Menopause and Metabolism

Many of my patients say some version of the same sentence: 

“I am eating less than I did in my thirties, I am exercising more than I ever have in my life, and my waistline is still expanding. What is wrong with me?”

If you are in the menopause transition or already postmenopausal and you feel as if your body has changed the rules without telling you, you are not imagining it. Your body really has changed the rules. The problem is that most of modern medicine keeps pretending nothing fundamental has happened, and that you should be able to “just eat less and move more” forever, with the exact same results you had at 28.

This article explains what I call the Life’s Not Fair Metabolism Factor. It is my way of describing the real biological changes that occur around menopause which make fat loss harder, especially around the abdomen, hips, thighs, and back, even when you are doing everything “right.” We will look at what the science actually shows, why it is so difficult for some women and comparatively easier for others, and why non-invasive fat-reduction technology like the Zerona VZ8 can finally help address the stubborn fat deposits that refuse to respond to diet and exercise alone.

You are not lazy. 

You are not weak. 

Your hormones and your fat tissue have simply entered a new phase of life. 

For decades, the cultural story about midlife weight gain in women has been that it is “just aging” or a sign of poor self-control. The research tells a more accurate and far less judgmental story. Longitudinal studies following women through the menopause transition show several consistent patterns:

• Total body fat tends to increase during the years surrounding the final menstrual period, even when body weight changes appear modest on the scale.

• Fat shifts from a more “pear-shaped” distribution (hips and thighs) toward a more “apple-shaped” pattern, with more fat deposited deep inside the abdomen around the organs (visceral fat).

• Lean mass (muscle) gradually decreases. Even if the scale does not move much, the body becomes “softer,” with a higher body fat percentage at the same weight.

• Cardiometabolic risk rises. Central obesity, insulin resistance, elevated triglycerides, and higher blood pressure become more common after menopause, even in women who are not clinically obese.

A large longitudinal study of women transitioning through menopause found that those who became postmenopausal over four years gained significantly more total body fat and, crucially, more visceral abdominal fat than women who remained premenopausal in the same time frame. These changes were closely tied to declining estradiol (a major estrogen) levels and to a decrease in daily energy expenditure and physical activity.

In other words, menopause changes both where your body stores fat and how many calories you burn without you doing anything differently. That is not a character flaw. That is biology.

Here is the part nobody tells you when you are handed the standard advice to “cut 500 calories a day.” Two women can follow the same calorie-controlled plan, perform the same exercise routine, track their food with identical accuracy, and live in similar environments. One of them steadily loses inches and weight. The other loses a few pounds, stalls, and then watches the same pounds creep back, sometimes with a bonus of extra belly fat she never had in her thirties.

The Life’s Not Fair Metabolism Factor is my shorthand for the complex mix of hormones, brain chemistry, fat-cell biology, genetics, and aging that makes midlife weight management wildly unequal from one person to the next.

Researchers have documented several pieces of this puzzle:

• Estrogen influences how and where fat is stored and how active fat tissue is metabolically. When estrogen levels fall, visceral fat tends to increase and adipose tissue becomes more prone to inflammation and metabolic dysfunction.

• In a well-designed longitudinal study, women who became postmenopausal experienced not only an increase in visceral fat but also a measurable decrease in 24-hour energy expenditure. In simple language, their bodies quietly started burning fewer calories per day for the same activities.

• Other research shows that while menopause itself clearly changes fat distribution and cardiometabolic risk, age itself is also linked to lower resting energy expenditure, independent of menopausal status. This means that a 55-year-old woman may burn fewer calories at rest than she did at 35, even if her lifestyle has improved.

• Review articles on menopause and obesity emphasize that the transition is associated with increased total and abdominal fat, decreased lean mass, and higher risk of metabolic syndrome, even when weight changes are relatively modest.

Put simply, there is real science behind your experience of thinking, “My body does not play by the same rules anymore.”

At this point, many readers are tempted to throw up their hands and declare calories irrelevant. They are not. Energy balance still exists. If a person consistently consumes more energy than they expend, weight usually increases over time. If they consistently consume less, weight usually decreases. However, the slope of that curve and the ease of creating a workable deficit are very different in a hormonally balanced 28-year-old compared with a postmenopausal 58-year-old.

