Proper diet, regular exercise and stress management can all prove helpful in controlling weight gain during menopause. (For Spectrum Health Beat)

Middle-aged women know it well.

They might call it menopausal weight gain. Or menopause belly.

Or they might call it just plain annoying.

“It drives everyone crazy,” said Casey Parini, MD, an obstetrics and gynecology specialist with Spectrum Health Women’s Health & Wellness Center. “It’s one of the most common complaints I hear.”

Why do so many women gain weight before and during menopause?

Turns out, it’s complicated.

Some people think the biggest culprit is hormones, but while they do play a role, other factors such as genetics, lifestyle change and simply the process of aging also contribute, Dr. Parini said.

During the menopausal transition, a woman’s hormone levels (estrogen and progesterone) can fluctuate wildly, as ovarian function declines and ovulation stops occurring regularly. This means missed periods until, eventually, a woman officially enters menopause when she has missed 12 periods in a row.

The fluctuating hormones seem to contribute more to where women gain weight than how much they gain, Dr. Parini said. For instance, research shows menopausal weight gain primarily hits in the middle of a woman’s body—around her stomach and waist.

“It shifts to the center,” Dr. Parini said. “Where the weight gain occurs is sometimes more annoying to women than the weight gain itself.”

But it’s the challenges of the menopausal transition, and the lifestyle shifts that come along with it, that make maintaining a healthy weight the most difficult, she said.

Some of the side effects women experience as they go through menopause can seem to make weight gain inevitable.

“It’s a very hard transition,” she said.

There’s much talk about topics like puberty and hormones shifting up, but not as much about menopause and the hormones shifting down, Dr. Parini said.

“It’s disruptive and it’s stressful,” she said.

The good news: Key lifestyle changes are proven to help many women fight menopausal weight gain.

Find a healthy eating plan

“The menopause transition sets off a fight or flight response in women because they don’t know what’s happening in their body,” Dr. Parini said. “Your sleep can be destroyed by anxiety and night sweats, so you’re more likely to make poor food choices.”

Plus, cortisol levels rise because of stress—and that makes it harder to lose weight, she said.

To combat that, it’s critical to find a healthy eating plan you can actually follow. Research supports a whole foods, plant-based diet, as well as the Mediterranean diet, which features whole grains, vegetables, legumes, fruits, nuts, seeds and olive oil.

During menopause, some women also develop glucose insensitivities, making it more difficult for their bodies to handle sugar and carbohydrate intake. Limiting carbs and eating enough fiber can help, Dr. Parini said.

Drink plenty of water

Water helps offset dehydration from excessive sweating of hot flashes and night sweats—and it can also help prevent them in the first place, Dr. Parini said.

She recommends 60 to 80 ounces of water each day, or about eight to 10 glasses. The trick is to remember that caffeinated beverages serve as a diuretic, pulling water from your body. Dr. Parini said.

The ratio is 1:1. An 8-ounce cup of coffee pulls 8 ounces of water from you.

You have to make up for that by drinking even more water.

Also watch your alcohol consumption, as it not only gives you wasted calories but can also contribute to night sweats, she said.

Exercise regularly

In addition to eating healthy, exercising regularly is critical to fighting menopausal weight gain, Dr. Parini said. The important thing is to find something you enjoy that fits into your schedule, even if it’s walking briskly for 30 minutes per day.

“You don’t have to do everything at once,” she said. “Research shows that 30 minutes at a time or three 10-minute walks are equally beneficial.”

She also encourages menopausal women to do some kind of strength training, which will not only help with weight management—muscle burns more calories than fat—but also promote good bone health.

Remember that strength training does not require weights. It could be body-resistance exercises such as squats and push-ups.

Manage stress

Midlife is a stressful time for women. Maybe you’re caring for children and your aging parents at the same time. Maybe your children are leaving the house for the first time and you’re experiencing an empty nest.

Maybe you’re advancing in your career and taking a big promotion. Those life circumstances, and many more, add to stress, which makes it hard to maintain a healthy weight.

“I tell women to make sure they make time for themselves,” Dr. Parini said.

This might be a time to take advantage of resources such as therapy, yoga, meditation and other mindfulness practices.

Ask about hormone replacement therapy

Talk with your doctor about hormone replacement therapy. While it’s not right for everyone, hormone replacement therapy might help you through the menopausal transition.

Dr. Parini said it will not necessarily help you lose weight or maintain your current weight, but it is FDA-approved to help with other menopausal symptoms such as hot flashes and vaginal discomfort. And if you feel better, you might be better equipped to combat weight gain.

The decision to try hormone replacement therapy must be made between a woman and her doctor and then reevaluated periodically to be sure the benefits still outweigh the risks.

Whether you’re battling menopausal weight gain or other bothersome symptoms, Dr. Parini urges you to remember that you’re not the only one going through it.

“Give yourself a little grace,” she said.