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Perimenopause weight gain
Why it can happen and how to support a slowing metabolism
Disclaimer: This article has been sponsored by Novo Nordisk
Top things to know:
Hormone changes during perimenopause can affect metabolism, appetite, and body fat storage
Weight gain, especially an increase in central belly fat or "menopause belly," is common during this time
Lifestyle changes such as diet, exercise, stress reduction, and improved sleep can help
Some people may benefit from additional support with weight management, including medical options
Tracking your sleep, cravings, exercise, and mood in the Clue app can help you identify your own patterns over time
Why am I gaining weight during perimenopause?
If you're in your 40s and start to notice irregular periods, interrupted sleep, and a snugger waistband, you aren’t alone. These are common symptoms of perimenopause, the hormonal transition to menopause, and can last for several years before the last menstrual period (1).
As many as 70% of women report weight gain in midlife (2). Weight and body shape changes at perimenopause may feel hard to understand, especially for people who haven’t changed their diet or exercise habits. Perimenopausal women gain an average of 1-1.5 pounds (0.45–0.68 kg) per year (3), though some may gain even more (4).
Weight gain is about more than just a number on a scale. A change in body shape and size can influence body confidence and sense of self. Changes in body weight also have important consequences for your overall health (3).
Why do hormone shifts in perimenopause lead to "meno belly?"
It’s not just a slower metabolism. In this article, we’ll break down perimenopause, why perimenopause weight gain happens, and what you can do to help manage weight and improve body confidence.
What is perimenopause?
Perimenopause is the hormonal transition to menopause (5). It can last for several years, ending once you have gone a full 12 months without a menstrual period (5).
During the reproductive years, the hormones estradiol (a type of estrogen) and progesterone play a key role in regulating the menstrual cycle (6). As the ovaries age and the number of eggs decreases, estradiol and progesterone levels fluctuate and gradually decline (5).
Beyond the cycle: Estrogen’s role in the body
Estradiol is involved in more than just the menstrual cycle. There are receptors for estrogen all over the body, including the brain, cardiovascular system, and bones (7).
That’s why when estradiol levels start to change, people may begin to experience perimenopause, including (3,5,8,9):
Vasomotor symptoms (hot flashes and night sweats)
Mood changes (anxiety, depressive symptoms)
Brain fog
Changes in sleep patterns (difficulty falling or staying asleep)
Muscle and joint aches
Weight gain
Vaginal dryness
Increased risk of urinary tract infections (UTIs)
Midlife vs. Perimenopause
It’s also helpful to distinguish between "midlife" and "perimenopause". Midlife is a life stage measured in years, typically between 40 and 65 (3). Whereas perimenopause and menopause refer to the hormonal transitions that happen as the body ages.
What causes perimenopause weight gain?
Estradiol helps to regulate metabolism, blood sugar, and appetite, and as estradiol decreases in perimenopause, multiple changes in the body can make it harder to maintain weight.
Increased appetite
Estradiol works in the brain to reduce appetite and promote satiety (a feeling of fullness after eating) (10). It interacts with other hormones in the body that control hunger, like leptin and ghrelin (11).
Initial animal studies have shown that lower estradiol levels could contribute to increased ghrelin sensitivity and decreased leptin sensitivity (10-12). This may make people feel hungrier or less satisfied with their usual meals. Over time, this could lead to an increase in caloric intake. Even if small, this could cause gradual weight gain.
Tracking your cravings along with your cycle in Clue can help you spot patterns in your experiences. For example, you may notice more cravings at certain times of your cycle.
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Change in fat storage
Higher estradiol levels promote body fat storage in the hips and thighs (13). As estrogen levels drop, perimenopausal women begin to hold more fat in the abdomen (13). Waist circumference gradually increases throughout the transition to menopause (3). Some people refer to this change in physical appearance as "menopause belly" or "meno belly."
The risk of visceral fat
Lower estradiol levels can also lead to an increase in visceral fat—fat stored on the inside of the body around the abdominal organs (11). Visceral fat is a particularly important health marker. Higher levels of visceral fat are linked to insulin resistance, inflammation, high cholesterol, and increased cardiovascular risk (2).
Insulin resistance
There is also a link between insulin resistance and estrogen levels. Lower estrogen levels have been linked to higher inflammation (14). Insulin resistance is caused by chronic low-level inflammation that prevents body tissues from taking up and using blood sugar (glucose). This leads to higher blood sugar levels, and extra blood sugar is stored as fat (15).
Menopause is linked to an increased risk of insulin resistance (16). These changes in blood sugar regulation could result in more belly fat storage for midlife women. More research is needed on how estrogen levels in perimenopause relate to insulin resistance.
Metabolism slows
During midlife, resting metabolic rate (RMR) decreases (3). This is the amount of calories that a person burns at rest just to stay alive (17). Body composition changes in midlife may account for this change. Women begin to lose muscle mass gradually after age 30, at a rate of 3-8% per decade (3).
Muscle burns more calories than fat. When a body contains more fat and less muscle, fewer calories are burned at rest. This reduces overall RMR. Someone with a decreasing RMR may find it harder to maintain their body weight despite similar diet and exercise habits (3).
Sleep, stress, and busier lives
Midlife is often a time of increased responsibility and stress. Many midlife women are busy with work, relationships, or caregiving duties. These full lives can leave little time for self-care activities, like regular exercise, mindfulness practice, or social engagement.
