“Menopause is associated with increased weight gain in the midsection and visceral adiposity—the term for when fat is distributed around the organs—along with a reduction of muscle mass,” Dr. Jolene Brighten, a Florida-based naturopathic endocrinologist and author of Is This Normal?, tells Fortune. “In general, aging can be behind the increase in central fat distribution, but the loss of estrogen is strongly associated with this change in body composition.”

The additional weight gain can also be due to changes in testosterone levels, diminished sleep, and muscle atrophy, says Brighten.

Those changes “could potentially cause things like cortisol and insulin to spike,” Dr. Karen Tang, a Philadelphia-based gynecologist with 460,000 TikTok followers, tells Fortune. And both can cause problems with weight gain and increased cravings, while cortisol, specifically, is associated with having more fat deposit in the abdomen.

“You also have a higher risk of things like insulin resistance and diabetes, which can sometimes contribute to some of the fat deposits,” she says. 

Further, explains Tang, also a menopause spokesperson for Centrum, the big change can create hormone-related bloating symptoms, including water weight gain. But the additional visceral fat that you “can’t crunch away,” she notes, is what’s often most bothersome. 

Especially since, adds Brighten, “The distribution of fat in the midsection is associated with an increase of diabetes, cardiovascular disease, high blood pressure, and metabolic syndrome.”

What can be done about extra belly fat in menopause?

To begin with, says Tang, it’s important to see your doctor who can check for medical reasons for weight gain, from thyroid problems to diabetes.

Once those are ruled out, though, it’s time to start looking at ways to change your workout and eating habits. 

“Your exercise routine may need to change,” says Brighten—especially if you notice that old workouts are no longer having much of an effect on your body.

Focusing on building muscle mass should be a priority, she advises. “In addition, finding ways to increase your activity level throughout your day, either by going for walks, starting new hobbies that require you to be physically active, or being more mindful about the time you are sedentary,” she says. For her patients who have desk jobs, Brighten recommends they look into the idea of working on a treadmill while wearing a weight vest. 

“You can also consider starting something like tennis or pickleball,” she adds, “which will give you the benefits of physical activity, community, and are strongly associated with longevity.”

Tang suggests working in strength training at least twice a week, as it’s been shown to preserve bone density and stave off osteoporosis. 

She also advises trying shorter, high-intensity intervals rather than just, say, a very long walk— but to always consider any other menopause symptoms you’re balancing, like joint aches. “Sometimes it’s a matter of finding what’s sustainable, in terms of something you enjoy and can keep up with, while not making your other symptoms worse,” Tang says. 

How you eat may also need to change

Even if you have eaten the same way your whole life, your body is now processing food differently—hence the seemingly unexplained weight gain, says Tang. “Muscle is reacting differently, and you have less lean muscle than you did before, so your metabolism changes.” You have to take that into account in terms of how you eat and how you exercise, she says, “to counteract some of those changes.” 

There’s some evidence that cutting back on extra sugar, extra salt, and processed foods—and leaning into a Mediterranean or plant-based diet—can help with menopause symptoms, says Tang. “And we obviously want people to eat a healthy way to nourish their bodies, and not just try and starve themselves,” she says. 

Brighten suggests simply upping your protein and fiber intake while limiting alcohol and added sugar to less than 25 grams a day. And if you’re not sure where to begin, she adds, “working with a registered dietitian or certified nutrition specialist who focuses on menopausal women can help get you started.”

In addition, says Brighten, speak to your doctor to see if you are a candidate for menopause hormone therapy, which can help decrease central weight gain, improve muscle mass, and help support your workout efforts. 

The good news in all of this, says Tang, is that while changes in metabolism and belly fat might feel severe in the transition of perimenopause into early menopause—a process that lasts an average of 10 years—there is some evidence that it eventually will even out. “So it doesn’t tend to be something that gets worse and worse, like a snowball, forever,” she says. “But it is a very challenging couple of years of people trying to figure out their new normal.” 

More on menopause:

• Menopause stigma is impeding women’s career growth, survey says. Here’s how a lack of support is hampering ambition—and the economy
• Actor Kate Winslet touts testosterone replacement therapy (TRT) for low sex drive in women. Here’s what it means
• A good workout routine can help you age better than your parents or grandparents did. Here’s how