Hot flashes and mood swings may steal the spotlight during the “change of life,” but they’re only part of the story. 

Research shows up to 70% of women gain weight during the menopause transition, with the scale creeping up by an average of 1.5 pounds per year starting in the mid-40s. 

But a sweeping new study suggests this trend may not be inevitable, identifying specific eating patterns that could help prevent weight gain and obesity in middle-aged and older women — and they don’t even have to give up carbs.

“The metabolic change in menopause is real, and it’s a very complicated interaction that’s related to hormones,” Dr. Stephanie McNally, medical director at the Northwell Katz Institute for Women’s Health, who wasn’t involved with the study, told The Post.

During the transition, estrogen and other hormones that help regulate feelings of fullness decline, weakening the body’s natural appetite control mechanisms, she explained.

At the same time, hormones that drive hunger, like ghrelin, tend to increase, along with cortisol, which can trigger cravings for high-fat and sugary foods.

While these physiological shifts can make it harder for perimenopausal and menopausal women to maintain or lose weight, McNally said the study underscores a key takeaway: “What you eat really matters.”

In the study, researchers from Harvard University tracked nearly 40,000 women over the 12 years surrounding their menopausal transition, analyzing how their diets and eating patterns influenced weight fluctuations.

The women’s diets were grouped into 11 different eating styles, with two emerging as the most effective at limiting weight gain.

The regimen that appeared most effective at preventing obesity was seen in what Harvard researchers have previously called the planetary health diet.

This eating pattern is largely plant-based, emphasizing whole grains, fruits, vegetables, nuts and legumes, while limiting red meat, added sugar and highly processed foods.

In earlier research, Harvard scientists found that adherence to this diet was linked to a lower risk of major causes of death, including cancer, heart disease and lung disease.

It also appears to benefit the planet — a factor that helped inspire its name.

When it came to minimizing weight gain year over year during the menopause transition, the so-called low-insulin diet rose to the top.

This eating style focuses on foods that help avoid sharp spikes in blood sugar and insulin, the body’s primary fat-storage hormone.

In practice, that means prioritizing high-fiber carbohydrates, healthy fats and lean proteins, while cutting back on refined grains and sugary foods.

When the researchers looked at popular low-carb diets, they found that not all approaches delivered the same results.

For example, while a low-carb diet rich in plant-based proteins and healthy fats was linked to less weight gain, a low-carb regimen heavy in animal fats and proteins was associated with the opposite effect.

“It’s not about the low-carb; it’s about what foods you are substituting in that health process,” McNally said.

“Really, the foods that are plant-based — that have legumes, vegetables, nuts, whole grains — that’s what’s going to help balance the metabolic health in this transition period for women. And that’s where we have to focus our energy.”

The implications go beyond aesthetics.

As women move through the menopause transition, where their weight is stored also tends to shift — moving away from the hips and thighs and accumulating more around the abdomen, a change often referred to as a “menobelly” or “menopot.”

Instead of subcutaneous fat — the “pinchable” layer just beneath the skin — this abdominal buildup is often visceral fat, which sits deeper in the body, wrapping around internal organs.

That’s a concern because visceral fat is metabolically active, releasing fatty acids, hormones and inflammatory compounds directly into the bloodstream.

Over time, this can create a dangerous cycle that women in menopause may be particularly vulnerable to: as visceral fat releases inflammatory signals, the pancreas responds by producing more insulin, which in turn can encourage the body to store even more visceral fat.

Higher levels of visceral fat are linked to increased risk of serious health problems, including heart disease, Type 2 diabetes, non-alcoholic fatty liver disease and even certain cancers.

“By choosing diets that have more insulin resistance built into it, like the foods we described, that will actually be the key driver to help maintain, lose weight and ward off an obesity situation,” McNally said.