High-quality studies confirm that menopausal and postmenopausal women can improve metabolic health and body composition with structured exercise and diet interventions. Resistance training and endurance exercise blunt some of the adverse changes in adipose tissue, reduce central obesity, and help preserve lean mass.

Calories and movement still matter. They always will. However, the Life’s Not Fair Metabolism Factor means that for many women, especially during and after menopause, lifestyle change on its own may not be enough to reshape stubborn fat deposits into the body they have in mind. The numbers in the app might look perfect, while the numbers on the tape measure barely budge.

Even before menopause, most people have “preferred storage areas” for fat. These are the places where weight seems to land first and leave last: the lower abdomen, flanks, outer thighs, back of the arms, and bra-line region. After menopause, that pattern often becomes more dramatic. Research using DEXA scans and imaging confirms that total and regional body adiposity tends to increase at midlife, with a shift toward more truncal and visceral fat. Women can experience noticeable changes in waist circumference and clothing fit even if the scale has barely moved.

Metabolically, not all fat depots behave the same way. Deep visceral fat is more hormonally active and more resistant to mobilization. Estrogen deficiency, changes in androgen levels, reduced physical activity, and age-related changes in muscle all contribute to the stubbornness of these depots. The result is the classic complaint: “Everything I do seems to come off my face and upper body first, and the places that bother me the most hardly change.” 

That is the menopause factor in action.

This is where modern non-invasive laser technology finally becomes relevant in a meaningful, scientifically grounded way. Zerona technology from Erchonia uses low-level laser light to influence fat cells through a photochemical, rather than thermal, mechanism. In early randomized, controlled trials, low-level laser therapy aimed at the waist, hips, and thighs produced statistically significant reductions in combined circumferences compared with sham treatment, without surgery, heat, or tissue destruction. 

The working model, supported by electron microscopy, is that specific wavelengths create temporary microscopic pores in adipocyte membranes, allowing stored triglycerides to leak out into the extracellular space where the body can process them and eventually eliminate them. At the same time, not every study has shown dramatic changes. A later split-body trial using a multiple-diode laser system (including an Erchonia laser configuration) did not find a clear difference in circumference between treated and untreated sides in a very small sample, and the authors correctly called for more research. Science is not a marketing brochure; results vary with protocols, devices, and populations. The point is that we are not dealing with a fad. We are dealing with a real, FDA-regulated technology that has demonstrated the ability, under specific conditions, to reduce body circumference non-invasively.

The Zerona VZ8 is the latest evolution of this approach. It combines Erchonia’s patented low-level red and violet wavelengths, including a 405 nm violet laser designed to stimulate fat cells at the mitochondrial level and trigger the release of stored fat without heating or injuring tissues. 

In January 2025, the United States Food and Drug Administration cleared the Zerona VZ8 as a non-invasive dermatological aesthetic treatment for the reduction of body circumference, including over-the-counter use.

As of January 2026, the Liebell Clinic is proud to provide it for our patients. Like all Liebell Clinic treatments, we used it for ourselves successfully, first.

It means that when we integrate Zerona VZ8 into a comprehensive program that already addresses calorie intake, nutrition quality, and physical activity, we finally have a tool that can specifically target those stubborn, diet-resistant fat regions that are so deeply influenced by menopausal hormonal changes. For more than twenty years, I have used Erchonia low-level laser systems at the Liebell Clinic for neurological, musculoskeletal, and other applications. 

Patients have been asking me, quite literally for decades, if there would ever be a safe, non-surgical way to help reshape fat in the very areas menopause seems to hijack. Zerona VZ8 is the technology those patients have been asking for.

It does not replace healthy eating, appropriate medical care, or physical activity. It does not cure menopause or change the underlying hormone shifts. It is not a treatment for diabetes, high blood pressure, or cardiovascular disease. Those medical problems require proper medical management.

Zerona VZ8 gives us a sophisticated, non-invasive way to help the body release fat from regions where it has become functionally “trapped,” especially once hormonal and metabolic changes have made those depots much more stubborn. It leverages the physics of photobiomodulation and cell membrane dynamics to assist the physiology you already have, instead of trying to burn, freeze, or surgically remove tissue.

