“Nothing I do works.  Ever since hitting menopause, I put on weight, and it does not come off like it used to.  I have tried everything!”

This sentiment is very common with middle-aged women and women who are going through perimenopause and menopause.

Should these women simply “work out more” or “eat better,” or is there more to achieving their health and weight goals than this?  

What role do female hormones such as estrogen, progesterone, and testosterone (yes, testosterone) play in weight management?  

Gender-based factors appear to come into play at least at the severe obesity level (NIKKD, 2021; Leeners et al., 2017).  

Overweight rates in the U.S. for adult men and women are similar as follows (NIKKD, 2021): 

• 77% of men are either overweight or obese 
• 69% of females are either overweight or obese 

However, amongst sufferers of severe obesity:

• 11.9% of females are severely obese
• 6.9% of men are severely obese

This disparity in severe obesity between women and men is noted globally, not just in the U.S. (Leeners et al., 2017). 

Reasons for disparities between men and women may be explained by differences in hormone profiles.

What effects do female hormones have on fat levels and fat distribution? 

 

Differences exist between men and women both in terms of total body fat norms as well as body fat distribution.  These differences first become apparent during puberty (Leeners et al., 2017).  

After sexual development, women naturally have higher body fat percentages but less abdominal fat than men (Leeners et al., 2017).

Women tend to store body fat in their thighs and buttocks (gluteal / femoral) regions and are less prone to storage of fat in their abdominal region compared to men prior to menopause (Leeners et al., 2017).  

These patterns of fat deposition appear to hold true across a wide range of BMI’s, meaning overweight and obese women are more likely to deposit excess fat in their buttocks and thighs than overweight men–at least prior to menopause (Leeners et al., 2017).  

This may be advantageous for women as abdominal fat deposition is associated with visceral fat which wraps around internal organs and is linked to conditions such as metabolic syndrome, cardiovascular disease, and insulin resistance (Leeners et al., 2017).  

Conversely, fat deposits in the skin, buttocks, and thighs may be neutral on health or possibly even protective against disease (Leeners et al., 2017).  These benefits assume healthy weight and fat percentages.

The fat distribution for women appears to result from an interplay of estrogen and genes, and in absence of estrogen after menopause, women lose this protective fat distribution pattern (Leeners et al., 2017).  

Androgens including testosterone are also present in females through the lifespan.   Testosterone in females largely originates from the adrenal glands, but also through enzymatic actions on androstenedion, with the ovaries also contributing to a degree (Bianchi et al., 2021).  

Testosterone in females is essential for maintenance of lean body mass, cardiac health, bone development, sexual health and function, and even cognitive health/ nerve protection (Bianchi et al., 2021).    

What hormone treatment teaches us about estrogen & progesterone and effects on weight

With the use of both oral and also patch combination (estrogen + progesterone) contraceptive hormone therapies, multiple studies show that neither starting these therapies or stopping these therapies correlate to weight changes (Kongnyuy, 1999; Leeners et al., 2017).

However, for women receiving progesterone only hormone replacement therapy, a small number of studies suggest approximately 4-5 lbs weight gain per year on average (Leeners et al., 2017).  

So estrogen increases and decreases appear to have neutral effects on weight, whereas progesterone increases appear to promote weight gain.  

Concerning estrogen, research notes that in pre-menopausal women, normal weight women have higher estrogen levels on average compared to obese women (40 pg/ ml versus 33 pg/ ml in obese women) (Leeners et al., 2017).  

However, an exception may exist for certain women with a “TT genotype” where obesity or fat gain occurs during pubertal years.  For women with the TT genotype, estrogen surges during puberty appear to increase fat mass significantly higher than in women with other genotypes (Leeners et al., 2017).

What exactly is menopause? 

Menopause is defined as the cessation of menses for 12 months due to ovarian reproductive hormone production permanently ceasing (Peacock, Carlson, & Ketvertis, 2023).  

Age of onset is typically 45-56 years for most women.  

Drop offs of the hormones estradiol, inhibin B, and antimullerian hormone leads to countering surges in follicular stimulating hormone and luteinizing hormone.  

These hormones stay elevated for years following menopause (Peacock et al., 2023).  Interestingly, high fiber diets have been shown to lower follicular stimulating hormone and luteinizing hormone levels (Gaskins et al., 2009). 

This may be one mechanism of multiple mechanisms explaining the benefits of plant-based dietary patterns for managing menopause symptoms.

