Get Rid of Menopause Belly Fat

By Kim Crawford, M.D. Last updated: February 19, 2021
Get Rid of Menopause Belly Fat

Why has my flat belly turned into a menopausal muffin top?

You’re a woman in her late 40’s. You’ve spent your life watching what you eat. You have done regular exercise. You are not packing on the pounds, but you notice that your previously  flat belly pooches out when you look from the side. Your pants are getting tight. Worst of all, wearing your skinny jeans, you seem to have some sort of, well, for lack of a better term: menopausal muffin top. Is this how you are doomed to live the rest of your life? In a word: no. I’ll explain. Yes, you can get rid of menopause belly fat.

  • Why is fat collecting specifically around your waistband? Is this “different fat” than your “younger self’s fat?”
  • What are the hormonal conditions causing this fat?
  • What can I do myself to get my flat belly back?
  • How can Functional Medicine help?

What’s the Story with this Abdominal Fat?

Is there something special and mysterious about the pounds we women accumulate just before and during menopause? There is actually rather mixed evidence favoring the opinion that there is more accumulation of the harder-to-lose visceral body fat in the belly area during menopause. That visceral fat which accumulates is linked mostly to elevated cortisol levels, which tend to go up when we’re stressed. In turn; those elevated cortisol levels can wreak all sorts of metabolic havoc.

Right now, we won’t get into how bad elevated cortisol levels are for your brain, your gut lining (leaky gut) or your microbiome. We know, however, that elevated cortisol levels lead to elevated leptin levels. Leptin, in turn signals your fat cells to “hold on for dear life”, making fat loss and in particular menopause belly fat loss darned near impossible. Let’s take a look at all of the contributing factors.

What Exactly causes Menopause Belly Fat?

We can blame a total of five hormones for that muffin top of yours-or maybe it’s not you-your best friend, is it? Here is a list and we’ll examine them one by one: reduced progesterone, estrogen and testosterone, and elevated cortisol and leptin.

Low Progesterone

Believe it or not, your cyclic progesterone level may begin to drop in your 20’s. When  this occurs, we can see the start of metabolic changes that favor the deposition of belly fat. When your progesterone is low, the production of the feel-good neurotransmitter, serotonin drops. First of all, low serotonin can trigger sugar cravings. Eating more sugar is obviously going to cause weight gain, body fat, and belly fat at some point. Low progesterone is the first stage of the rise in the “hunger hormones” leptin and ghrelin. Rather than having a large impact on hunger, leptin is the hormone that makes you “hold onto fat”, including belly fat. We’ll talk about leptin specifically in a bit, but will de-focus on the true hunger hormone, ghrelin; as it isn’t specifically linked to the accumulation of belly fat.

Low progesterone can also trigger inflammation which can cause your metabolic rate to drop and contribute to daytime fatigue. Fatigue can also be a results of disturbed sleep caused by those reduced serotonin levels. Sleep deprivation leads to elevated cortisol levels and thereby elevated leptin levels. Fatigue often leads to excess consumption of stimulant beverages which also leads to increases in cortisol and leptin.

Low Estrogen

Most women with a little bit of middle-of-the-night awakening due to progesterone deficiency get a whopping dose of sleep deprivation during active menopause. When estradiol levels drop (usually when a woman is in her late 40’s or early 50’s), the drop triggers vasomotor changes, causing the sensation of hot flushing. The vast majority of menopausal women experice “hot flushes” (not flashes) during the night, causing the sensation of being “warm” or “dripping in sweat.” Either way, sleep is interrupted, causing less refreshed sleep, raised cortisol and therefore; leptin levels. Low estrogen also triggers ghrelin, increasing appetite; again causing non specific weight gain.

Before we talk about cortisol and leptin, let me mention that both estradiol and progesterone oppose the fat storing action cortisol has on the belly.

Low Testosterone

As you progress through the menopausal years, your testosterone levels will drop. You might notice a decrease in muscle mass; which then decreases your metabolic rate, causing weight gain. There are many reasons to love bioidentical testosterone replacement, including brain health, bone health and maintenance of muscle mass. However, a drop in this particular hormone doesn’t cause belly fat per se.

High Cortisol

Cortisol is known as the “stress hormone” which is linked to many ailments including packing belly fat on men and on women; particularly during menopause years. There are so many ways that we cause ourselves stress (and therefore high cortisol levels), I’ll only mention the “big ones” or the “surprising ones.” For example we know smoking is absolutely awful for your health, but did you know that as little as two cigarettes can raise cortisol levels for the day? Yes; seriously.

