The Real Reasons You Gain Weight in Perimenopause

In perimenopause, a few things seem inevitable: You’ll be compelled to book all-female vacations; you’ll play Perimenopause Symptom Bingo with said females; and you won’t care if your side part or cherished bootleg jeans are “in” or not. You may also develop tummy rolls or maybe that thing where you look like you’re carrying a small fanny pack on your abdomen. This, of course, is perimenopausal weight gain and is the only one of the above that isn’t exactly enjoyable.

Weight gain during perimenopause (the years leading up to menopause) is typical, especially around the midsection. Most women gain weight around 1.5 pounds per year as they progress through their 50s, according to the Mayo Clinic.

But it’s important to know that perimenopause sudden weight gain and changes in body shape aren’t down to “letting yourself go.” They’re the real and predictable effects of age and physiological and hormonal shifts as your body adjusts to being on the road to menopause.

It’s easy to bemoan perimenopause for the need to buy a new wardrobe (which, by the way, is totally worth it). But hormones and a slower metabolism may not be fully to blame. According to the Centers for Disease Control and Prevention, most of us gain weight in midlife, regardless of sex, largely because of changes in our movement and eating habits (1). We also lose muscle mass as we age, which may account for some of the pounds. So do you gain weight during perimenopause? Yes, but it may not be primarily because of perimenopause. 

About the Experts

Yves-Richard Dole, M.D., a general OB/GYN at Mercy Medical Center in Baltimore. 

Neha Lalani, M.D., an Austin-based board-certified endocrinologist and obesity medicine specialist practicing at Bluebonnet Diabetes & Endocrinology.

Why Am I Gaining Weight During Perimenopause?

It’s not your imagination that the weight piles on easier during perimenopause and is harder to take off. Here’s why:

Lower muscle mass

According to a paper funded by the National Institute on Aging, women’s muscle mass decreases 3 to 8 percent every decade after age 30, and even faster after age 60. Less muscle slows the metabolism, which is at least part of the reason you burn up to 250 to 300 fewer calories per day at 60 than you used to at 20. Burning calories at a slower rate during the perimenopause years = weight gain from the same diet.

Increased stress

Endless research shows that stress is tied to weight gain, and guess what midlife women have a lot of? Stressors that are distinct from those that men experience. In fact, women consistently report higher levels of stress than men, according to the American Psychological Association. 

A big part of it for many of us is that we’re the turkey and cheese in the Sandwich Generation sandwich. Regardless of whether perimenopause causes weight gain, women are more likely to provide care to older family members, according to the Bureau of Labor Statistics, and be the primary caregivers in families, according to a report by the AARP. We’re helping with day-to-day living as well as financial and emotional support to both our parents, older relatives, and our children, a survey from Pew Research found.

Plus, a lot of us are doing it alone: Eighty-four percent of single-parent families are headed by a mother, according to the 2023 US Census. How does stress make weight gain more likely? Feeling frazzled causes cortisol to flood your system, raising blood pressure and insulin production and suppressing the immune system. Add to the mix that a stressful day makes us want to pull into the drive-through for fries and a shake, or partake in other “rewarding substances and behaviors,” as one study on stress and weight gain put it (2). Important to know: the impulse to “eat your feelings” or seek comfort through something enjoyable and caloric isn’t a personal failing. It’s biology.

Other perimenopause symptoms

Sleep disturbances, anxiety, depression, and weight gain are all typical symptoms of perimenopause. They can produce a cascade effect that results in more weight gain. 

Disturbed sleep can lead us to eat more, including high-fat, high-carb snacks (3). Irregular sleep may also contribute to changes in the body that predispose midlife women to weight gain during perimenopause. Plus, when you’re tired, you aren’t as inclined to want to get out and move your body.

That in turn can make you more anxious and depressed, which can prompt more comfort eating and less interest in moving your body. “You can imagine a feedback loop where these issues feed on themselves. If you have a certain stressor you’re gaining weight and that causes you more stress and the loop just continues,” says Yves-Richard Dole, M.D., an OB/GYN at Mercy Hospital in Baltimore.

Shifts in fat distribution

You may not be gaining weight; your body may just hold more fat around the middle, versus your butt and hips. If you do gain weight during the perimenopause years, it’s more likely to show up around your abdomen due to hormonal changes and fluctuations. 

“During puberty when the girls start going through changes, estrogen encourages fat to accumulate on hips, thighs, and arms,” says Neha Lalani, M.D., a board-certified endocrinologist and obesity medicine specialist who practices at Bluebonnet Diabetes & Endocrinology, in Austin, Texas. “In perimenopause and menopause fat moves away from those areas” and concentrates on the abdomen, an area where fat distribution is driven by testosterone.