Common symptoms women experience in the years surrounding menopause include: 

• Vasomotor symptoms which can last 1-6 years typically, but at times up to 15 years:
  • Hot flashes 
  • Night sweats 
  • Palpitations 
  • Migraines
• Genital urinary symptoms: 
  • Vaginal itching, burning, dryness, and irritation
  • Urinary frequency, urgency, and discomfort
  • Risk for urinary tract infections due to elevated pH in urine
• Psychogenic symptoms: 
  • Anxiety
  • Irritability
  • Depression
  • Difficulty concentrating
  • Difficulty sleeping

Menopause and impact on weight

Menopause is consistently associated with an increase in fat tissue–on average significant increase of 5% of body weight–and decreased lean body tissue–this occurs in both healthy-weight and overweight/ obese women (Leeners et al., 2017).  

The net effect of menopause on weight according to numerous studies is often neutral–as the change is one of composition as opposed to weight (Leeners et al., 2017).

However, this change in body composition can worsen pre-existing cardiac and metabolic conditions (Leeners et al., 2017; Santos-Marcos et al., 2023).

Even more concerning, the fat gain that occurs during menopause is disproportionally deposited in the abdomen as visceral fat as opposed to storage in the hips, buttocks, and subcutaneous tissue (Leeners et al., 2017; Santos-Marcos et al., 2023).

As visceral fat increases in women (and men), the risk of type 2 diabetes and heart disease increases.

Hormone replacement therapy and menopause

Interestingly, estrogen therapy within 6 years of menopause onset produces the following effects (Leeners et al., 2017):

• Lower fat mass
• Improved bone density
• Lower diabetes risk
• Lower atherosclerosis plaque formation
• Preservation of lean mass
• Reduction in mortality related to all causes

Just as drops in estrogen during menopause contribute to unfavorable body composition changes–without necessarily directly contributing to weight gain–the use of estrogen hormone therapy similarly contributes to the above positive body composition changes while causing a neutral effect on weight (Kongnyuy et al., 1999, Leeners et al., 2017).

Estrogen therapy, combination therapy, risks and benefits are nuanced, appear to depend on time of treatment onset, treatment duration, and form of treatment used (Cho et al., 2023)

Testosterone can drop sharply during menopause for some women (Bianchi et al., 2021).  Unlike ovarian hormone drops, testosterone decreases during menopause are not an issue for all women.  

Testosterone replacement has been approved for menopause symptom management in Germany and Australia for more than 60 years (Glaser, & Dimitrakakis, 2013).

Benefits of testosterone replacement for women include the following (Glaser et al., 2012; Glaser & Dimitrakakis, 2013;  Somboonporn,  Bell, & Davis, 2005): 

• • Thicker scalp hair as reported by 63% of treated women with confirmed low testosterone prior to starting testosterone therapy following treatment with testosterone pellet placement
  • Improvements in cholesterol, lean body mass, and blood sugar
  • Mental health:  90% of all women treated with testosterone replacement reported improvements in anxiety, aggression, and irritability in one study
  • Sexual frequency and improved sexual pleasure
  • Maintenance of normal levels may improve cardiovascular risk profile

GLP-1 therapy and menopause

At the time of this article, the use of GLP-1 therapies such as Mounjaro, Wegovy, Ozempic, and Zepbound specifically for menopause symptoms has not been specifically studied.

Anecdotal reports from clients include improvements in hot flash symptoms, body aches and pains.  In terms of less aches and pains, GLP-1 therapies have repeatedly demonstrated anti-inflammatory activities in research trials (Olukorode et al., 2024).

GLP-1 therapies clearly improve body weight, improve metabolic syndrome, insulin sensitivity, and cardiometabolic risk profiles (Olukorode et al., 2024).

So while menopause is not an indication for GLP-1 therapy, GLP-1 therapy may be appropriate for those going through menopause dealing with worsening of underlying conditions such weight gain, insulin resistance, etc.  

Natural interventions that support women with menopause

According to research cited by the Physician’s Committee for Responsible Medicine (PCRM, 2025), the following natural interventions supported women going through menopause:

• • Hot flashes: a low fat whole food plant-based diet PLUS ½ a cup of edamame reduced hot flashes by 79%, with 59% of women reporting complete resolution of hot flashes in a randomized-controlled trial with menopausal women experiencing 2 or more hot flashes per day over a 12 week period
  • Weight gain reversal: whole food plant-based diets in multiple randomized controlled trials produced:
    • 13-14 lbs weight loss without counting calories, without portion control, and without an exercise intervention 
    • Improved insulin sensitivity superior to the Mediterranean diet, and superior to the American Diabetic Association’s own diet in multiple randomized controlled trials—without counting calories or portion control, and without an exercise intervention (Bernard et al., 2009; Bernard et al., 2022; Kahleova et al., 2020).

• Mental health:  depression risks can double and even quadruple during menopause.  However, the risk is highest (about 50% higher) in women consuming ultraprocessed foods.  Conversely, every serving of fruit, and every serving of vegetables, showed a dose effect for reducing depression risk (3% for each half cup approximately).
• Heart disease:  women’s risk for heart disease increases after menopause.  Whole food plant-based diets protect against developing heart disease, and have been used to reverse heart disease plaques in a randomized-controlled trial.

