This EMAS webinar opened a new monthly series with a practical, evidence-based session on one of the most common concerns in midlife care. Weight gain and metabolic changes during perimenopause and menopause. Chaired by Prof Marina Šprem Goldstajn, the webinar brought together an endocrinology and diabetology perspective with gynecological endocrinology and menopause medicine. Translating science into guidance clinicians can use in everyday practice.
With Davorka Herman, Asst Prof Ivan Bolanča and Prof Marina Šprem Goldstajn.
Why weight changes feel different after 45
Dr Davorka Herman opened the session with a reality clinicians hear every day:
“Many women feel betrayed by their bodies because they come to me and they say, I’m doing everything I used to do, but it’s not working anymore.”
She framed the key clinical question clearly:
“Is weight gain biologically inevitable or clinically preventable?”
The presentation reviewed what changes with age and with declining estrogen. Including shifts in body composition, reduced lean mass, and a drop in basal metabolic rate. Central fat distribution was emphasised as more than a cosmetic issue:
“It’s not only the aesthetic problem around the belly. It also serves as a great cardiovascular risk factor.”
Menopause as a metabolic turning point
Asst Prof Ivan Bolanča expanded the discussion from symptoms to systems. Reminding the audience that menopause is not only defined by the last menstrual period:
“We need to think about menopause as a metabolic event, not only as the last menstrual period.”
He described how visceral and hepatic fat can increase even when weight stays stable, leading to higher cardiometabolic risk:
“It is more redistribution and less about kilos.”
A recurring theme across both talks was that fat distribution matters. Visceral fat is metabolically active and more inflammatory, which influences insulin resistance and long-term risk.
What helps most in practice: muscle, protein, lifestyle
Lifestyle strategies were central, with a strong emphasis on maintaining lean mass. Dr Herman highlighted that structured interventions can make a real difference:
“It’s common, but it’s not physiologically mandatory.”
She stressed that prevention depends on protecting muscle:
“The key determinant stays the preservation of lean muscle mass.”
Practical takeaways included resistance training plus aerobic activity, adequate protein intake, and realistic caloric adjustments over time. She also offered a memorable line clinicians may recognise:
“You lose or get weight in your plate and you remain healthy in the gym.”
When asked directly about training priorities, she leaned toward strength work:
“If I can choose one, I think that strength exercise is something which is really giving us the whole package.”
Menopausal hormone therapy and metabolic health
Bolanča addressed a frequent concern among patients and clinicians. Whether MHT causes weight gain. He stated clearly:
“Contrary to what many of our patients and colleagues still believe, MHT does not cause any meaningful weight gain.”
Instead, evidence suggests it may modestly reduce central fat accumulation and help preserve lean mass, especially when started in the window of opportunity and using contemporary regimens.
He also underlined a point that resonated strongly with the audience:
“Withholding or refusing to prescribe MHT in a symptomatic, otherwise low-risk, healthy patient is also a therapeutic choice. And it has a cost.”
GLP-1 receptor agonists and careful integration
Dr Herman discussed GLP-1 receptor agonists as part of modern obesity management, while reinforcing that lifestyle remains foundational. She described the combined approach as complementary:
“Hormone therapy and GLP-1s. It’s a perfect match made in heaven.”
At the same time, she stressed the importance of appropriate prescribing and follow-up:
“It has to be done under medical supervision.”
Key messages from the session
This webinar offered clinicians a clear framework for counselling patients and planning care. Menopause is a period where metabolic risk can rise, but weight gain is not inevitable.
As Dr Herman concluded:
“Weight gain after 45 is not inevitable. It’s modifiable.”
And as Bolanča summarised, the shift is often silent and central:
“Menopause is a metabolic turning point.”
Watch the full webinar for a practical, multidisciplinary overview of diet, exercise, muscle preservation, metabolic risk, and the role of MHT in shaping body composition.
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