Perimenopause Weight Gain: Causes and Management

It’s common to gain weight during perimenopause, the time leading up to menopause. Menopause is the stage in your life when you’ve stopped having your period for 12 months in a row and can no longer get pregnant. Perimenopause typically begins in your mid- to late 40s and lasts about four years.

During this transition period, hormone levels change, introducing perimenopause symptoms such as irregular periods, hot flashes, and trouble sleeping. Many people also notice weight gain, especially around the belly, even if they haven’t changed their eating or exercise habits.

Different factors can add to weight gain during perimenopause. On average, people gain about five pounds during perimenopause.

Overall, weight gain can affect several aspects of life, from self-image to the risk of related health conditions. Understanding the changes and challenges that come with perimenopause—and how to address or accommodate them—can help you navigate perimenopause weight gain with more confidence and control.

Hormonal shifts and a slowing metabolism drive perimenopausal weight gain. Related factors, like stress, sleep issues, and a less active lifestyle, can also play a role.

Hormonal Shifts

During perimenopause, levels of the sex hormone estrogen start to drop as your ovarian function decreases. Levels of the hormone progesterone start to shift as well. These hormonal imbalances can have various effects, including slowing your metabolism, increasing your appetite, and causing water retention, all of which can contribute to weight gain.

Slowing Metabolism

As you age, your metabolism (your body’s ability to change food to energy) naturally slows down. This change is one reason weight gain becomes more common in middle age. You may also experience slowed metabolism when your estrogen levels drop, which may cause your body to store fat around your belly.

Appetite and Food Choices

Estrogen helps regulate hunger hormones, including leptin (which signals fullness) and ghrelin (which triggers hunger). When estrogen levels drop, an imbalance in these hunger hormones can occur. You may feel stronger hunger signals and cravings for high-calorie foods. When that happens, it’s easy to rely on convenient, processed foods high in sugar, salt, unhealthy fats, and preservatives. These foods can lead to higher calorie intake and weight gain.

Stress associated with perimenopause can also lead some people to drink more alcohol, which adds calories, slows metabolism (the body burns alcohol before fat), and increases cravings for less nutritious foods. 

Insulin Sensitivity or Resistance

With age, your body naturally becomes less sensitive to insulin, the hormone that regulates blood sugar. Lower estrogen also reduces adiponectin, a hormone that helps control blood sugar and burn fat. This combination can makes it harder for your body to manage blood sugar, often leading to more fat storage. 

Loss of Muscle Mass

Muscle burns more calories than fat does. However, as you get older, your muscle mass naturally decreases. Having less muscle mass means you may burn fewer calories at rest, making it easier for extra calories to turn into body fat and weight gain.

Sedentary Lifestyle 

Balancing life aspects such as work, family, and caregiving in your 40s and 50s often leaves little time for self-care. Mental fatigue can make rest more appealing than a workout. As a result, some people replace physical activity with sedentary behaviors without adjusting their calorie intake, which can contribute to weight gain.

Stress

Perimenopause can be a stressful time. Stress can lead to emotional eating, especially high-calorie comfort foods. Many people also cope with stress by watching TV or scrolling on devices. Stress-related eating and inactivity can make weight management more challenging.

Sleep Disturbances

Perimenopause can lead to insomnia and night sweats that disrupt your sleep. Poor sleep and tiredness can increase your cravings for high-calorie foods that offer quick energy. Fatigue also makes it harder to stay motivated to exercise, creating a cycle of low energy and weight gain.

Health Conditions and Medications

Health conditions that can co-occur with perimenopause can sometimes affect your weight. For example, depression can change how much you eat and how active you are. Certain antidepressant medications, which your healthcare provider may prescribe for mood changes and other symptoms, may also lead to weight gain.

Gaining weight during perimenopause isn’t just about appearance. It also carries an increased risk for health concerns such as:

• Worsened hot flashes
• Increased risk of urinary incontinence, or difficulty “holding it” when you need to pee
• Sexual dysfunction
• Anxiety and depression
• Some cancers 
• Osteoporosis (weak bones that break easily)
• Diabetes 
• Heart disease and stroke
• Liver and kidney disease
• Metabolic syndrome (high blood pressure, high blood sugar, and high cholesterol)

Managing your weight during perimenopause can be complex due to factors within and outside your control. A personalized approach focuses on lifestyle strategies and may include medical treatment.

