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Is my menopausal belly something to worry about?

We love it when we get questions from blog readers.  This one came in last week:

There’s a general recommendation that women keep their waist circumference to 35 inches or less, because of associations with metabolic syndrome, and insulin resistance. It seems at mid age this becomes more of a concern.  What’s Fit is a Feminist Issue’s perspective on this?

Kitty inspecting her waistline


Here’s how I read this question:   we’ve all heard that carrying more of your weight in your middle (“apple shaped”) is a bigger risk for heart disease, diabetes and other metabolic issues than carrying your weight in your hips, bum and thigh (“pear shaped”).  This belief has been around for a while — I’m old, and I remember learning this in high school.  So I think the questions are — Is there evidence behind this recommendation?   When we hit menopause, we tend to accumulate more fat in our middles — so are we at bigger risk for cardiovascular disease at menopause?  Is there a specific guideline?   Is there anything we can to do manage our fat distribution with an eye to preventing heart disease?

Turns out, this is a super not easy question to answer. 

Screenshot 2019-10-18 15.28.46

I went down a few rabbit holes here, but I’ll try to break it down.

(But first, a quick note about gender terminology.  When I write about menstruation, menopause, vaginas, etc, I try to be conscious of recognizing that there are a lot of vagina and uterus-having people who don’t identify as female, and to de-gender my discussion as much as possible.  I’m finding this hard to do in looking at this research, because it’s strongly correlated to hormones that are categorized as male and female.  It’s also taken decades for science to begin to study gender differences around issues of cardiovascular disease at all, and I have yet to see one define what how they ascribe gender to their participants.  Given all of that, I’m going to sometimes use “women” and “female” here, because it’s what the research refers to, knowing that I am generally referring here to people assigned female at birth (AFAB), who are not taking testosterone and who are experiencing a naturally occurring menopause at mid-life).  

Why does where your body stores fat matter?

  1.  The apple/pear thing is technically called Gynoid-Android fat distribution patterns
    Screenshot 2019-10-18 15.54.47
    Lizzo is a great example of a pear shaped body
    Gynoid — or pear — is, as you would discern from the name, more typically associated with women, with the belly-prominent fat storage (Android/apple) more associated with men.
  2. Gynoid fat distribution is controlled by female reproductive hormones, and android fat storage by testosterone.  
  3. Gynoid and android fat patterns aren’t just about where they show up on the body but where they show up in relation to your organs.  Android fat storage can compress and restrict blood flow to your vital organs and can be a risk factor for both insulin resistance and heart disease.


How does menopause affect fat storage?

As a general rule, as AFAB people reach menopause, they tend to gain weight.  A large percentage of this weight tends to shift to an “android” pattern, because hormonal changes make it harder to store fat around their hips and butt.  In other words, even if you didn’t have much of a belly before menopause, there’s a high likelihood that you’ll develop one after.  On average, people accumulate abdominal fat after menopause twice as fast as before.

Does post-menopausal waist size correlate to cardiovascular and metabolic risk?

I waded through a sea of science to try to get an answer to this, and the bottom line seems to be:  maybe.  probably.  sure.  What is true is that women tend to develop cardiovascular disease on average 7 – 10 years later than men — but it’s the highest cause of death in women over the age of 65 years.  Estrogen seems to have a regulating effect on several metabolic factors, which lessens at menopause.  So menopause is associated with a greater risk for heart disease and metabolic syndromes.  And women with diabetes are at greater risk for heart disease than men with diabetes.

But it is not entirely clear whether this risk is generally due to aging and changing hormones, or fat distribution patterns.  

Do I have to worry that my middle aged belly is going to cause heart disease or diabetes?

I am not a doctor (except of patterns of words), but from what I can tell, the size of your tummy is a bit of a red herring — except that visible changes in your metabolism are a reminder that cardiovascular risk increases as we age, and women’s profile for that risk is different than men’s. 

Historically, women don’t tend to know their own risk of heart disease, and clinicians tend to under-recognize symptoms and risks in women.  So it’s important to be aware that risk rises at menopause and pay attention to things like blood pressure, blood sugar and cholesterol.  They’re imperfect but important indicators of changes in your body.

What about hormone replacement therapy?

HRT in post-menopausal woman does help protect against intra-abdominal fat accumulation — but there is no evidence at this point that it reduces menopausal cardiovascular risk.  So it might make you feel better in different ways, but it doesn’t change your risk. 

So what do I do?

As we preach often on this blog, weight is not the issue to focus on.  If you want to lower your risk for heart disease as you reach menopause, the biggest “bang for your buck” seems to be:


Until I did the reading for this post, I didn’t really know how much risk of heart disease changes at menopause.  What was news to you?




Fieldpoppy is Cate Creede, who lives and jumps around in Toronto.













15 thoughts on “Is my menopausal belly something to worry about?

  1. I knew. But I thought HRT helped. I thought of it as the breast cancer increased risk, decreased heart disease risk. Weigh your risks accordingly and look at your family history. Mine is full of breast cancer so no HRT for me.

    1. So this is the bit that was news to me,
      “HRT in post-menopausal woman does help protect against intra-abdominal fat accumulation — but there is no evidence at this point that it reduces menopausal cardiovascular risk.  So it might make you feel better in different ways, but it doesn’t change your risk. “

  2. Great article. I’ve always been very conscious of the numbers (mainly sugar, blood pressure) because my Mom has diabetes and a heart condition. Runs in her family. I still wonder if HRT increases risks of heart disease (and cancer). Not sure the current scientific consensus. But then there’s that vaginal atrophy thing to think about…!

    1. Changes in various indicators (blood sugar, cholesterol, etc) that are correlated to the development of diabetes and heart disease).

  3. Whenever clients ask me about belly fat, I do explain that, during menopause, your body stores estrogen in fat cells, in preparation for the times ahead when our bodies will not be making its own. Belly fat cells are more mobile and the fat here gets burned more readily than the body fat stored in other parts of our bodies (such as hips and butt). Which I interpret to mean, the body stores estrogen in belly fat so it is readily available. This is why, when you embark on a weight loss+exercise program, your waistline gets smaller before your hip measurement gets smaller. Weight gain during menopause is common (I am not super keen on the word “normal”, but many people use it instead), and it shouldn’t panic you or your doctor. I have heard anecdotally that some doctors come down pretty hard on their patients: “Hey, you’ve gained 5 pounds, you need to watch out,” which is sooo unhelpful when this is something that happens on a cellular level for a very good reason. I am also discovering that belly fat and/or weight gain is an issue for people well into old age (ah, vanity!). I have a client in her 80s who was recently very concerned about having a bit more belly fat now than she used to have, and how can she get rid of it (we do pilates once a week and she walks every day – and she eats very healthily). I explained to her that her health is her number one concern, not her waist measurement (her doctor agrees), and that having a few extra pounds at her age can offer a helpful buffer in case she ever becomes ill. And I should also mention, that the belly fat I am referring to is the jiggly subcutaneous kind, not the deeper visceral fat that can interfere with proper organ function.

  4. Overall I really liked this post. But I’m curious about the specificity of referring to menopause that occurs naturally at midlife. For women who become menopausal early due to medical treatment (such as breast cancer, where HRT is not an option), I would expect the risks to be higher. Is the research silent on this question or is this not something you looked into?

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