Perimenopause Weight Gain: Understanding the Causes and How to Take Control

Have you noticed your jeans fitting a little tighter even though your lifestyle hasn’t changed much? Welcome to perimenopause—the transitional life stage women struggle with before menopause. It’s notorious for its hormonal fluctuations, slow metabolism, and weight gain. 

So, does perimenopause cause weight gain? Not exactly, but it creates a hormonal turmoil that can make gaining weight much easier. Here’s the good news: with the right combination of nutrition, exercise, and expert advice, you can break the cycle and feel like yourself again. 

Today, we will explore the causes of perimenopausal weight gain, dispel common myths, and offer you our best tips to prevent weight gain. 

• Hormonal shifts, particularly a decline in estrogen levels, lead to changes in fat distribution and metabolism. This makes it easier to gain weight, especially around the abdomen. A decline in testosterone may also contribute to this.
• There is more to weight gain in perimenopause than just hormones. Other factors like poor gut health, increased inflammation, poor sleep, genetics, and other lifestyle habits, can also impact your weight. 
• A balanced diet rich in whole, anti-inflammatory foods, regular strength training and cardio, and targeted supplements like probiotics, omega-3s, and vitamin D can help you manage your weight and overall health during perimenopause.

Perimenpause and Body Changes 

You might have noticed your body change, seemingly overnight. The pounds start to accumulate, even though your eating habits remain the same. You find yourself stepping on the scale repeatedly, but the number isn’t budging as easily as you’d hoped. 

One of the most noticeable physical changes that often accompanies perimenopause is what is commonly referred to as the “menopausal belly.” As you can imagine, this term describes the extra fat stored around the abdomen. 

Why do Women Put on Weight During Perimenopause? 

One of the reasons for the sudden weight gain in perimenopause is hormonal fluctuations. As you approach menopause (defined as the absence of a menstrual period for 12 consecutive months), your levels of estrogen and progesterone begin to decline.¹ The drop in female sex hormones can lead to weight gain in a way you haven’t experienced before. 

But it’s not just female sex hormones that contribute to these changes. Fluctuations in testosterone and cortisol can also play a role. But how does this process occur? 

Increased appetite

If you’ve been feeling hungrier than usual, perhaps perimenopause is to blame. Fluctuations in your reproductive hormones may affect the production of ghrelin, also known as the “hunger hormone”. Ghrelin, produced in the stomach when empty, stimulates appetite and food intake. Research suggests that shifts in female sex hormones can lead to significant spikes in ghrelin levels, which may explain your increased hunger during this time.²

Slower metabolism

You might be eating more food, but your body is not keeping up with that increased intake. Changes in your reproductive hormone levels may affect the way your body uses fat and even slow down energy metabolism. This net effect: your body will use less of the ingested energy and store the rest as fat.³

Muscle loss

As you enter perimenopause, it’s common for body composition to change due to the natural aging process. This results in an increase in the percentage of body fat alongside a reduction in muscle mass, a phenomenon known as sarcopenia. Since muscle tissue is highly metabolically active, the loss of muscle mass can lead to a lower metabolic rate. Simply put, your body will use less energy than before, resulting in the surplus energy being stored as fat.⁴ 

Other Factors That Can Contribute to Perimenopausal Weight Gain 

Hormonal fluctuations may be the primary drivers behind the weight gain in perimenopause. However, there are other contributing factors that you should know about.

• Gut health. The gut microbiome of premenopausal and menopausal women is not the same.⁵ The relationship between the tiny organisms residing in your intestines and your reproductive hormones seems to go both ways. Certain bacteria may influence your estrogen levels, while your hormonal fluctuations appear to disrupt your gut microbiome.⁶
• Inflammation. Changes in fat metabolism can result in a state of generalized inflammation. These fat metabolism shifts along with extra fat stores trigger the production of the molecules that promote inflammation, like pro-inflammatory cytokines and reactive oxygen species.³

• Disrupted sleep patterns. A common challenge during perimenopause is disrupted sleep, often triggered by symptoms like night sweats, irritability, and mood swings. A recent study found a link between poor sleep and changes in energy metabolism, contributing to weight gain in perimenopausal women.⁷ Additionally, poor sleep and the accompanying circadian rhythm disruptions are linked to other health risks. This includes insulin resistance and higher inflammation levels, as evidenced by markers such as high cortisol.⁸  
• Genetics. Does your mom carry excess abdominal fat? Genetics can also impact the way your body responds to hormonal fluctuations. Genetic defects in the receptors for hormones associated with hunger regulation appear to be associated with a syndrome of overeating and obesity in women.⁹ 
• Lifestyle habits. Perimenopausal weight gain can be influenced by the same lifestyle factors that contribute to weight gain at any stage of life. Among these, key contributors include a poor diet, lack of physical activity, and insufficient sleep. 