Other interventions that have some level of research supporting their effectiveness in management of menopause symptoms include(Kazemzadeh et al., 2016; Johnson, Roberts, & Elkins, 2019):

• Lavender oil aromatherapy for sleep and hot flash management: 
  • A randomized-controlled trial study 67 menopausal women found that those assigned to the group that received 20 minutes of lavender aromatherapy from a diffuser experienced improved sleep quality superior to a placebo group 
  • A separate double-blinded randomized-controlled crossover trial of 100 women using lavender aromatherapy versus a placebo solution found a 50% reduction in hot flashes when smelling lavender essential oil from an aromatherapy bottle for 20 minutes twice daily versus less than 1% from the placebo
• Black cohosh + St. John’s Wort combination supplement:  an RCT involving more than 300 women found that a combination of these two herbs together reduced hot flashes by 50% versus the placebo reducing symptoms by 19%.  However, black cohosh has the potential to cause liver injury, and St John’s Wort infamously interacts with many prescription medications.
• Yoga, mindfulness meditation, and cognitive behavioral therapy were helpful for psychological factors of menopause and coping with symptoms, but not for reducing their severity or frequency.    
• Maca root enjoys some success in 4 randomized controlled trials for improving a variety of symptoms of menopause compared to placebos, though researchers note long term safety data is lacking.

Natural therapies that may NOT be helpful for menopause symptoms

The following therapies are noted to be ineffective or to lack sufficient evidence due to mixed results in studies (Johnson et al., 2019): 

• Black cohosh (when administered alone):  multiple randomized-controlled trials noted black cohosh to be no better than a placebo in reducing hot flashes or other symptoms.  As noted above, combination therapy was significant, making it difficult to ascertain if black cohosh only works in combination therapy or is useless altogether for menopausal symptoms.
• Evening primrose oil: research findings noted reductions in hot flashes severity and frequency were too small versus placebo to make a meaningful difference for the women in the studies 
• Wild yam:  study results have been inconsistent, with some randomized controlled studies showing no benefit in symptom reduction, and other randomized studies showing improvement. Data on safety is lacking.
• Dong Quai: research studies on this Chinese herb shows some success when it is used in combination with other Chinese herbs, but this also makes it difficult to know which herbs are producing which effects.

Summary 

Estrogen, progesterone, testosterone and androgens all impact how women store their body fat.  Of these hormones, progesterone seems to be most significant in promoting weight gain whereas estrogen appears to protect against weight gain except in genetically susceptible individuals.  Testosterone is useful for managing lean body tissue and preserving sex drive and cognitive health.  

As these hormones drop during menopause, women experience significant changes in their body that can impact mood, create physical symptoms such as hot flashes, vaginal and predispose them to weight gain.   

Of these changes, significant gains in abdominal fat and loss of muscle can impact metabolic health and predispose women to weight gain, insulin resistance, heart disease, and other adverse effects. 

Treatments for these undesirable effects can range from surprisingly effective lifestyle interventions such as adopting a low fat plant-based diet with inclusion of edamame to combat weight gain, hot flashes, and promote cardiovascular health, to lavender aromatherapy to improve both hot flashes and sleep.  

Hormone replacement of both estrogen and testosterone may offer cardiovascular benefits and metabolic benefits by preventing muscle loss, reducing fat gain/ body composition changes, and benefitting mental health/ wellbeing.  

Finally, GLP-1 therapy can help with metabolic syndrome and weight gain that may result or worsen from changes in the body during menopause.

How we can help

At Lancaster Wellness, we have helped many women struggling with metabolic changes associated with aging and menopause.  

We collaborate with our clients side by side, helping them to make lifestyle shifts that support better metabolic health and lower inflammation.  With certified personal trainers and certified health coaches we support our clients in terms of nutrition and engaging in movement/ activity that works for them.  

With close medical supervision we provide medication and hormone therapies as appropriate when desired by clients.  

Give us a call at 717-297-7900, or schedule an appointment online if you have been struggling with metabolic or hormonal symptoms of menopause!! 

Written by Donovan Carper MSN RN CPT CHC

References 

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Barnard, N. D., Alwarith, J., Rembert, E., Brandon, L., Nguyen, M., Goergen, A., Horne, T., do Nascimento, G. F., Lakkadi, K., Tura, A., Holubkov, R., & Kahleova, H. (2022). A Mediterranean Diet and Low-Fat Vegan Diet to Improve Body Weight and Cardiometabolic Risk Factors: A Randomized, Cross-over Trial. Journal of the American Nutrition Association, 41(2), 127–139. https://doi.org/10.1080/07315724.2020.1869625

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