Perimenopause weight gain: hormonal changes & how to manage

Bear in mind that creating a healthy lifestyle is a deeply personal journey — one that is best done with the guidance of healthcare providers who can support your unique health circumstances and goals. Make sure to consult them before making any major changes to your lifestyle.

If you’re in or nearing midlife, you might have already noticed signs that you’re entering perimenopause (like unexpected weight gain). Perimenopause is a transitional time that leads up to menopause — when your menstrual period stops and you can no longer get pregnant. This time can come with some frustrating symptoms that stem from the hormonal changes happening in your body [1, 2]. Let’s take a closer look at the root causes of perimenopause weight gain.

What causes perimenopause weight gain?

Perimenopause is a phase characterized by irregularities in your menstrual cycle [1], and the underlying cause of these irregularities may also be causing weight gain. You can thank shifting hormones for most perimenopause symptoms, but metabolism changes and lifestyle factors like excess stress may also contribute to a changing body shape during this time [2].

Hormonal imbalance

During perimenopause, the regular rise and fall of estrogen and progesterone (the female sex hormones that control our menstrual cycle) starts to be disturbed and becomes increasingly irregular [3]. As they fluctuate, they also gradually decline over time until menopause, at which point levels of both are very low in your body [4]. Both of these hormones contribute to a variety of bodily functions, including your cycle, weight distribution, and more. With that in mind, the hormonal shifts that happen during perimenopause may play a part in weight gain [5].

Metabolic changes

These hormones also help regulate your metabolism (the way that your body uses energy). When they’re out of balance, this can change the way your body uses the energy you consume. For example, you may retain more fat than you did pre-menopause [6]. It’s also common for women to gain weight around the midsection specifically during this time [1].

Stress levels

Weight gain can also come from stress. Perimenopause usually happens during your 40s and/or 50s, a time that might coincide with major life stressors like caring for an aging parent, making career decisions, or managing personal health issues (not to mention the stress of managing perimenopause itself with symptoms like joint pain, and period changes). These challenges can increase stress levels, leading to hormonal imbalances particularly with cortisol — a hormone linked to increased body fat [7].

On top of that, stress and fluctuating hormones can lead to fatigue and disrupted sleep patterns, which can also cause weight gain [8]. All of this can make weight loss quite difficult during this time because it’s hard to determine if the root cause is hormone shifts, stress, a lack of sleep, or all three. The ongoing cultural pressure to lose weight and keep it off can also be a stressor. 

If you’re feeling like this is far too much to address all at once, you’re not alone. There are millions of women experiencing similar pressure and struggles, and it’s important to lean on your community and reach out for support when you can. Before we offer some solutions, let’s get clear on why maintaining a healthy weight during perimenopause is a valuable endeavor.

How risky is perimenopausal weight gain?

Although the underlying causes of weight gain can be complex and difficult to address, it’s still worthwhile to explore what a healthy lifestyle looks and feels like to you, and work on building it as best you can — even if that just means making small changes in your day-to-day life.

This is because weight gain during perimenopause has been associated with an increased risk of certain health conditions such as diabetes, arthritis, high cholesterol, and cardiovascular issues [8]. Declining estrogen levels associated with perimenopause can also cause disruptive conditions like sarcopenia and low libido. We’ll explore these two conditions more in depth below:

Sarcopenia

Age-related muscle atrophy, also called sarcopenia, is a progressive disorder that involves low skeletal muscle mass and low muscle strength [7]. It’s thought that estrogen directly influences skeletal muscle metabolism while playing a role in carbohydrate and fat metabolism. It also indirectly regulates growth hormone (which is responsible for building muscle). All of this means that decreasing estrogen levels during perimenopause may lead to sarcopenic conditions in the body. Low protein intake, low vitamin D levels, and low physical activity can also lead to sarcopenia [7]. With all of that in mind, it’s worth creating a healthy lifestyle in order to prevent as much perimenopausal muscle loss as possible.