This is likely due to a drop in estrogen, but there’s an evolutionary hypothesis as to why this happens: After you get your period in puberty, fat gathers in your butt and hips, perhaps in part to clear space in your abdominal area to carry a baby, according to a paper published in Evolution, Medicine and Public Health (4). Once you’re getting done with baby making, the theory goes, the fat can go back to your belly.

MORE MENOPAUSE

Perimenopause Decoded: Common Signs and Smart Solutions

8 Signs You Might Need Menopause Hormone Therapy

The Problem with Belly Fat in Perimenopause

Every body is a bikini body, as the saying goes, so kudos if you’re out there in your SPF embracing your slightly softer midsection. But we’d be remiss if we didn’t point out the health implications of abdominal fat.

Abdominal fat—more specifically what’s known as “visceral fat”—increases the risk of breathing problems, type 2 diabetes, and heart disease. It can raise blood pressure and increase the risk of cancer, in particular breast, colon, and endometrial cancers. That’s because compared with subcutaneous fat, visceral fat makes more cytokine proteins, which can trigger the inflammation that’s a risk factor for heart disease and other health conditions.

Tummy exercises that promise to “torch belly fat” are a fantasy, but strength training combined with aerobic activity (such as walking or running) can help keep visceral fat at a minimum. Core exercises can tighten abdominal muscles (a good thing) but don’t touch visceral fat, according to Harvard Health.

How to Lose Weight During Perimenopause

While there’s no magical formula, there are specific things you can do to prevent or reduce perimenopause weight gain.

Start weight training

Maintaining muscle mass helps keep the metabolism fired up and improves strength and balance, key factors for weight loss during perimenopause. Lifting weights also guards against bone loss and osteoporosis — significant risks for women in perimenopause and menopause. Cardio exercise remains important, “but lifting light weights is protective for bone health,” says Dole. 

Experts at Stanford University’s Stanford Lifestyle Medicine Program recommend midlife women do resistance training 2 to 3 times a week for each muscle group (5). Use weights that feel heavy for you: Doing three sets of 4 to 6 reps should feel challenging (6).

Exercise regularly

“To ensure good metabolic health, regular exercise programs are important,” says Lalani, “and it also helps bone health, stress management and insomnia.” Metabolic health simply means that your blood sugar, blood pressure, HDL cholesterol, and other health measures are in the healthy range so that your body turns the food you eat into energy efficiently. 

Here’s a guideline: An article in the National Library of Medicine recommends women in the menopausal transition should combine at least 150 minutes of moderate aerobic exercise per week with strength training along with yoga, Pilates, and stretching to help with menopause-related symptoms (7).

Eat more protein

Muscle mass is a key factor to maintaining or losing weight during perimenopause and beyond. And protein provides the amino acids for building and maintaining muscle fibers. You may even crave more protein during perimenopause because of “hormonally-induced tissue protein breakdown,” according to researchers from the University of Sydney. When the body isn’t getting enough protein, they say, we eat until we have the amount we need, resulting in too many overall calories. 

How much protein do you need? It depends on who you ask, along with lifestyle factors such as how athletic you are. Recommendations generally range from 0.8g – 1.0g to 1.2g for every kilogram of body weight. For a 150-pound woman (68kg), that translates to 68g to 81.6g of protein per day, spread across meals. When you reach 40 or 50, your protein intake should be on the higher end of that range to prevent sarcopenia, or muscle wasting, per the Mayo Clinic.

Eat less

It may not be the most welcome advice, but starting in our 50s we need to eat 200 calories less per day to maintain the same weight, according to the Mayo Clinic. The good news: by employing a few key strategies, you won’t even miss them. 

Americans, on average, consume 300 calories per day from added sugar. If you skip the sugar-sweetened soft drinks, the vending machine candy break, the post-workout juice or that venti caffe latte with oat milk, you’ve easily made a sizable dent in that calorie count.

Scaling back on alcohol can also quickly reduce your daily tally. A glass of wine can contain between 125 to 165 calories. 

Instead, load up on lean protein, and eat more plant-based meals featuring ingredients like lentils, soy, and fish. Cook with olive oil instead of butter, and reduce the amount of processed foods, which can be calorie-dense without the benefits of whole foods.

What About Weight Loss Medications?

Perimenopause weight gain on its own is not a reason to use weight loss drugs. But if you have a BMI over 30 or a BMI over 27 with a weight-related condition like diabetes, speak to an endocrinologist or obesity doctor, suggests Dole. Drugs like Wegovy and Ozempic (semaglutide), Mounjaro (tirzepatide) and others – called GLP-1 agonists – work by stimulating hormones that control blood sugar and curb appetite, but they can cause side effects.