How Hormones Shape Weight and Health in Midlife, With Caissa Troutman, M.D.

Caissa Troutman, M.D., founder of Midlife reMDy and Weight reMDy, explains that menopause isn’t just a single moment in time — it’s part of a longer transition. Menopause is officially reached when a woman has gone 12 months without a period. But before that, there’s perimenopause, which can start up to 10 years earlier. During perimenopause, hormone levels (especially estrogen and progesterone) fluctuate unpredictably, causing many of the same symptoms as menopause — from hot flashes and night sweats to brain fog, anxiety, depression, insomnia, heart palpitations and changes in libido.

When it comes to weight gain in midlife, Troutman emphasizes that it’s not simply about “calories in versus calories out.” Our brains regulate energy storage and use through hormones such as insulin, cortisol, leptin and ghrelin. As estrogen levels drop in menopause, the body tends to store more visceral fat (especially around the belly, sometimes called “meno belly”). This change in fat distribution can increase insulin resistance, making it easier to gain weight and harder to burn it off.

Another major factor is muscle loss. We naturally lose lean muscle as we age, starting in our 30s, and menopause may accelerate this process. Since muscle acts like a metabolic engine, burning more calories even at rest, losing muscle mass can make weight management more challenging — even if eating and exercise habits haven’t changed.

Troutman notes that hormone therapy is U.S. Food and Drug Administration (FDA) approved for certain menopause-related conditions, including bone loss prevention, moderate to severe hot flashes, vaginal dryness and early menopause. However, experienced providers may also use it off-label to help with other symptoms like insomnia, anxiety and joint pain when these issues significantly impact quality of life.

Improving sleep is one example of how treating menopause symptoms can have a ripple effect on health. Poor sleep can raise hunger hormones and cortisol levels, leading to increased appetite, more inflammation and greater fat storage. Restoring hormone balance for patients whose insomnia is linked to menopause can help them sleep better, boost energy, and make it easier to stick to healthy habits like meal prepping and regular physical activity.

Her message to patients: Menopause-related changes are real and rooted in biology, not willpower. By understanding what’s happening in the body and addressing symptoms — whether through lifestyle changes, medication or hormone therapy — women can take control of their health and feel better in midlife and beyond.