Autoimmune disease Hormones

Get Rid of Menopause Belly Fat

By Kim Crawford, M.D. Last updated: March 24, 2023
Get Rid of Menopause Belly Fat

My Flat Belly has become My Menopausal Muffin Top. Help!

You’re a woman in her late 40s. You’ve spent your life watching what you eat, and you exercise regularly. You are not packing on the pounds, but you notice that your previously flat belly pooches out when you look at it 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. You can get rid of menopause belly fat. I will explain by answering these questions:

  • 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 you do by yourself to get your flat belly back?
  • How can Functional Medicine help you?

What is the Story with Muffin Top Abdominal Fat?


Is there something unique and mysterious about the pounds we women accumulate just before and during menopause? Mixed evidence favors the opinion that there is more accumulation of harder-to-lose visceral body fat in the belly area during menopause. Elevated cortisol levels, which tend to go up when we are under stress, results in this visceral fat, and those elevated cortisol levels can wreak all sorts of metabolic havoc.


While in this blog, I won’t get into how bad elevated cortisol levels are for your brain, your gut lining (leaky gut), or your microbiome, I will stress that elevated cortisol levels lead to high leptin levels. Leptin, in turn, signals your fat cells to hold on for dear life,’ making it darned near impossible to lose fat, in particular menopause belly fat.

What Exactly causes Menopause Belly Fat?

A total of five hormones are responsible for that muffin top of yours, as well as, possibly, the one sported by your best friend, your sister, and other women around you. Hmmm? Here is a list of the contributing factors, which I’ll examine 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 20s, which signals the beginning of metabolic changes that favor the deposition of belly fat. When your progesterone is low, the production of the feel-good neurotransmitter serotonin drops.


Low progesterone is the first stage in the rise of the “hunger hormones” leptin and ghrelin. Rather than having a significant impact on hunger, leptin is the hormone that makes you ‘hold onto fat,’ including belly fat. I’ll discuss leptin specifically below and will de-focus on the actual hunger hormone, ghrelin, which isn’t explicitly linked to the accumulation of menopausal belly fat.


The Domino Effect of Low Progesterone on Your Body:

  • Low serotonin can trigger sugar cravings
  • Eating more sugar causes weight gain and then additional body and belly fat
  • Low progesterone can trigger inflammation, which can cause your metabolic rate to drop, which contributes to daytime fatigue
  • Fatigue can also be a result of disturbed sleep, as a result of reduced serotonin levels
  • Sleep deprivation leads to elevated cortisol levels, and thereby elevated leptin levels
  • Fatigue also often leads to excess consumption of stimulant beverages, which in turn leads to increases in cortisoland leptin


Low Estrogen

Most women with a 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 experience ‘hot flushes’ (not flashes) during the night, creating the feeling 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, leading to increased appetite, which causes non-specific weight gain.


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


Low Testosterone

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

High Cortisol

Cortisol, known as the ‘stress hormone,’ is linked to many ailments, including packing belly fat on men (during andropause) and women during their menopause years. There are so many ways that we create stress and, therefore, high cortisol levels. Here I only mention the ‘big ones,’ or the ‘surprising ones.’


For example, we know that smoking is disastrous for your health, but do you know that as little as two cigarettes can raise cortisol levels for the day? Yes! Seriously.

Everything from excessive noise pollution, disrupted sleep, excessive caffeine or alcohol, any sort of pain and opiate withdrawal, and even some nutritional deficiencies (e.g., zinc and magnesium) can raise cortisol and contribute to the dreaded muffin top. Speaking of nutritional deficiencies, oxidative stress – a pervasive problem that is closely associated with deficiencies of antioxidant vitamins – also contributes to cortisol elevations.


And finally, leptin elevation causes cortisol elevation and vice versa. Now, let me tell you about leptin.


High Leptin

A variety of 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 now know, stress is the most common ‘unhealthy habit’ that raises leptin levels. When stressed, your body releases leptin, and the more leptin you release, the more you will tend to eat comfort foods. And comfort foods tend to be high-carbohydrate, serotonin-producing foods.


