Ten questions ranking the factors most likely to be driving weight gain around menopause, because the usual advice fails when it targets the wrong one.
The change is real and it is not imagined. But the most common explanation given, that metabolism collapses, is not what the evidence shows.
The largest study of human energy expenditure, covering more than 6,400 people from infancy to age 95, found that metabolic rate stays remarkably stable from age 20 to 60 once body composition is accounted for.
It does not fall off a cliff at menopause. What changes is what your body is made of.
Muscle mass declines, and muscle is metabolically active tissue. Fat redistributes from hips and thighs to the abdomen, which is a genuine hormonal effect of falling oestrogen. The result is a body that needs slightly less and stores differently.
That distinction matters, because a lower requirement caused by lost muscle is addressable. A collapsed metabolism would not be.
Muscle loss, the largest single driver and the most reversible.
Sleep disruption, which raises cortisol, worsens insulin sensitivity and increases appetite through ghrelin and leptin. Night sweats are often the actual cause.
Protein intake, which most women in this age group do not reach, and which determines whether weight loss costs muscle.
Alcohol, which contributes energy without fullness and disrupts sleep.
Movement outside the gym, which declines quietly and accounts for more daily energy than most people assume.
Insulin resistance, which develops as visceral fat increases.
Trial evidence does not support HRT causing weight gain, and it does not cause weight loss either.
What it can do is make the work possible, by improving sleep, mood and joint pain. A woman sleeping through the night has a different chance of training consistently than one waking four times.
But it is not a weight treatment and should not be sold as one.
Address the top factor rather than everything at once.
For most women that is either muscle or sleep, and both take twelve weeks to show a difference. Judging at three weeks is why most attempts stop.
Measure your waist rather than weighing yourself. Body composition changes underneath a number that may barely move, and the waist tracks the change that matters.
Related reading: Why weight gathers around your middle · Losing weight in menopause · Does HRT cause weight gain? · Waist-to-height ratio
Educational only, not medical advice.