Coping With Physical Changes During Menopause
- While going through menopause, women often complain of gaining weight in the tummy, but experts say that menopause doesn’t necessarily cause weight gain. Hormonal changes can shift fat from the hips and thighs and increase deeper fat in the midsection, known as visceral fat.
- Dr. Sara L. Stockman, Department of Obstetrics, Gynecology and Reproductive Sciences at UPMC Magee-Womens Hospital, tells SurvivorNet that this perceived “weight gain” is typically caused by a shift in fat storage in the body due to hormonal changes. “Menopausal women tend to lose subcutaneous fat,” Dr. Stockman explains to SurvivorNet. This is the pinchable fat located just beneath the skin.
- Beyond hot flashes, night sweats and sleep disruptions, menopause can trigger under‑recognized symptoms like urinary irritation, vaginal dryness, pain during sex, and increased UTIs — many of which are easily treatable.
- Mood changes, brain fog, and cognitive shifts are commonly reported, but research is still evolving; breaking the taboo around menopause is key to improving care and advancing science.
Dr. Sara L. Stockman, Department of Obstetrics, Gynecology and Reproductive Sciences at UPMC Magee-Womens Hospital, says the story is far more nuanced than simple “weight gain,” and can actually be caused by a shift of fat storage in the body.
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Helping Women Navigate Menopause
The Fat Migration: From Hips and Thighs to the Belly
This fat migration to the belly is one of the most recognizable and, to many women, frustrating markers of menopause.
“The fat that’s on the hips and thighs and butt… that actually gets transitioned into the belly area for what we call visceral adipose tissue,” Dr. Stockman explains.
This visceral fat sits deeper in the abdomen, creating that classic menopausal “bloating” or roundness around the midsection.
“That is something that we definitely know is caused by these hormonal changes of menopause,” Dr. Stockman says, sharing that some women even describe feeling stuck in their bodies because of the difficulty in losing weight.
“Body composition is changing. So that’s something I talk about with all of our patients because it’s a big complaint,” adds Dr. Sarah Richina, OB/GYN and Director of UPMC Magee-Womens Midlife Health Center.
Dr. Richina tells SurvivorNet that women will voice similar frustrations: they haven’t done “anything differently,” they’re still physically active, and nothing has “changed” with their diets.
‘Changes in Hormones’
Weight gain, Dr. Richina notes, is attributed more to the aging process, but how it is redistributed is due to “changes in hormones through menopause.”
“Through menopausal transition, you lose muscle, you lose bone. There’s a shift in more visceral adiposity, but also where weight gain goes, it’s more central,” she continues.
“Inherently, as we age, we become less physically active and our metabolism shifts and changes through menopause to the tune of, you know, upwards of 300 calories a day. So it’s going to catch up, right? And that balance is shifting and changing.”
In turn, hormones can make it harder to lose weight.
“And then it becomes this vicious cycle because not only are you holding on to that weight, but you have less energy, you have less motivation. A lot of patients are just like, ‘I don’t want to work.’ You know, you’re fatigued, you’re exhausted because of sleep.”
“If you’re not sleeping, that’s kind of the vicious cycle.”
The Symptoms That Don’t Get Enough Attention
Along with the sleepless nights women may be experiencing, hot flashes and night sweats are often the most “typical presentation” of menopause, according to Dr. Sara Stockman. However, she stresses that other symptoms deserve more recognition.
One of the most overlooked issues is genitourinary syndrome of menopause, which affects the urinary tract and vaginal tissues.
“The urinary area is very sensitive to estrogens, and when you remove those estrogens, it can become very sensitive, very irritated,” she explains.
This can lead to:
- More frequent urinary tract infections
- Vaginal dryness
- Pain during sex (dyspareunia)
The good news? These symptoms are highly treatable.
“That is something that can be very easily addressed,” she says. “Estrogen replacement can just be used as a vaginal estrogen.”
Mood Changes and Brain Fog
Dr. Stockman says that many women also report emotional and cognitive changes, but the science is still catching up.
“There are definitely a lot of mood changes,” Dr. Stockman notes, pointing to data from the SWAN study.
“But in terms of the nuances between anxiety and depression, we just don’t have enough research to really understand exactly what is downstream of the hormonal changes.”
The same is true for brain fog and cognitive shifts.
“There are a lot of patients who mention things like brain fog and cognitive changes,” she says. “We just don’t have good data that has looked at these symptoms.”
Breaking the Silence Around Menopause
For Dr. Stockman, one of the biggest barriers to progress is the lingering taboo around menopause.
“I think it used to be so taboo for women to talk about what was happening with their bodies,” she says.
But as more information reaches the public consciousness, Dr. Stockman believes those taboo-like sentiments are changing. She adds that openness is key to better menopausal care and better science.
“Menopause is happening to everyone, and we can learn from each other,” she says.
“We can really inspire the research to inform targeted strategies, helping us understand what all these connections look like.”
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