Perimenopause and Its Effects on Weight and Health: what you need to know

Perimenopause, often referred to as the menopause transition, is a natural phase in a woman’s life marking the end of her reproductive years. Typically beginning in a woman’s 40s (though it can start earlier), this transition can last anywhere from a few months to several years before menopause officially begins—defined as 12 consecutive months without a menstrual period.

While symptoms like hot flashes and mood swings are commonly discussed, many women are surprised and frustrated by one particular side effect: unexpected weight gain. This blog explores how perimenopause impacts weight and overall health, and what science says about managing these changes.

Hormonal Shifts and Weight Gain

One of the hallmark features of perimenopause and its effect on weight and health is fluctuating hormone levels—especially estrogen and progesterone. These hormonal changes can lead to:

1. Increased Fat Accumulation

Estrogen plays a role in regulating body fat distribution. As estrogen levels decline during perimenopause, there’s a shift in fat storage from the hips and thighs to the abdominal area. A 2012 study from the Journal of Clinical Endocrinology & Metabolism found that perimenopausal and postmenopausal women experience a significant increase in visceral fat, which surrounds internal organs and is linked to metabolic diseases (Lovejoy et al., 2012).

2. Lower Resting Metabolic Rate

Research shows that the resting metabolic rate (RMR) tends to decline with age, and this process can be accelerated during perimenopause. This means women burn fewer calories at rest, making it easier to gain weight even without changes in diet or activity (Poehlman et al., 1995).

3. Changes in Appetite and Cravings

Hormonal fluctuations also impact hunger and satiety signals. Estrogen has been shown to suppress appetite, so lower estrogen levels can lead to increased hunger and cravings, particularly for high-carbohydrate or sugary foods (Asarian & Geary, 2013).

Health Implications Beyond Weight

The weight gained during perimenopause isn’t just a cosmetic concern—it can have serious health consequences, including:

• Increased risk of cardiovascular disease: Visceral fat contributes to insulin resistance and inflammation, both of which raise the risk of heart disease.

• Higher likelihood of type 2 diabetes: A study published in Menopause (2010) found that women with greater weight gain during the menopause transition were significantly more likely to develop diabetes.

• Worsened bone health: Estrogen decline also affects bone density, increasing the risk of osteoporosis—especially concerning if weight gain leads to sedentary habits that reduce bone-strengthening activity.

What You Can Do: Evidence-Based Strategies

While these changes are challenging, there are proven ways to manage weight and support health during perimenopause:

1. Prioritize Resistance and Strength Training

Building muscle is key to increasing metabolic rate. A 2015 meta-analysis in Obesity Reviews found that strength training improved body composition and reduced abdominal fat in postmenopausal women.

2. Incorporate Cardiovascular Exercise

Aerobic activity helps burn calories and improve insulin sensitivity. The Women’s Health Initiative observational study showed that women who walked briskly for at least 30 minutes a day gained less weight over time than those who didn’t.

3. Focus on a Nutrient-Dense, Lower-Glycemic Diet

Reducing sugar and refined carbohydrate intake can help stabilize blood sugar and limit fat storage. A study in The American Journal of Clinical Nutrition found that a lower-glycemic diet helped middle-aged women maintain healthier weights and reduce inflammation.

4. Monitor Sleep and Stress

Perimenopause often brings sleep disturbances, which are associated with weight gain due to their effects on cortisol and appetite hormones. Mindfulness, therapy, and establishing a consistent sleep routine can mitigate this.

5. Consider Medical Support

Some women benefit from hormone replacement therapy (HRT) or non-hormonal medications to manage symptoms. Always consult with a healthcare provider to explore your options.

Final Thoughts

Perimenopause can feel like an uphill battle, but understanding the physiological changes at play can empower women to take proactive steps. Weight gain isn’t inevitable—it’s a signal that your body is shifting, and it may need a new approach to movement, nutrition, and self-care. One of the often overlooked facts is that perimenopause happens around exactly the same time as a general slowdown of metabolic rate across all sexes. As we hit our 40s and 50s, gradual decline in muscle mass and usually activity mean that despite eating the same foods in the same quantities our weight may creep up. Allowing for this can remove some of the inevitability associated with weight gain in perimenopause, and shows that it can be reversed or prevented through achievable changes to training and nutrition.

We specialise in training the over 50s and over 40s so have over 20 years’ experience in helping women stay strong and lean through perimenopause.

By tuning into your body and embracing science-backed strategies, it’s entirely possible to maintain a healthy weight and feel strong, vibrant, and in control during this transitional time.

References

1. Lovejoy, J. C., Champagne, C. M., de Jonge, L., Xie, H., & Smith, S. R. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. Journal of Clinical Endocrinology & Metabolism, 93(2), 550–555.

2. Poehlman, E. T., Toth, M. J., & Gardner, A. W. (1995). Changes in energy balance and body composition at menopause: a controlled longitudinal study. Annals of Internal Medicine, 123(9), 673–675.

3. Asarian, L., & Geary, N. (2013). Sex differences in the physiology of eating. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 305(11), R1215–R1267.

4. Pan, A., et al. (2010). Changes in physical activity and weight gain in middle-aged and older women. Menopause, 17(2), 402–407.

5. Howe, S. M., et al. (2015). The effects of exercise on fat mass in postmenopausal women: a systematic review and meta-analysis. Obesity Reviews, 16(11), 1052–1065.

6. Ebbeling, C. B., et al. (2012). Effects of dietary composition on energy expenditure during weight-loss maintenance. The American Journal of Clinical Nutrition, 96(2), 377–385.