Key takeaways:
- BMI and fat mass tend to increase more in women after age 45 years.
- Menopausal HT may improve body composition for women.
- Obesity management options include lifestyle intervention, medications and surgery.
LAS VEGAS — Weight gain is a common concern for women during menopause, and health care professionals should take a comprehensive approach to managing weight in this population, according to a speaker.
According to data published in Mayo Clinic Proceedings in 2025, approximately 80% of midlife women report problems with weight gain, and 20% categorize those problems as severe or very severe. However, Maria Daniela Hurtado Andrade, MD, PhD, assistant professor of medicine in the division of endocrinology, diabetes and metabolism and part of the Precision Medicine for Obesity program at Mayo Clinic in Jacksonville, Florida, said weight gain for midlife women cannot be attributed to just one cause. In a presentation at the American Association of Clinical Endocrinology Annual Scientific and Clinical Conference, Andrade discussed how many factors influence weight gain in midlife women and highlighted steps health care professionals can take with their patients.
“When we’re talking with [midlife] women, it’s really important that we provide a holistic weight management approach that includes weight gain prevention, management of menopausal symptoms and evidence-based overweight and obesity treatment,” Andrade said during a presentation.
Factors linked to weight gain
During midlife, women gain 0.4 kg to 0.7 kg per year, Andrade said. However, she added that weight gain is primarily due to chronological aging and not menopause. Men also gain weight as they age, though Andrade noted BMI and fat mass rise more in men before age 45 years, whereas women experience higher BMI and fat mass increases after age 45 years.
“These changes do not happen at a steady pace,” Andrade said. “Fat mass increases and lean mass decreases most rapidly around the final menstrual period, particularly in the 2 years preceding and the 2 years after the last menstrual period.”
Andrade listed seven factors that may cause weight gain during menopause: lean mass loss, physical activity changes, dietary changes, fat oxidation changes, vasomotor symptoms, sleep disturbances and mood disorders. Andrade said its crucial for health care professionals to pay attention to these factors because midlife women are vulnerable to weight gain due to the decrease of estrogen that occurs during menopause. Because estrogen serves as a regulator of multiple metabolic systems, declines in levels that occur during the menopause transition removes the protective effect the hormone serves earlier in life.
“The concern is not cosmetic,” Andrade said. “It’s not just weight gain alone. It is the combination of menopause, weight gain and aging that increases long-term risks, particularly of cardiovascular disease.”
Menopausal HT
Andrade said weight management for midlife women should be centered on three areas: weight gain prevention, treating menopausal symptoms and utilizing evidence-based treatments for overweight and obesity. Andrade advised health care professionals to counsel women about weight gain and emphasize the importance of dietary change and behavior modification in addition to physical activity.
Hormone therapy can be prescribed to improve menopausal symptoms, Andrade said. Some of the indications for which the FDA has approved menopausal HT include moderate to severe vasomotor symptoms, moderate to severe genitourinary symptoms, premature menopause and osteoporosis prevention. HT may also have indirect benefits on mood, sleep, sexual dysfunction and joint pain.
Menopausal HT does not have a direct effect on weight, but it may be able to improve other body composition measures, Andrade said.
“What we know based on studies is that HT can improve fat distribution,” Andrade said. “It decreases visceral adiposity, it decreases total adiposity and it decreases muscle mass loss. It also is associated with improvement in metabolic parameters.”
Andrade said transdermal estradiol may be better for improving body composition than oral formulations, as it can help preserve lean mass. Additionally, Andrade said, standard dose estrogen is better than lower dose forms, and HT must be taken continuously for women to receive benefits.
“The key message is that HT is not a weight-loss treatment, but when used for appropriate menopausal indications, it may have a favorable effect on body fat distribution,” Andrade said.
If a woman has a contraindication for HT, lifestyle change, cognitive behavior therapies and other pharmacological options should be considered, Andrade said.
Obesity management
Both lifestyle intervention and obesity therapies may benefit midlife women, according to Andrade. Some dietary changes health care professionals can consider include caloric restriction and making sure women are receiving adequate protein intake. Andrade said physical activity has a “very modest effect” on weight loss, but may improve body composition. She also recommended behavioral therapy to improve eating behaviors and quality of life among midlife women.
In terms of therapies, obesity medications, endoscopic bariatric procedures and bariatric surgery are all options for women, depending on their BMI. However, Andrade advised health care professionals to look at body composition measures as well when determining a therapeutic option for patients, including body fat percentage, waist circumference, waist-to-hip ratio and waist-to-height ratio.
Andrade said limited data exist on the efficacy of obesity medications specifically in midlife women. However, a study published in Obesity in 2025 found tirzepatide (Zepbound, Eli Lilly) conferred reductions in body weight and waist circumference across all reproductive stages for women. Similar observations were made with semaglutide (Wegovy, Novo Nordisk) in an analysis of data from the STEP and OASIS 4 trials.
Andrade said there is a trend toward slightly less weight loss with obesity drugs postmenopause compared with the premenopausal and perimenopausal stages.
“There are possible mechanisms that may explain this differential response,” Andrade said. “Again, the changes in body composition, changes in metabolism, but there is also a possible synergistic effect of estrogen and GLP-1 therapy.”
If obesity pharmacotherapy is prescribed, health care professionals should be mindful of its effect on lean mass, Andrade said. Andrade recommended increasing protein intake to mitigate lean mass loss.
Sources/Disclosures
Source:
Andrade MDH, et al. Menopause: Overcoming changes in metabolism and weight. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; April 22-24, 2026; Las Vegas.
References:
Disclosures:
Andrade reports advising for Hoffmann-La Roche and Novo Nordisk; consulting for Verge Genomics; and receiving research support from Eli Lilly, Endogenex and Phenomix Sciences.
Ask a clinical question and tap into Healio AI’s knowledge base.
- PubMed, enrolling/recruiting trials, guidelines
- Clinical Guidance, Healio CME, FDA news
- Healio’s exclusive daily news coverage of clinical data
<
Leave a Reply