Obesity and sleep apnea also increase leptin, as does systemic inflammation caused by being overweight, eating inflammatory foods, or having leaky gut, AKA gut hyperpermeability syndrome, which sustained high cortisol levels can cause! So, what foods are inflammatory? I’ll get into that when I tell you how you can help yourself fix this whole negative hormonal cascade.


If you are one of those women who tells herself, “I just can’t lose weight no matter what I do,” know that certain toxins, especially biotoxins such as mold mycotoxins, can also create sky-high leptin levels. When someone tells me, “I have suddenly put on weight for no reason. I can’t sleep, and I’m tired all the time,” my mold radar goes off big time.


Now I’ll discuss four powerful ways you can do help yourself.

#1. Diet

Muffin top or no muffin top on your belly, real baked muffins are ‘inflammatory foods’ made with sugar, grains, and fat. It is difficult to take the entire anti-inflammatory diet plunge, but if you continue to eat a standard American diet (S.A.D.), you will not lose body fat or belly fat. You simply will not be able to.


Here is a place to start:


Limit or eliminate (ideally) all processed foods, which are typically a significant source of ‘bad’ (starchy) carbohydrates. Processed foods also contain harmful toxins in artificial flavors and colors, preservatives, and a long list of other unhealthy ingredients. Toxic processed food ingredients can hinder your ability to lose body fat, and therefore belly fat.


Live without ‘fast foods,’ unless, of course, you are eating from the salad bar and bringing your own salad dressing


Limiting all sugars and most grains. The bulk of the research reveals that lectins are inflammatory, and high lectin foods include grains (especially those containing gluten), beans, nightshade vegetables, and low-fat dairy. Nightshades are white potatoes, tomatoes, and peppers, for the most part. Eating this way is the basis for the good-old Paleo Diet, but I definitely would not pile on the meat, as is suggested if you “follow Paleo.”


#2. Stress and Cortisol


If you have 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.


Here is a list of easy behavioral stress reducers:


  • Practice relaxation breathing
  • Meditation
  • Exercise
  • Cut out energy drinks
  • Cut down on caffeine
  • Cut down on alcohol
  • Do not take decongestants (such as pseudoephedrine) for allergies
  • If applicable, limit marijuanaconsumption, as marijuana raises cortisol
  • Get even more sleep!


If excessive cortisol secretion has ‘gone on for a while,’ you might need adrenal support, usually in the form of 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, achieved by gargling, doing vocal exercises, or singing, which I easily work into my busy schedule. You may know that I have written elsewhere that singing aloud and dancing with abandon to your favorite music is a powerful mood booster.


Aromatherapy also referred to as essential oil therapy, uses naturally extracted aromatic essences from plants to treat various physiological and psychological imbalances. Different mixtures of essential oils are documented to lower cortisol levels. Aromatherapy is also easy to work into your schedule. You can put oils in a diffuser in your workplace or bedroom and then just let the diffuser help you as you go about your day.


The data is particularly astonishing for lavender and lavender oil blends. Clinical studies have found that 8-12-20 weeks of inhaling lavender or lavender blends will improve cortisol levels, self-reported anxiety levels, and sleep quality.


The addition of weekly massage therapy to the use of aromatherapy will further enhance these positive effects.

#3. Sleep

Here are a few things you can try to help you sleep, depending on what is causing the problem:

If sleep initiation is the problem:

  • Try taking a hot shower or bath before bedtime, or use a hot tub if you have one.
  • Do not watch T.V. in bed and, if possible, do not use your phone or tablet sitting up in bed.
  • Instead, read a book with non-blue lighting in the background.
  • Try using a liberal dose of liposomal GABA

If you are awakening several times during the night to urinate:

  • Figure out what time you need to stop drinking beverages to fix this problem.

If you are awakening during the night with hot flushes:

  • Try sleeping with a cold gel pack on your head
  • Try a climate-controlled sleeping pad such as a Chilipad.
  • Lower the air temperature since a cold room promotes better sleep for everyone, including menopausal women
  • Try a black cohosh supplement

If you awake unrefreshed, you need deeper sleep. Try a long-acting melatonin supplement. Try getting more sleep.

