“Belly fat” is a common concern for many women along their transition to menopause. Several factors contribute to changing body composition, such as less time for exercise with family and career responsibilities, less motivation due to sleep disturbance, fatigue, depression, and or anxiety, in addition to the hormonal shifts that render the body less efficient in burning energy. However, what is often overlooked as a major culprit in that stubborn accumulation of fat cells around the middle is an overactive stress response system, which can occur as a result of low energy availability (LEA). 

Energy availability is crucial for females, as evidenced by its impact on puberty onset and menstrual cycle regularity. When available energy is chronically less than what the body expends through training and support of normal physiologic processes, it can trigger the activation of the stress response system, including the release of cortisol. This activation of the stress response system can contribute to the accumulation of belly fat because the body instinctively holds on to adipose tissue when energy intake is insufficient. This is particularly relevant during menopause when the absence of menstrual cycles leads to a greater sensitivity of the stress response system to energy imbalance.  

In addition to cortisol, other hormones like leptin, ghrelin, and kisspeptin communicate with the control centers in the brain regarding available fuel for the body and, in turn, regulate appetite, satiety, and other physiologic functions to achieve energy balance. When energy availability is chronically low, the stress response system is activated in an effort to conserve energy (i.e. increasing fat storage) in an effort to return the body to a more balanced state. This is why overtraining and underfueling can exacerbate fat retention due to the activation of the stress response system in response to LEA. Therefore, interventions that help return the stress response to baseline and that further energy balance is crucial for optimal recovery, injury prevention as well as reducing excess accumulation of belly fat.

So, what can you do to optimize your physiology during perimenopause and menopause? Here are some practical tips:

  1. Ensure adequate protein intake: Protein is essential for muscle maintenance, repair, and recovery. Consuming 0.7-1g of protein per pound of body weight is recommended by Dr. Stacy Sims, a renowned expert in women’s performance. 
  2. Maintain adequate energy intake: According to a study cited by the International Olympic Committee (IOC) 2023 Consensus Statement on REDs, 45 kcal / kg of fat-free mass per day supports maintenance and growth. So for a 135 lb woman with 20% body fat, this equates to 2160 kcal per day. It is important to note that this is just a guideline. Every woman’s physical activities are different and require an individualized approach when optimizing energy requirements.
  3. Focus on high-quality carbohydrate sources and avoid refined sugars: Opt for whole grains, fruits, and vegetables as your primary sources of carbohydrates. These nutrient-rich options provide sustained energy and help regulate blood sugar levels, as opposed to refined sugars, which can lead to spikes in insulin levels and promote fat storage.
  4. Avoid prolonged fasting and train with fuel onboard: Fasting for extended periods can trigger stress response system activation and excess fat accumulation. Instead, ensure that you have fuel available within an hour before and an hour after engaging in exercise or physical activity. This will support the stress response system and prevent excessive inflammation and potential injury, as well as reduce excess fat storage.

Understanding the link between fat accumulation and the stress response system is crucial for managing weight gain around the midsection, particularly for women during perimenopause and menopause. Dr. Carla DiGirolamo, the pioneer in women’s performance endocrinology, emphasizes the importance of working with your physiology during this stage of life to maintain vitality and metabolic health. By following practical tips such as ensuring adequate protein intake, maintaining a balanced energy intake, focusing on high-quality carbohydrate sources, avoiding prolonged fasting, and paying attention to nutrient timing, you can support your stress response system and thrive through these changes. Remember, taking care of your body is a lifelong journey, and understanding menopausal physiology is an essential step in maintaining vitality into later decades. 

Dr. Carla DiGirolamo is a leading authority in women’s performance endocrinology. She specializes in helping active and high-performing women reach their health, wellness, and performance potential from puberty through menopause. Schedule your consultation today!