Then, everything from excessive noise pollution to disrupted sleep, to excessive caffeine or alcohol, any sort of pain, opiate withdrawal, and even some nutritional deficiencies (e.g. zinc and magnesium) can raise cortisol and contribute to those muffin tops.  Speaking of nutritional deficiencies, oxidative stress, a problem that is extremely common, closely associated with deficiencies of antioxidant vitamins- also contributes to cortisol elevations. And finally- leptin elevation causes cortisol elevation and vice versa. Now, let’s discuss leptin.

High Leptin

Various unhealthy physical factors and habits will increase leptin levels, causing our fat cells; especially our belly fat cells to hang onto fat, no matter what we eat and how much we exercise. As you just read and presumed- stress is the most common “unhealthy habit” that raises leptin. When stressed, you release leptin and the more you release, the more you will tend to eat comfort foods. Comfort foods tend to be high-carbohydrate, serotonin producing foods.

Obesity and sleep apnea also increase leptin. Systemic inflammation increases leptin which in turn is caused by being overweight, eating inflammatory foods or having leaky gut AKA gut hyperpermeability syndrome which can be caused by sustained high cortisol levels! You may wonder, what foods are inflammatory foods? We’ll get into that when I discuss how you can help yourself fix this whole negative hormonal cascade. But before we leave the topic of high leptin, if you “just can’t lose weight no matter what you do”, certain toxins, especially biotoxins such as mold mycotoxins can create sky-high leptin levels. In fact, when someone tells me they have “suddenly put on weight for no reason, can’t sleep and are fatigued” my mold radar goes off big time.  Now, let’s talk about what you can do to help yourself.


Muffin top or no muffin top, things like actual muffins are “inflammatory foods” due to sugar, grains and fat. It’s difficult to take the entire anti-inflammatory diet plunge, but if you continue to eat a standard American diet (S.A.D.) you cannot lose body fat or belly fat; you just can’t. Where should you start? How about limiting or (better yet) eliminating all processed foods, which are typically a major source of “bad” (starchy) carbohydrates? They also contain harmful toxins in the form of artificial flavors and colors, preservatives and a long list of other unhealthy ingredients. In fact, there are actually toxic processed food ingredients that can hinder your ability to lose body fat, and therefore belly fat.

Next, how about going without “fast foods” unless you are eating from the salad bar and bringing your own salad dressing?

Limiting all sugars is also needed. You might want to consider limiting most grains, as well. The bulk of the research reveals that lectins are inflammatory. High lectin foods includes grains (especially those containing gluten), beans, low-fat dairy and nightshade vegetables. Nightshades are white potatoes, tomatoes, and peppers for the most part. This is the basis for the good-old paleo diet plan, but I definitely wouldn’t pile on the meat, as is suggested if you “follow paleo.”

Stress and Cortisol

In case there’s any doubt-yes-you can indeed be under so much stress that it gives you belly fat. When this happens, your adrenal glands are secreting too much cortisol and adrenaline. This will eventually result in fatigue, sleep issues and immune system depression.

Easy behavioral stress reducers: relaxation breathing, meditation, exercise and more sleep. In addition, cut out energy drinks and cut down on caffeine and alcohol. Be careful you are not taking decongestants (such as pseudoephedrine) for allergies. Also, if applicable-limit your marijuana consumption, as this can also raise cortisol.

If excessive cortisol secretion has “gone on for a while”, you might need some adrenal support. This is generally herbal mixtures of rhodiola, ashwagandha, astragalus, siberian ginseng and adrenal glandulars.  If you “feel stressed” you can increase your GABA levels with liposomal (not oral) GABA preparations.

You can also activate your parasympathetic nervous system (your vagus nerve) and decrease cortisol secretion by activating your hypoglossal nerve- a nerve which is activated by gargling, doing vocal exercises or singing. I personally find this to be something that’s easy to work into my busy schedule. Lalalaaaaa.

Aromatherapy, also referred to as essential oil therapy, uses naturally extracted aromatic essences from plants to treat various physiological and psychological imbalances. Various mixtures of essential oils have been documented to lower cortisol levels. This, too, is easy to “work into your schedule” as you can put oils in a diffuser in your workplace or bedroom, and then just forget about it. The data is really astonishing for lavender, and lavender oil blends.

Clinical studies have found that 8-12-20 weeks of lavender or lavender blends inhalation will improve not just cortisol levels but other factors such as self-reported anxiety levels and sleep quality.  Adding  weekly massage therapy to the use of aromatherapy further enhances these positive effects.


There are a few things you can try to help your sleep, depending on what is causing the problem. If sleep initiation is a problem, try taking a hot shower or bath before bedtime, or use a hot tub if you have one.  Don’t watch T.V. in bed and if possible, don’t use your phone or tablet, sitting up in bed. Instead, read a book with non-blue lighting in the background. You can also try using a liberal dose of liposomal GABA.

