Perimenopause Weight Gain? It’s Common, But Manageable
Hint: Your hormones aren’t totally to blame.
In perimenopause, a few things seem inevitable: You’ll feel compelled to book all-women vacations, you’ll play Perimenopause Symptom Bingo with said women, and you won’t care whether your side part or cherished bootleg jeans are “in” or not. You may also develop tummy rolls or that thing where you look like you’re carrying a small fanny pack on your abdomen.
Weight gain during perimenopause is typical, especially around the midsection (known as “menopause belly”). But it’s important to know that weight gain and changes in body shape aren’t a matter of “letting yourself go.” They’re the real and predictable effects of age and physiological and hormonal shifts.
About the Experts
Yves-Richard Dole, M.D., a general OB/GYN at Mercy Medical Center in Baltimore.
Alexander Watson, M.D., a board-certified physician in Physical Medicine and Rehabilitation and Obesity Medicine.
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?
Sudden weight gain in perimenopause can be directly linked to hormonal changes that affect body composition, appetite, and metabolism. Other perimenopause symptoms and general midlife stress can also make it hard to stick to healthy habits.
“You can imagine a feedback loop where these issues feed on themselves. If you have a certain stressor, and you’re gaining weight, and that causes you more stress, the loop just continues,” says OB-GYN Yves-Richard Dole, M.D.
And while sudden weight gain in perimenopause can happen, for most women, it’s a steady creep that adds up over the years. Research on women ages 42 to 52 participating in the Study of Women’s Health Across the Nation found that, on average over a three-year period, women gained nearly 5 pounds, and their waist circumference increased by almost 1 inch.1
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.2 We also lose muscle mass as we age, which may account for some of the pounds.
Hormone fluctuations during perimenopause
Hormonal shifts in estrogen, testosterone, and progesterone drive gradual or sudden perimenopause weight gain.
However, perimenopause sudden weight gain doesn’t simply happen because of hormone declines. It’s the dramatic peaks and valleys of shifting hormone levels that drive the most dramatic perimenopause symptoms. During perimenopause, the body’s natural production of estradiol, testosterone, and progesterone becomes erratic. At times, estradiol levels will spike and then drop, affecting many parts of a woman’s day-to-day health.
- Estrogen: Declines in estrogen during perimenopause shift the body’s fat distribution. Rather than gaining subcutaneous (under the skin) fat, which is generally not harmful, women gain more metabolically unhealthy abdominal, or visceral, fat. “Visceral fat causes direct problems that accelerate weight gain, including insulin resistance,” says obesity specialist Alexander Watson, M.D.
- Testosterone: Testosterone levels also decrease during perimenopause, combining with estrogen losses to amplify muscle atrophy. Declines in muscle mass lead to a slower metabolism, affecting overall energy levels, motivation to work out, and the body’s ability to burn calories. Fatigue from low testosterone makes it challenging to manage sudden perimenopause weight gain.
- Progesterone: Declining progesterone levels can impact perimenopause weight gain because they affect sleep quality, which then has a downstream effect on hunger hormones. These changes in hunger signals can lead to overeating and higher cortisol levels, pushing your body to store more abdominal fat, says Watson.
CAUSES OF MENOPAUSE WEIGHT GAIN
How to Stop Perimenopause Weight Gain
Although it may seem as if midlife stacks the cards against you, “we have pharmacological and lifestyle changes that can stop and reverse weight gain in perimenopause,” Watson says. Here are some tips to fight perimenopause weight gain:
Increase protein
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 60.3 Muscle mass is a key factor in preventing or managing perimenopause weight gain, and dietary protein provides amino acids needed to stimulate muscle growth.
Protein also has a higher thermic effect, meaning your body burns more calories to metabolize it compared to other nutrients, says Watson. And protein intake is important for maintaining muscle during a calorie deficit in weight loss. Watson recommends consuming about 1 gram of protein per pound of body weight.
Cut back on alcohol
Scaling back on alcohol can also quickly reduce your daily calorie intake, which can be key in fighting back against sudden weight gain during perimenopause. While research surrounding menopause alcohol intolerance is still in progress, the connection between alcohol and calorie intake is clear: A glass of wine, for example, contains between 125 and 165 calories. And while light to moderate intake of alcohol has not been linked to weight gain, heavy drinking is linked to obesity and the accumulation of liver fat.4
Assess overall nutrition
You can manage perimenopause weight gain by following a diet that allows you to maintain a calorie deficit while still getting the nutrients your body needs. (Diets that go below 1,200 calories per day are simply unsustainable.)5
A healthy, balanced diet can also help mitigate some of the symptoms of perimenopause while reducing other health risks associated with the transition, such as heart disease and osteoporosis. Rather than following a diet that cuts out food groups or sways into fad territory, consider measures like cutting out snacks, reducing portions, and limiting added sugar and alcohol.You can manage perimenopause weight gain by following a diet that allows you to maintain a calorie deficit while still getting the nutrients your body needs. (Diets that go below 1,200 calories per day are simply unsustainable.)6
As for supplements for perimenopause weight gain, if you can’t or don’t want to use HRT, there are a few Watson might recommend, such as black cohosh, red clover, chasteberry, and/or phytoestrogens. These are not directly for weight loss, but they can help relieve symptoms during perimenopause, such as mood changes or sleep problems, that can play a role in weight gain. “All of these can work together to address similar menopause symptoms, and there may be synergy to them,” says Watson.