#4. Exercise

Your first question will understandably be, “What is the least amount of exercise I can get away with and still lose all my menopause belly fat?” Guess what? You’re in luck! I’ll give you the minimum requirement, based on current research guidelines,

but first, please, let me recommend what I’d like you to also do ‘for your health’ in the category of exercise.


Here is the familiar ‘Check with your doctor first’ list that applies to everything about exercise:


  • You need cardiovascular exercise for weight control, metabolic control, and heart disease prevention.
  • You need cardiovascular exercise to help your microbiome composition and cortisol levels and decrease your cancer risk. You can achieve this with a brisk 30-minute daily walk, which you can even divide into three 10-minute segments. Your dog needs cardiovascular exercise too, so if you have a dog, do it for your furry four-legged best friend, if not for yourself!
  • You need to keep your bones solid and your muscles strong. You can accomplish this in a one-set-to-failure workout per muscle group in about 20 minutes. If you do this twice a week, accompanied by some basic stretches, you are good to go.

Now I’ll tell you how you can cheat this routine and get what you need to help you lose that belly fat.



The study results I cite 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 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 F.M. 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%) F.M. 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, and repeat four times. Or you can do jumping jacks, run in place, or jump rope. You get the idea. The literature suggests that you do this five times per week.


But what if you have tried everything you have read here, and you still aren’t sleeping well? What if you still have some (predictable) brain fog, fatigue, hot flushes, and that blasted menopausal muffin top just won’t budge?


You need help, and your regular Ob-Gyn will not be able to provide it.



How can a Functional Medicine doctor help? Here is what a Functional Medical Doctor like me can do for you:

Functional Medical Doctors are trained to treat our patients as “whole people” and not ‘heart cases’ or “hormone cases,” and so on. This training is the key to good medical care, and, quite honestly, it is only available through Functional Medicine docs who are also Board Certified in Internal Medicine. We use peptides and integratives for energy and sleep, and we can create specialized, personalized eating plans. We explore all of a patient’s hormones, including ‘minor but often significant players’ not discussed in this article. We can replace deficiencies and lower cortisol, leptin, and even ghrelin, using non-pharmaceutical methods.


And finally, we can make sure you lose that menopause belly fat and keep it off for good!


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

F MaillardS RoussetB PereiraA TraoreP de Pradel Del AmazeY BoirieM DuclosN Boisseau
Endocrinol Metab Clin North Am. 2015 Sep; 44(3): 497–515.

doi: 10.1016/j.ecl.2015.05.001

PMCID: PMC4890704
PMID: 26316239

Menopausal Symptoms and Their Management

Nanette Santoro, MD, C. Neill Epperson, MD, and Sarah B. Mathews, MD
Review: Obstet Gynecol Clin North Am

doi: 10.1016/j.ogc.2017.02.008.

The Menopausal Transition

Janice L Bacon 


Review: Obstet Gynecol Clin North Am

doi: 10.1016/j.ogc.2018.07.002. Epub 2018 Oct 25.

Onset of the Menopause Transition: The Earliest Signs and Symptoms

Clarisa R GraciaEllen W Freeman

doi: 10.1097/GME.0000000000001290.

Menopausal symptoms: not just estrogen deficiency

Amnon Brzezinski
J Evid Based Integr Med. 2019; 24: 2515690X19829380.
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

doi: 10.1016/j.mcna.2015.01.006.


Traci A TakahashiKay M Johnson
Review: Front Horm Res

doi: 10.1159/000443864. Epub 2016 May 17.

Metabolic Alterations and Cardiovascular Outcomes of Cortisol Excess

Rosario PivonelloMaria Cristina De MartinoDavide IacuanielloChiara SimeoliGiovanna MuscogiuriFrancesco CarlomagnoMonica De LeoAlessia CozzolinoAnnamaria Colao

J Physiol Anthropol 2020; 39: 12.

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
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