If you are awakening several times, what’s the cause? If you’re getting up to urinate, figure out what time you need to stop having beverages in order to fix this problem. If you are awakening with hot flushes, try sleeping with a cold gel pack on your head, or even a climate-controlled sleeping pad such as a Chilipad. Turn down the air conditioning, as a cold room promotes better sleep for everyone- menopausal women included. A black cohosh supplement might be helpful.

If you awakening feeling “unrefreshed”, you need deeper sleep. Try a long acting melatonin supplement. Try getting more sleep.


Your first question is going to be about the least amount of exercise you can “get away with” and still lose that menopause belly fat so guess what-you’re in luck-I’ll tell you exactly how little you can do. But first, please let me recommend to you what I’d like you to also do “for your health” and in this category, I’ll give you “the bare minimum” based on current research guidelines. The usual caveat of “check with your doctor first” applies to everything about exercise, below.

You know you need cardiovascular exercise for weight control, metabolic control, and heart disease prevention. Did you know that this also helps your microbiome composition, your cortisol levels, and decreases your cancer risk? All of this can be achieved with only a 30 minute daily brisk walk. And you can even chop this into 3, 10 minute segments. If you have a dog, your dog needs this too- so do it for your dog, if not for yourself!

As you age, you need to keep your bones solid and your muscles strong. Doing a one-set-to-failure workout per muscle group can be accomplished in about 20 minutes. If you do this just twice a week, accompanied by some basic stretches, you’re good to go. Now I’ll tell you how you can cheat this routine and get what you need to help you lose the belly fat.


The study cited below compared the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) for 16 weeks on whole-body and abdominal fat mass (FM) in postmenopausal women with type 2 diabetes. Cycling full-out in 8-60 second bursts twice weekly was compared to aerobic cycling for 40 minutes twice weekly to see which reduced both visceral and total abdominal fat the most.

Results: Dietary energy (caloric) intake, physical activity level and total body mass did not vary in either group from the beginning to the end of the training intervention. Overall, total FM decreased and total fat-free mass significantly increased over time (by around 2-3%). Total FM reduction at the end of the intervention was not significantly different between groups. However, significant loss of total abdominal (-8.3±2.2%) and visceral (-24.2±7.7%) FM was observed only with HIIT.

Easy ways to do HIIT

If you have access to a lap pool or a track, all you need to do is five “bursts” of activity-running or swimming-followed by “catching your breath.” It’s that easy. If you are looking for an easy way to do it at home, just do “burpees” until you’re short of breath, repeat another four times. Or you can do jumping jacks, run in place, jump rope-you get the idea. The literature suggests that you do this five times per week.

What if you’ve tried everything you’ve read here and you still aren’t sleeping well, have some (predictable) brain fog, fatigue, hot flushes, and that blasted menopausal muffin top? You need help, and your regular Ob-Gyn will absolutely not do what you need. Here’s what someone like me can do for you.

How can a Functional Medicine doctor help?

We are trained to treat the patient as “a whole person” and not “a heart case” or “a hormone case” and so on. This is the key to good medical care and quite honestly, it’s only available via Functional Medicine docs who are also board certified in Internal Medicine. We have peptides and integratives for energy, sleep, and we can create special, personalized eating plans. We can explore all of the hormones, including the “minor but often important players” not discussed in this article. We can replace what’s deficient, and lower cortisol, leptin, and even ghrelin, using non-pharmaceutical methods. And finally, we can make sure you lose the menopause belly fat for good and keep it off!


doi: 10.1016/j.diabet.2016.07.031. Epub 2016 Aug 24.

High-intensity interval training reduces abdominal fat mass in postmenopausal women with type 2 diabetes

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doi: 10.1016/j.ecl.2015.05.001

PMCID: PMC4890704
PMID: 26316239

Menopausal Symptoms and Their Management

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doi: 10.1097/GME.0000000000001290.

Menopausal symptoms: not just estrogen deficiency

Amnon Brzezinski
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Published online 2019 Mar 14. doi: 10.1177/2515690X19829380
PMCID: PMC6419242
PMID: 30868921

Complementary and Alternative Medicine for Menopause

Alisa Johnson, PhD, Lynae Roberts, MA, and Gary Elkins, PhD

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Published online 2020 Apr 19. doi: 10.1186/s40101-020-00222-0
PMCID: PMC7168819
PMID: 32307016

Association of abdominal fat with metabolic syndrome components in overweight women: effect of menopausal status

Shigeharu Numao, Yasutomi Katayama, Yoshio Nakata, Tomoaki Matsuo, Masaki Nakagaichi, and Kiyoji Tanaka