Lower libido

As many as 10% of women experience decreased libido during the perimenopause years [4]. While there are many factors that contribute to this symptom (including vaginal dryness and a decrease in testosterone), declining estrogen and weight gain can also contribute to lower sexual desire, or even sexual dysfunction [1, 4, 8]. Some people may also find that gaining weight has an effect on their self-confidence and general mood, which can also have an effect on libido.

Can you lose weight during perimenopause?

Losing weight during perimenopause can be challenging, but it’s definitely possible. To stay motivated, it may help to know that even modest weight loss can improve your mood and overall health while reducing other perimenopause symptoms like hot flashes. In fact, losing just 3% of your body weight (if you’re overweight) can lower your risk of diabetes and cholesterol issues. Up to 10% can help improve your blood pressure, blood sugar, liver function, and chronic pain [9]. 

Consult with your healthcare professional about your body’s unique needs and goals before starting any sort of workout or diet regimen, but in general, remember that it’s never too late to start living a healthier lifestyle.

The science behind perimenopausal weight loss

A comprehensive approach to weight loss that includes increased physical activity, new dietary habits, and support from friends, family, and professionals, is essential for sustainably reaching and maintaining your goals. We’ll go through each of these elements individually below to help you understand the science behind weight loss during perimenopause a bit better, but keep in mind that they all need to work together to create sustainable, healthy changes [8]. Here’s a few tips on how to lose weight during perimenopause:

Exercise: Regular exercise can have major positive impacts on your mental and physical health. It can boost your mood while improving insulin sensitivity, which lowers your risk for diabetes. Physical activity also helps manage your cholesterol and blood pressure levels while decreasing your odds of cardiovascular issues. Resistance or strength training in particular can decrease midsection fat and improve your lean body mass, and this can improve your overall metabolism and contributes to weight loss. The American College of Cardiology recommends 150 to 175 minutes of gentle moderate physical activity per week for healthy weight loss [8].

Manage your diet: Eating lots of fruits and vegetables, healthy fats, whole grains, and high protein can help you maintain a healthy weight and thus manage the symptoms associated with perimenopause more effectively. If a diet or meal plan is easier for you to follow, check out the Mediterranean diet — it’s been shown to decrease cardiovascular risk, which is the biggest disease risk for perimenopausal women [8, 11]. 

If your intention is weight loss specifically, you may want to follow a calorie-restricted diet, meaning that your body burns more calories than you consume. It’s important to keep this modest and avoid a “crash diet” so that the weight loss is sustainable over time. The obesity guidelines from the American College of Cardiology recommend a daily calorie deficit of about 500 to 750 calories to facilitate sustainable, healthy weight loss, but speak with your healthcare provider or a nutritionist to assess your unique dietary needs and create a plan for success. There are also certain apps available on most smartphones that can help you track your calorie intake and meet your goals [8].

Accountability: Consulting a nutritionist, your doctor, a counselor, or even a trusted family member or friend can really improve outcomes for any weight loss or weight maintenance journey. These accountability partners can help you stay on track to reach and maintain your goals [8].

What's the best way to prevent menopause weight gain?

If you haven’t gained perimenopause weight yet and you’re just looking to prevent it in the first place, good old-fashioned nutrition and exercise are still going to be your go-to methods for healthy weight maintenance. Women who consistently exercise before perimenopause and continue their routine, or those who become more active during or after menopause, are less likely to experience significant weight gain compared to those who do not [8]. Creating a sustainable, active lifestyle is key to maintaining your health during this phase of life — and it’s possible you may not gain any weight at all.

Learn more about your perimenopause journey with Natural Cycles

The perimenopause years come with all sorts of changes, and it’s important to support your health — physically, mentally, and emotionally — as best you can. Remember that you’re not alone in this transition. Millions of women have experienced or are currently going through this struggle with perimenopause weight, and there are solutions available to support your health.

Natural Cycles is an FDA Cleared app packed full of useful guidance and resources designed to assist you throughout your fertility journey, so find out how Natural Cycles can help you get more in tune with your body today.