Keep a Well-Balanced Diet

A well-balanced diet with the following nutrient-rich foods can help energize you, manage cravings, and balance blood sugar levels: 

• Fruits and vegetables, especially leafy greens, non-starchy foods, and lower-sugar options
• Lean proteins such as chicken, salmon, tuna, turkey, and eggs
• Legumes such as beans, lentils, and chickpeas
• Healthy fats such as avocado, coconut oil, olive oil, nuts, and chia seeds

Many people find success with the Mediterranean diet, which emphasizes these foods while limiting red meat, processed foods, and added sugars. If you find intermittent fasting helpful, start slowly and ensure you get enough healthful calories during your eating window.

One approach to making sure you are eating appropriate portions of your well-balanced diet is to follow the pie plate method. To do this, divide your plate into three sections. Fill half of your plate with vegetables, a quarter with lean protein, and another quarter with a mixture of fruits, legumes, and healthy fats.

Stay Hydrated

Helping to control your appetite is just one of the many benefits of drinking enough water. Aim for at least 68 ounces (about two liters or half a gallon) of water daily, or more if you’re active.

Avoid sugary drinks, which add empty calories and can spike blood sugar. Instead, choose low-calorie options like herbal teas, sparkling water, or water infused with lemon or cucumber if you prefer something other than plain water.

Be Active

Keeping up with physical activity can help burn extra calories, build muscle, and relax your mind, which may limit how weight gain affects you.

Here are the weekly exercise recommendations for adults:

• 150 minutes of moderate aerobic activities, starting with easy-paced walks and gradually adding options such as cycling, dancing, jogging, or swimming
• Two to three weightlifting or resistance exercise sessions
• Two to three balance and flexibility sessions, like yoga or Pilates

Adding movement to your day, like taking the stairs or walking during breaks, also makes a difference. Tracking your steps with a pedometer or smartwatch can help you monitor activity and see your progress.

Consider Taking Supplements

Some supplements may help with weight management during perimenopause. Other supplements may help support hormonal balance, boost mood, improve sleep, and promote heart and bone health, making it easier to maintain a healthy lifestyle with diet and exercise. For example, black cohosh may help reduce mood swings and hot flashes, while St. John’s wort may help lift mood and enhance sex drive.

A healthcare provider like a nutritionist can talk with you about the different supplements for perimenopause, including which may be safe and helpful for you.

Manage Stress

Keeping stress in check is important for your overall well-being, including during perimenopause. You can explore relaxation techniques to find what works for you. Some options include the 4-7-8 breathing method, meditation, or engaging in hobbies you enjoy. 

Prioritize Sleep

For better sleep in perimenopause, all the tips for good sleep hygiene apply. These include avoiding caffeine and limiting screen time in the evening, keeping your bedroom comfortable and cool, and following a regular sleep schedule with a calming bedtime routine.

Some medications may help prevent or manage weight gain in perimenopause. If you’re interested in one of these options, your healthcare provider can explain whether a prescription would be right for you.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) can help balance estrogen and progesterone during perimenopause. This hormonal medication can help decrease a range of menopausal symptoms like hot flashes and vaginal dryness, but evidence for the effect of HRT on weight gain or weight loss is mixed. HRT also may not be recommended for everyone, such as those with a history of breast cancer.

Other Medications

Nonhormonal weight loss medication can help with weight management by helping to block fat absorption, control appetite, or improve blood sugar. Some of these medications include:

• Alli, Xenical (orlistat)
• Contrave (bupropion and naltrexone)
• Ozempic, Wegovy (semaglutide)
• Victoza, Saxenda (liraglutide)

Consider talking to a provider if healthful eating or exercise isn’t helping you maintain your weight. A healthcare provider can also help if you have other perimenopause symptoms, like insomnia, fatigue, mood changes, or swelling. They can check for other health conditions, like those that affect your hormones or thyroid, and suggest safe ways to help you manage if weight gain is a concern for you.

Weight gain is common during perimenopause, the time leading up to menopause. Hormone changes, a slower metabolism, stress, and sleep quality are all factors that contribute to perimenopause weight gain. You can support your body during this transition into menopause by nourishing yourself with healthful foods, staying active, managing stress, and prioritizing sleep. If you’d like extra support, a healthcare provider can offer personalized guidance and discuss options like supplements, hormone therapy, or nonhormonal medications to help you feel your best during this transition.