Creatine can also aid in building muscle and improving body composition.
MENOPAUSE DIET TIPS
Prioritize strength training
Women who stayed active during perimenopause were able to avoid weight gain and increased waist circumference.7 Some even lost weight.
“To ensure good metabolic health, regular exercise programs are important,” says Neha Lalani, M.D., a board-certified endocrinologist and obesity medicine specialist.
Metabolic health simply means that your blood sugar, blood pressure, HDL cholesterol, and other health measures are in the healthy range, allowing your body to turn the food you eat into energy more efficiently. Exercise also helps with stress management and insomnia, both of which can play a role in weight gain.
Resistance training in particular can help you maintain muscle mass, which helps keep your metabolism fired up and improves strength and balance, key factors for weight loss during perimenopause. Experts at Stanford University’s Lifestyle Medicine Program recommend that women in midlife do resistance training two to three times a week for each muscle group.8 Use weights that feel heavy for you; doing three sets of 4 to 6 reps should feel challenging.9
Aerobic exercise, which burns calories and helps protect your heart, should also be incorporated into your weekly routine. Aim for 150 minutes per week of moderate-intensity aerobic activity, such as brisk walking, cycling, jogging/running, or swimming—whatever gets you out there.10
MENOPAUSE EXERCISE TIPS
Discuss medications with your doctor
Whether it’s gradual or sudden, 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. Phentermine, which works by reducing appetite and stimulating your metabolism, is another drug that can be used as part of a weight loss plan for women in perimenopause and menopause.
MEDICATIONS AND MENOPAUSE
Does HRT Help with Perimenopause Weight Loss?
Hormone-replacement therapy (HRT), also known as menopause hormone therapy, is not typically prescribed to manage perimenopause weight gain. However, hormone treatment may help support weight loss in a few ways, says Watson:
- Estrogen therapy (typically prescribed as patches or creams) can help address the redistribution of weight gain, reducing the accumulation of belly fat.
- Testosterone (injections or creams) can improve motivation for exercise and the body’s response to exercise, enhancing gains in muscle mass.
- Progesterone (pills or cream) can aid sleep, helping regulate hunger and cortisol. They supplement the body’s natural production of progesterone, a calming, “chill” hormone.11 Progesterone makes you tired because it improves the absorption of a relaxing neurotransmitter in the brain called gamma-aminobutyric acid.
Research on postmenopausal women shows that HRT is associated with less accumulation of body fat with age and a reduction in visceral fat and BMI. However, these benefits only lasted as long as women were on HRT.12
If you’ve experienced gradual or sudden weight gain in perimenopause in combination with other symptoms, your provider might recommend HRT. Ideally, your treatment plan should be customized to your individual needs.
HRT OPTIONS FOR WEIGHT LOSS
The Bottom Line
Perimenopause weight gain is caused by a variety of factors, including hormone fluctuations, metabolic changes, and muscle loss. Women can address it with lifestyle changes like diet and exercise as well as medication options like GLP-1s and hormone -replacement therapy.
Sternfeld, B. et al. (2004) Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women’s Health Across the Nation.
↑Pontzer, H. et al. (2021) Daily energy expenditure through the human life course
↑Volpi, E. et al. (2010) Muscle tissue changes with aging
↑Martínez-Urbistondo, D. et al. (2024) Alcohol Drinking Impacts on Adiposity and Steatotic Liver Disease: Concurrent Effects on Metabolic Pathways and Cardiovascular Risks
↑Erdélyi, A. (2023) The Importance of Nutrition in Menopause and Perimenopause—A Review
↑Erdélyi, A. (2023) The Importance of Nutrition in Menopause and Perimenopause—A Review
↑Sternfeld, B. et al. (2004) Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women’s Health Across the Nation
↑Stanford Lifestyle Medicine. (2023) Stop the Clock.
↑Stanford Lifestyle Medicine. (2023) Strength Training During Perimenopause
↑Chopra, S. et al. (2019) Weight Management Module for Perimenopausal Women: A Practical Guide for Gynecologists
↑Tando, V. et al. (2022) Menopause and Sleep Disorders
↑Papadakis, GE. et al. (2018) Menopausal Hormone Therapy Is Associated With Reduced Total and Visceral Adiposity: The OsteoLaus Cohort
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The Edge upholds the highest standards of health journalism. We source research from peer-reviewed medical journals, top government agencies, leading academic institutions, and respected advocacy groups. We also go beyond the research, interviewing top experts in their fields to bring you the most informed insights. Every article is rigorously reviewed by medical experts to ensure accuracy. Contact us at support@honehealth.com if you see an error.
About the author
Jennifer Howze is an award-winning journalist, writer, editor, and social media entrepreneur based in London. She has worked at or contributed to some of the most prestigious media organizations, including The Times of London, The Wall Street Journal, Conde Nast, and Hachette Filipacchi.
About the reviewer
Natalie Kunsman, M.D., is a board certified physician specializing in functional, anti-aging, and regenerative medicine. She is a fellow of the American Academy of Anti-Aging medicine and the American Academy of Family Physicians.
