you can explore our Weight Management Supplements and Blood Sugar Support. A registered practitioner can help you decide what's right for you.

Does HRT help with weight or bone health?

Just a word on HRT. HRT reduces the bone loss associated with falling oestrogen (Anagnostis et al., Hormones, 2021), and the NHS notes that taking HRT can reduce the risk of osteoporosis (NHS). However, evidence around HRT and body composition is mixed, so HRT shouldn't be viewed as a weight-loss treatment. If you're considering HRT, talk it through with your GP.

What can you do now to look after your muscles and bones?

This is all very well, but what can you do now to support yourself as you move through these life stages? Here are a few practical habits you can introduce straight away.

1. Add protein to every meal and snack

When you add protein, aim to spread it evenly through the day. For example, two eggs at breakfast give you roughly 12 g of protein, while a chicken breast at lunch or a salmon fillet at dinner provides around 25 to 30 g. Grains and vegetables add a little more, and you can top up with snacks such as nuts or nut butters, seeds, or bone broth.

2. Join a Pilates class or yoga session

A good Pilates or yoga instructor will be well versed in accommodating all levels. If you haven't exercised for a while, research local studios and look for someone recommended for smaller, more personalised classes, where you'll get the attention you need, particularly if you're returning to exercise after a long break. Local Facebook groups can be a great source of recommendations.

3. Plan your meals

If you're time-poor, this may sound like another problem to overcome, but planning is worth the time. Make sure you have a balanced plate, whether you've adapted to eating smaller meals or are eating normal portion sizes. Aim for half your plate to be vegetables, a quarter protein and a quarter starchy carbohydrate.

4. Find a gym that will help you lift weights

Many areas now have small, personal training gyms that specialise in weight training for women. If you already exercise, consider building a regular weight-training programme into your routine.

If you're taking medication or haven't exercised for a long time, speak to your GP before starting a new exercise programme.

Common questions

Why do women gain weight and belly fat during menopause?

Falling oestrogen changes where the body stores fat, shifting more of it to the abdomen, which is why belly fat often increases through perimenopause and menopause. But midlife weight gain usually has several causes, including ageing, stress and less time for exercise and good food, rather than menopause alone (Davis et al., Climacteric, 2012).

Does menopause cause muscle loss?

Muscle mass and strength decline with age, and the hormonal changes of menopause contribute to that decline. Low physical activity and low protein intake are the biggest factors you can change (Maltais et al., 2009).

How much protein should I eat during menopause?

European clinical nutrition experts recommend at least 1.0 to 1.2 g of protein per kg of body weight a day for healthy older adults, which is a helpful reference point through midlife. Spread it across your meals (Deutz et al., Clinical Nutrition, 2014). Individual needs vary, so a registered practitioner can help you find the right amount.

Do you lose muscle on Mounjaro or other GLP-1 medications?

Some of the weight lost is usually lean mass. Studies put it at around 25% to 39% of total weight lost with medications such as Wegovy, Ozempic and Mounjaro, depending on the medication (Eisa and Barood, 2026). Combining resistance training with enough protein is linked with losing less lean mass.

What exercise is best for muscle and bone during menopause?

The NHS recommends regular exercise that includes weight-bearing activities, such as walking, running or dancing, and resistance exercises, such as using weights (NHS).

Is HRT a weight-loss treatment?

No. HRT reduces menopause-related bone loss (Anagnostis et al., 2021), but the evidence on HRT and body composition is mixed. Speak to your GP about whether HRT is right for you.

The bottom line

The menopause transition is about far more than the number on the scales. At this stage of life, preserving muscle, maintaining strong bones and nourishing your body well are just as important as losing excess body fat. Prioritise protein, build in resistance and weight-bearing exercise, look after your calcium and vitamin D, and if you're taking a GLP-1 medication, plan your nutrition around it.

So make your weight-loss strategy work for your long-term health, not against it.

This article is for general information and is not a substitute for personalised advice. If you are taking medication, including GLP-1 medication or HRT, are pregnant or breastfeeding, or have a medical condition, speak to your GP, pharmacist or practitioner before changing your diet, exercise or supplements.

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