Myths about Perimenopause and Weight Gain

Myth: Weight gain during perimenopause is inevitable.
Fact: While hormonal fluctuations make it easier to gain weight, lifestyle habits play a significant role. Factors like quality sleep, diet, and physical activity can still help you maintain or even lose weight during perimenopause. 

Myth: Eating less is the only way to prevent weight gain.
Fact: Severe caloric restriction can actually slow down your metabolism and lead to muscle loss. The right approach to long-term weight management should be balanced: eating nutrient-dense foods, hydrating your body, and exercising. 

Why You Need Good Eating and Exercise Habits 

The way you look and feel during perimenopause is a result of more than just your hormonal status. Here are some ways to navigate any weight gain:  

• Adopt a healthy, balanced diet. Focus on whole, nutrient-rich foods like quality animal protein, healthy fats, fruits, and vegetables to support your body’s changing needs during perimenopause. Eat anti-inflammatory foods, such as fatty fish, nuts, and seeds, and minimize processed foods, added sugars, and refined carbohydrates. 
• Introduce supplements. Some beneficial perimenopause supplements may include:¹⁰
  • Calcium and vitamin D for bone health
  • Magnesium to for better muscle function and improved sleep 
  • Omega-3 fatty acids to reduce inflammation
  • Probiotics to support gut health. 

This list is not exhaustive. It’s a good idea to consult a healthcare provider before introducing any new supplements to ensure they align with your individual needs.

• Exercise regularly. Muscle mass, which naturally declines with age, can be preserved through strength training. Combine it with aerobic exercises like walking, swimming, or cycling for cardiovascular health and a more efficient metabolism. 

The bottom line

Perimenopause weight gain can feel frustrating, but don’t give up just yet. Understanding the physical changes your body goes through will help you make the right lifestyle adjustments. You can combat the natural process of aging through a comprehensive approach: a balanced diet, targeted supplementation, and regular exercise.  

As usual, please make sure to reach out to your healthcare provider before introducing any new supplements into your regimen. This is especially important if you are trying to conceive or are breastfeeding. 

Opt Health can be your partner towards better health. To help you navigate perimenopause with confidence, we will check your hormones, make evidence-based exercise and nutrition recommendations, and explore options like hormone replacement therapy and key supplements. Our experienced physicians have a proven track record in guiding women through this transitional stage. Together, we’ll create a personalized plan to support weight management and improve overall well-being. Join us on a journey towards better health. 

References

1. What Is Menopause? National Institute on Aging. October 16, 2024. Accessed January 22, 2025. https://www.nia.nih.gov/health/menopause/what-menopause

2. Sowers MR, Wildman RP, Mancuso P, et al. Change in adipocytokines and ghrelin with menopause. Maturitas. 2008;59(2):149-157. doi:10.1016/j.maturitas.2007.12.006

3. Ko SH, Kim HS. Menopause-Associated Lipid Metabolic Disorders and Foods Beneficial for Postmenopausal Women. Nutrients. 2020;12(1):202. doi:10.3390/nu12010202

4. Hunter GR, Singh H, Carter SJ, Bryan DR, Fisher G. Sarcopenia and Its Implications for Metabolic Health. J Obes. 2019;2019:8031705. doi:10.1155/2019/8031705

5. Peters BA, Santoro N, Kaplan RC, Qi Q. Spotlight on the Gut Microbiome in Menopause: Current Insights. Int J Womens Health. 2022;14:1059-1072. doi:10.2147/IJWH.S340491

6. He S, Li H, Yu Z, et al. The Gut Microbiome and Sex Hormone-Related Diseases. Front Microbiol. 2021;12. doi:10.3389/fmicb.2021.711137

7. Grant LK, Coborn JE, Cohn A, et al. Sleep Fragmentation and Estradiol Suppression Decrease Fat Oxidation in Premenopausal Women. J Clin Endocrinol Metab. 2022;107(8):e3167-e3176. doi:10.1210/clinem/dgac313

8. Singh T, Ahmed TH, Mohamed N, et al. Does Insufficient Sleep Increase the Risk of Developing Insulin Resistance: A Systematic Review. Cureus. 14(3):e23501. doi:10.7759/cureus.23501

9. Leeners B, Geary N, Tobler PN, Asarian L. Ovarian hormones and obesity. Hum Reprod Update. 2017;23(3):300-321. doi:10.1093/humupd/dmw04510. Erdélyi A, Pálfi E, Tűű L, et al. The Importance of Nutrition in Menopause and Perimenopause-A Review. Nutrients. 2023;16(1):27. doi:10.3390/nu16010027