Midlife Belly Fat: Real Talk — What Most People Get Wrong
- Meredith Paci
- Apr 6
- 6 min read
Annoyed ---that’s probably the most accurate way to describe how many women feel when their body starts to change in midlife and nothing they try seems to make a difference. Open up social media and you’ll see the pushback:
“Metabolism doesn’t slow down in midlife. Women just move less.”
That’s not entirely wrong — but it’s also not fully correct. It’s only a fraction of the full picture.
Could some women be moving less? Absolutely. But if we’re being honest, that kind of oversimplification is dismissive — and often reflects a subtle form of ageism. Reducing women’s midlife challenges and real life changes to “just move more” completely overlooks the biological, psychological, and environmental shifts that happen during this stage of life.
Fortify Health Coaching and the coaches we mentor know better!
Yes, resting metabolic rate remains relatively stable between the ages of 20 and 60, assuming no major illness and no significant muscle loss. And I say “relatively” very intentionally.
Because let’s be honest — how many women in their late 30s through 60s are walking around with enough muscle mass, eating adequate protein, sleeping well, managing stress effectively — and doing those things consistently?
And how many are being thoroughly assessed for thyroid function or hormone status — let alone given meaningful guidance on how those systems affect metabolism, energy availability, and body composition?
Exactly.
So while metabolism (in the strict definition) might not tank overnight, the combination of how we live and what our hormones are doing in midlife often leads to very real changes in body composition — especially, and specifically, around the midsection.
Why Does Midsection Fat Increase During Perimenopause and Menopause?
1. Estrogen Decline and Fat Redistribution
This is a big one. Estrogen influences fat distribution. In the reproductive years, it encourages fat to be stored in the hips and thighs — a protective pattern that supports fertility.
As estrogen begins to fluctuate during perimenopause — and drops further in menopause — fat storage shifts toward the abdomen, following more of an android (apple) pattern typically seen in men.
Estrogen also influences lipoprotein lipase (LPL), the enzyme that promotes fat storage. When estrogen drops, LPL activity increases in abdominal fat stores more than in gluteofemoral areas. That’s why fat is now sticking where it didn’t used to.
This isn’t just an aesthetic issue. The abdominal fat being stored during this stage is largely visceral fat — the kind that wraps around your internal organs.
Unlike subcutaneous fat (the kind just under the skin), visceral fat is hormonally active, inflammatory, and metabolically disruptive. It secretes cytokines that further interfere with insulin sensitivity, raise blood pressure, and increase the risk for cardiovascular disease.
For some women, this increase in cytokine activity can also contribute to histamine-related symptoms ---things like skin issues, headaches, anxiety, digestive reactivity, or disrupted sleep. Estrogen fluctuations during perimenopause can already impair histamine clearance, and when you add inflammatory signaling from visceral fat into the mix, it can amplify the effect.
Let me be clear: perimenopause is a full-body, whole-system shift. It can unfold gradually over years or show up seemingly overnight. And while all of this is true about estrogen (and what I’ll go on to explain), it’s not just about hormones.
Can hormones drive it? 100 % yes --I am showing you how today! BUT your body keeps score ---your overall health, nutrition, and lifestyle history AND present all influence how this transition plays out. Keep this in mind as you continue to read.
2. Relative Androgen Dominance
As estrogen declines, the ratio between estrogen and androgens shifts. Even if testosterone doesn’t increase, the relative dominance favors central fat storage.
SHBG (sex hormone-binding globulin) also declines, increasing free androgens — another driver of belly fat, oily skin, and facial hair for some women.
It is worth noting that SHBG can be low for reasons unrelated to just/only age.
3. Loss of Lean Mass and Decreased Activity
Muscle mass naturally declines with age. There’s debate around how fast — but does the speed even matter?
The point is: if you don’t use it (or never had it), you’ll lose it. And respectfully, to those who say this is fear-mongering? Fine — call it fear if that gets you moving.
I call it truth.
Most people are under-muscled to begin with. If strength training hasn’t been consistent, muscle loss accelerates — and fewer calories are burned at rest.
And beyond just calorie burn, low muscle mass increases the risk of serious comorbidities — including insulin resistance, type 2 diabetes, osteoporosis, falls, fractures, and chronic inflammatory conditions. It's not just about aesthetics or strength. It’s a health issue.
This is where the “told you so” crowd chimes in about movement. And sure, some women eat the same (some eat more) and move less. But before we assume anything we encourage the coaches to ask clients why: Fatigue, joint pain, chronic stress, and the mental/emotional load of life in this stage—take a pause to help navigate that. Movement can drop because capacity and focus drop — not because all women are inherently becoming lazy when they turn 37.
If you want to read more about Sarcopenia (age related muscle loss) check out a previous blog HERE
4. Stress and Cortisol
No stage of life is stress-free — what’s stressful to a 17-year-old is valid and real. But as we age, stress doesn’t necessarily decrease — the context expands.
More relationships. More responsibility. More complexity. By midlife, many are navigating career transitions, caregiving roles, grief, divorce, aging parents, or even going back to school. Some are also wrestling with the loss of what they once defined as vibrancy — or the realization that they never truly felt it in the first place.
Layer that with the hormonal shifts of perimenopause or menopause, and the internal load increases.
High cortisol paired with poor or inconsistent sleep — both common in this stage (both having a hormonal and life-stage component) — can lead to reduced insulin sensitivity and increased abdominal fat storage.
This isn’t only mindset issue. It’s not about just “handling stress better.” It’s a physiological reality. You can’t out-positive-talk this away. Although, that does matter!
5. Insulin Resistance
Estrogen helps regulate insulin sensitivity. When it declines, glucose clearance becomes less efficient. Blood sugar and insulin hang around longer — driving visceral fat storage, even without a change in calorie intake.
And many women were never taught how to fuel themselves well in the first place. This is where individual history matter — socioeconomic status, education, and health conditions like PCOS or endometriosis all contribute to unpacking education and strategy.
So if you’re feeling like “nothing works,” take a moment to consider what you’ve been chosen or perhaps handed.
Dieting History and Training Habits Compound the Issue
Most midlife women have spent decades in some form of restriction. When we ask on our intake form, “When was the last time you weren’t trying to diet, restrict calories, or lose weight in any way for six or more months?” The answers are usually “I can’t remember” or “Never.”
Chronic under-eating leads to poor muscle retention, unstable blood sugar, irregular hunger cues, and a body stuck in survival mode — especially when it leads to cycles of overeating or binging.
Layer that with a training history focused more on calorie burn and fatigue than muscle building and strength, you have a body that’s been underfed, under-recovered, and over-stressed for years.
This isn’t here to discourage you — it’s here to give context. You’re not broken. You are overdue for a better strategy.
My Final Thoughts
If you’ve been feeling like your body has changed without your permission — you’re not wrong.
If you’ve been told to “just try harder” or “move more,” and it’s only left you more confused or exhausted — you’re not crazy.
Fat redistribution in midlife is real. There is unequivocally a hormonal component. Our hormones are intertwined into every organ and system we have. And while it’s easy to feel like you’ve lost control, there are still so many things you can influence — even if they look different than they used to.
Diet, movement, and recovery aren’t magic. They won’t bring estrogen back, although they matter big time. BUT these habits, especially when done with intention, can make your body not only more resilient but more responsive when combined with hormone therapy (HRT or MHT) . And the combination (wow)--- can completely shift the trajectory of not only how you feel in your body–-but your health ongoing. That is some pretty epic stuff, in my opinion.
At Fortify Health Coaching, we help women — and the coaches who support them — understand these layers and build sustainable strategies for real, lasting change.
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