In the context of the Life’s Not Fair Metabolism Factor, this matters. Menopausal and postmenopausal women are often doing the work. They are counting calories. They are prioritizing protein. They are tracking their steps. They are lifting weights. They are managing careers and families while making midlife health their priority.

They deserve tools that respect that effort and acknowledge the biology they are up against.

When we integrate the science of menopause, adipose tissue, and energy expenditure with modern non-invasive laser body contouring, a more honest and hopeful picture emerges:

• Menopause fundamentally changes fat distribution, lowers spontaneous activity and sometimes daily energy expenditure, and increases visceral and central fat even at similar weights.

• These changes contribute to both cosmetic frustration and real health risk. They are not imaginary and they are not a moral failure.

• Calories and movement still matter, and structured exercise is one of the most powerful tools available to protect adipose tissue health and metabolic function after menopause.

• The Life’s Not Fair Metabolism Factor explains why women have vastly different responses to the same lifestyle prescriptions. Genetics, hormones, age, fat-cell biology, and brain-body regulation make the playing field uneven.

• The Non-invasive low-level laser system, Zerona VZ8, add a physics-based option to safely help reduce circumference in menopause-affected fat depots when lifestyle alone is not delivering the desired change.

At Liebell Clinic, our menopause-aware weight management and body-contouring programs are built around this reality, not around outdated blame or wishful thinking. We combine clinical nutrition, realistic guidance about calories and energy balance, focused movement strategies, and state-of-the-art Zerona VZ8 laser protocols as part of a comprehensive plan.

If you are in the menopause transition or beyond, frustrated by your body’s apparent refusal to respond to your efforts, there is nothing “wrong with you.” Your biology has changed. The goal of modern care is to change your strategy to match it.

In a separate article, I address the broader principle of calories consumed versus calories burned and practical tools like smartphone apps for tracking. 

This menopause-specific article exists because you deserve a dedicated explanation of what your hormones have done to the playing field—and why technology like Zerona VZ8 finally offers a way to help level it.

References

1. Lovejoy JC, Champagne CM, de Jonge L, Xie H, Smith      SR. Increased visceral fat and decreased energy expenditure during the      menopausal transition. Int J Obes (Lond). 2008;32(6):949-958.      doi:10.1038/ijo.2008.25.
2. Greendale GA, Sternfeld B, Huang M, et al. Changes in      body composition and weight during the menopause transition. JCI Insight.      2019;4(5):e124865. doi:10.1172/jci.insight.124865.
3. Kodoth V, Scaccia S, Aggarwal B. Adverse changes in      body composition during the menopausal transition and relation to      cardiovascular risk: a contemporary review. Womens Health Rep (New      Rochelle). 2022;3(1):573-581. doi:10.1089/whr.2021.0119.
4. Marsh ML, Oliveira MN, Vieira-Potter VJ. Adipocyte      metabolism and health after the menopause: the role of exercise.      Nutrients. 2023;15(2):444. doi:10.3390/nu15020444.
5. Crawford SL, Casey VA, Avis NE, McKinlay SM. A      longitudinal study of weight and the menopause transition: results from      the Massachusetts Women’s Health Study. Menopause. 2000;7(2):96-104.      doi:10.1097/00042192-200007020-00005.
6. Palacios S, et al. Obesity and menopause.      Climacteric. 2024; published online ahead of print.      doi:10.1080/09513590.2024.2312885.
7. Karppinen JE, Wiklund P, Ihalainen JK, et al. Age but      not menopausal status is linked to lower resting energy expenditure. J      Clin Endocrinol Metab. 2023;108(11):2789-2797. doi:10.1210/clinem/dgad321.
8. Jackson RF, Dedo DD, Roche GC, Turok DI, Maloney RJ.      Low-level laser therapy as a non-invasive approach for body contouring: a      randomized, controlled study. Lasers Surg Med. 2009;41(10):799-809.      doi:10.1002/lsm.20855.
9. Elm CML, Wallander ID, Endrizzi B, Zelickson BD.      Efficacy of a multiple diode laser system for body contouring. Lasers Surg      Med. 2011;43(2):114-121. doi:10.1002/lsm.21016.
10. US Food and Drug Administration. 510(k) Premarket      Notification K243811: Erchonia Zerona VZ8 Fat Reducing Low Level Laser.      January 10, 2025.