Menopause weight gain and loss of libido: what you need to know

Published January 2023 | 5 min read
Expert contributors Dr Fiona Jane, women’s health GP, Jean Hailes for Women’s Health, Dr Yasmin Tan, gynaecologist
Words by Katherine Chatfield

Your libido and weight fluctuate naturally throughout your life, but menopause can make the changes more dramatic. Here’s what’s going on and what you can do about it.

How often you feel like having sex and how much you weigh both fluctuate throughout your life. Pregnancy, illness, stress, relationship difficulties and the mental load can all contribute to the changes you experience.

But even if your libido and your weight have stayed relatively constant, many women entering perimenopause and menopause can find their sex drive drops and their weight increases, particularly around the belly area.

Menopause is the time of life when your menstrual cycle has officially stopped for a year. Perimenopause refers to the natural process leading up to menopause when your ovulation and periods may become irregular or stop.

Some women experience the symptoms of menopause for up to 10 years.

“During this stage, levels of the hormone oestrogen swing erratically from high to low and back again. This can cause significant emotional and physical symptoms for some women like hot flashes, sleep disturbances, itchy skin, bladder problems, anxiety and brain fog. A decrease in libido and a change in your body shape are also really common,” says Dr Fiona Jane, a specialist women’s health GP at Jean Hailes for Women’s Health.

How to deal with low libido during menopause

Your libido is influenced by the sex hormones oestrogen and testosterone. While oestrogen fluctuates during perimenopause and eventually declines, testosterone steadily declines from your 20s and bottoms out in your 50s, explains Dr Jane. “These two factors combined can lead to a decline in sex drive, as well as reduced sexual satisfaction due to painful sex, poor arousal and impaired orgasm.”

This reduced sex drive can be further compounded by other menopausal symptoms. “Low oestrogen can lead to the vaginal lining becoming dry and thin, which can make sex uncomfortable or even painful,” says Dr Jane. “Then there’s the sleep disturbance that comes with menopause; if you’re waking up 10 times a night in a pool of sweat, it’s not exactly conducive to an active sex life. Many women experience joint aches and pains which can make things difficult, and anxiety and depression can also affect your libido.”

For some women, fluctuating hormones can mean the opposite and they find their sex drive is higher. “Testosterone kicks up again in your 60s and 70s, and sexual satisfaction can increase post-menopause,” says Dr Jane.

If a reduced sex drive is an issue for you, it’s good to discuss it with both your GP and your partner.

“When you talk to your partner, pick the right time to have the conversation,” says Dr Jane. “Firstly, say something positive about them and your relationship to help them understand they’re being considered. Then, tell them what you’re feeling, and what you’d like to happen.

“For example: ‘I'm experiencing pain during sex. Maybe we can use a lubricant.’ Keep your partner informed and help educate them so they can be involved in the process.”

Gynaecologist and women’s health expert Dr Yasmin Tan says there's a whole range of treatments to help, too. “Systemic treatments treat the whole body, and topical medications can treat more localised symptoms like vaginal dryness,” she says.

“The most effective treatment for oestrogen deficiencies is hormone [replacement] therapy (HRT), which can be delivered either as a tablet, patch, cream, or even an implant.”

How to reverse menopause weight gain

“Menopause itself doesn’t cause weight gain,” says Dr Jane. “When we lose oestrogen at menopause, our body fat is redistributed. Prior to menopause, women carry fat around their bottoms and hips, but after menopause this fat shifts to the abdomen. This belly fat is associated with visceral fat, which is around the internal organs. This increases our risk of heart disease, stroke, and metabolic diseases such as type 2 diabetes.”

If you’re looking to lose some weight, the best way to approach it is sensibly and methodically. “Exercise and nutrition are key to controlling your weight at all stages of your life, and this doesn’t change during perimenopause and menopause,” says Dr Jane.

Walking is great exercise, and may also help reduce some menopausal symptoms like mood changes, depression and sleep problems. Resistance or weight training should be part of your routine, too. Small studies show it may help reduce hot flushes in menopause, but more importantly, Dr Jane says “it is excellent for maintaining muscle mass which naturally decreases as you age and is important for your bone strength, which you need as you get older”.

“Focus your diet on whole foods such as vegetables, fruits, whole grains, nuts, seeds and legumes. Add in some healthy protein choices too so you can continue to build muscle to increase your metabolism. Seeing a dietitian or health practitioner can help keep your food intake on track,” says Dr Jane.

If you’re overweight and living with osteoarthritis^* and joint pain requiring surgery, you may be able to access our Osteoarthritis Healthy Weight for Life program. This is free for eligible HCF members with hospital cover who meet the program's eligibility criteria.

How to deal with the physical changes of menopause

Perimenopause and menopause can’t be stopped, but some of the symptoms can be relieved or reduced. “Now’s the time to really put yourself first,” says Dr Tan. “At this age, many women are in leadership roles at work, have teenage children and elderly parents. Plus, you might be having heavy periods due to perimenopause, making you very tired and possibly anaemic. All these things need to be addressed and optimised – otherwise it affects your ability to function.”

This is a great time to reset some habits that might not be benefiting this stage in your life. If you’re not used to exercising regularly, now is an excellent time to start. Regular exercise, including resistance or strength training, and good nutrition are key.

You can reset your drinking habits by downloading the Daybreak app^#, Hello Sunday Morning’s online behaviour change program giving you access to 24/7 digital support. The program connects you anonymously with a like-minded online community trying to change their relationship with alcohol.

Sleep is also essential. “Chronic tiredness, which can be due to menopause symptoms such as hot flashes, depression or insomnia, can be debilitating,” says Dr Tan. “Alcohol can also affect how you sleep, so it may be worth cutting back.”

To help you build better sleep habits, we’ve partnered with Sleepfit Solutions, who deliver an app that can help you identify sleep issues, recommend improvements and give you access to personalised tools. Eligible members with hospital or extras cover⁺ can get a free 12-month Sleepfit subscription.

The bottom line is that getting help – from professionals, family and friends – is essential in navigating the symptoms of perimenopause and menopause. “Find a good health practitioner who’s experienced in menopause,” says Dr Jane. “The Australasian Menopause Society has a directory of doctors across Australia who are interested in menopausal medicine. If your GP doesn’t have the information you need, get a second opinion. Plus, talk to your friends – they may be feeling the same as you. Sharing experiences can be really valuable.”

Finally, know that the post-menopausal part of your life is, for many women, the time they get to rediscover themselves. “Moving into this post-menopausal part of your life will actually bring hormonal stability,” says Dr Jane. “For most women this brings a reduction, if not resolution, of symptoms.”