The Complete Guide to Perimenopause and Weight Gain

When you’ve stopped having your period for 12 months in a row due to menopausal hormonal changes, you’ve been through menopause.

Perimenopause, which translates as “around menopause,” is the time leading up to menopause.

On average, perimenopause lasts about 4 years, but it differs greatly from person to person. It usually happens between the ages of 45 and 55.

Body changes and perimenopause

Women may start to experience symptoms and physical changes during perimenopause. Some examples are:

• irregular periods, which may be heavier or lighter than usual
• weight gain
• hot flashes and night sweats
• mood changes
• vaginal dryness
• brain fog
• sleep disturbances
• incontinence
• joint pain
• changes in sexual function, such as a low sex drive

Our own unpublished research, which involved over 25,000 women, found that sleep problems, night sweats, mood changes, and hot flashes are the most common symptoms. We also found that women with obesity experience hot flashes, mood changes, and sleep problems — as well as chills and thinning of hair or dry skin — more often than women without obesity.

Why we put on weight during perimenopause

Studies have found that our body composition changes when we go through perimenopause. This includes an increase in fat mass and waist circumference and a decrease in muscle mass. Fat is also more likely to accumulate around the abdomen.

These shifts likely stem from several factors, including changes in reproductive hormones.

In fact, experts know that estrogen plays a role in energy metabolism, and studies have shown that the way the body metabolizes fat and other lipids changes during the menopause transition.

For example, shifts in energy metabolism caused by fluctuations in estrogen may lead to the accumulation of body fat around the abdomen and an increase in “bad” blood fats. These changes, in turn, are linked to health conditions such as type 2 diabetes and heart disease.

Experts call ghrelin the “hunger hormone” because it helps regulate appetite. It’s produced in the stomach and increases the sensation of hunger, prompting us to eat.

Genetics may also play a role. For example, if members of your close family tend to carry excess weight around their abdomens, you’re more likely to, as well. And lifestyle factors, such as an unhealthy diet, a lack of physical activity, and not getting enough sleep, can also contribute to weight gain.

Does HRT cause weight gain?

Hormone replacement therapy (HRT) is sometimes called menopausal hormone therapy, or MHT. It’s an effective way to relieve symptoms during perimenopause and menopause.

It often comes as tablets, but it’s also available as skin patches, skin implants, or a spray or gel that you apply to your skin.

A common misconception is that HRT causes weight gain. However, research has shown that it doesn’t have this effect. In fact, HRT may help prevent weight gain.

What you can do about weight gain

There are several ways to help prevent excess weight gain during perimenopause.

Nutrition

Having a healthy, diverse diet rich in fresh produce can help reduce the chances of weight gain. It’s a good idea to have a plant-based diet that includes a variety of fruits, vegetables, whole grains, nuts, seeds, beans, and other pulses.

Try to avoid highly processed foods and keep high-fat, high-sugar, and high-salt options to a minimum.

Physical activity

Adding physical activity into your daily routine can be easier than you might think. It doesn’t have to be a hard slog at the gym or a marathon. Your exercise routine should be manageable and sustainable.

Most importantly, choose something you enjoy. Maybe that’s a yoga or Pilates session, a salsa class, or a swim at your local sports center. Remember, physical activity also includes everyday things like walking, housework, and gardening.

Ideally, aim for around 150 minutes of physical activity each week.

Sleep

Sleep is essential for every bodily process, and it influences our physical and mental health. So, making sure you get enough quality sleep is important. Ideally, aim for 7–9 hours each night, but your personal requirement may be a little more or a little less.

What’s at the root of poor sleep during perimenopause isn’t entirely clear. This is an area that clearly needs more attention from researchers.

Gut health

Scientists have identified differences in the gut microbiome before and after menopause. Interestingly, the relationship between gut bugs and hormones goes both ways: Your gut microbiome influences levels of reproductive hormones, and levels of reproductive hormones influence the gut microbiome.

Look after your gut by keeping our nutrition tips above in mind. And if you have ongoing gut symptoms, contact your doctor.

Supplements

While many supplements claim to help with weight loss, there is no solid evidence to back this up. More specifically, the evidence that probiotic supplements can help with weight loss is limited and mixed.

Summary

Going through perimenopause can involve many physical and psychological changes. Weight gain is common during this time. It likely stems from a combination of things, including changes in your reproductive hormones and body composition, as well as genetics and lifestyle factors.

Good nutrition, physical activity, and sleep may help prevent excess weight gain during perimenopause.

If you want to understand how to eat for your body, start with our free quiz.