High stress increases cortisol levels in the body, which can lead to more belly fat storage (18,19).
Sleep troubles are another common perimenopause experience. Other symptoms, like night sweats or hot flashes, can also disturb sleep. Interrupted sleep can increase cortisol levels. It can also lead to increased appetite and food intake (20).
When something else is at play
Body changes at midlife may be common, but perimenopause hormones aren’t always the culprit. Health conditions like thyroid disorders, PMOS (formerly named PCOS), kidney disease, or heart disease can impact body weight (21).
Menstrual conditions like uterine fibroids or premenstrual dysphoric disorder (PMDD) may also have overlapping symptoms (22,23).
Medications, including steroids, mental health medications, and some diabetes medications, can cause weight gain (21). It is important to look at the entire picture of your health and discuss any concerns with your healthcare provider.
Science-based ways to manage weight during perimenopause
Now you know that perimenopausal hormone shifts might be at play for your recent change in body shape. Is there anything you can do to prevent or reverse weight gain?
Exercise
An exercise regimen that includes both cardio and strength training is important for not just managing weight, but overall health in perimenopause.
Experts recommend at least 150 minutes of moderate-intensity aerobic exercise per week (24). This could include cardio activities like walking, jogging, biking, or swimming. Strength training at least twice per week is critical to maintain muscle mass and improve bone health (24).
Diet
Midlife women benefit from a heart-healthy diet that includes a variety of fruits, vegetables, whole grains, and lean proteins. Like other adults, they should limit added sugars, saturated fats, sodium, and alcohol (25).
Adequate protein intake is particularly important for maintaining muscle mass in perimenopause. The minimum recommended protein intake to maintain muscle mass is 0.8 grams per kilogram of body weight (26). This increases to up to 1.2 grams per kilogram for those who exercise regularly (26). For someone who weighs 150 lbs (68 kg), this would equal 55-82 grams of protein per day.
Sleep
Simple sleep hygiene shifts may help improve sleep patterns (27). This includes:
Limiting evening screen time
Avoiding late afternoon naps
Following a regular sleep routine
Keeping a cool, comfortable sleep space
Avoiding caffeine, heavy meals, and exercise late in the evening
Cognitive behavioral therapy for insomnia (CBT-I) is also a helpful tool for those struggling with sleep despite lifestyle interventions (28).
Stress
Some research has shown that mindfulness-based stress reduction could reduce the risk of depression and trouble sleeping in the menopause transition (29). Stress and poor mood can increase cortisol, food consumption, and weight gain (30). Managing mood and sleep might help someone manage appetite more effectively, but more research is needed in this area.
Managing vasomotor symptoms
Vasomotor symptoms (VMS) occur in as many as 3 in 4 women in the menopause transition (31). They commonly interfere with sleep, causing trouble falling asleep and trouble staying asleep all night.
More severe or frequent VMS are linked to higher levels of weight gain in perimenopause, and they are also associated with increased risk of heart disease (31). Managing your vasomotor symptoms could help improve overall health (3).
Some methods used to manage VMS include (32):
Wearing light layers
Keeping a cool sleep temperature
Avoiding alcohol, tobacco, and caffeine
Practicing mindfulness
Medications
If diet and lifestyle recommendations alone do not help you manage body changes in perimenopause, there could be other options.
Weight loss medications
Certain medications specifically help reduce body weight. Medications that affect GLP-1 receptors can be used to reduce body weight in menopausal women (33 ). These medications can also help manage blood sugar and reduce the risk of heart disease (33). More research is needed on the effect in perimenopausal women.
Other weight loss medications can also help those who can’t take GLP-1 medications (34).
Other medical therapies
Treating the symptoms of menopause may indirectly help with weight gain. Systemic menopause hormone therapy (MHT) can treat vasomotor symptoms that interfere with sleep.
Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, fezolinetant, or clonidine are used in people who are not able to take MHT (5,35). Treating hot flashes and night sweats can help perimenopausal women get more sleep, reduce stress, and improve their quality of life.
Many studies have shown that MHT can help reduce central belly fat storage (36). However, research has not consistently linked MHT alone to changes in body weight (36). Recent observational studies have found that combining MHT with GLP-1 agonists can improve weight loss compared with either treatment alone (33,37). But more research is needed in this area (36).
When to talk to a healthcare provider about weight gain
Tracking your symptoms and making small changes can help you care for your metabolic health. However, sometimes self-help strategies are just not enough. The support of a trusted healthcare provider can be validating while navigating body changes in the menopause transition.
Sometimes, weight gain is a sign of something more serious happening in the body. Consider reaching out to your healthcare provider if you notice other symptoms, including (21,38):
Hair loss
Heat or cold intolerance
Swollen ankles/feet and shortness of breath
Vision changes
Increased appetite, shaking, heart palpitations, and sweating
Rapid weight gain of more than 2 to 3 pounds (~1- 1.5 kg) per day or more than 5 pounds (2.3kg) in a week
Confusion or trouble thinking clearly
Weight gain and/or perimenopause symptoms that are severe enough to interfere with your quality of life
How Clue can support you through perimenopause changes
You are the expert on your own body. A tool like Clue can help you organize your own experiences to give you some insight and control during a time of huge change.
You can track more than just cycle length in Clue. Symptoms like hot flashes, sleep, moods, cravings, exercise, and weight can be tracked alongside menstrual patterns in one easy place with Clue Perimenopause mode.
There are so many science-backed reasons why weight gain happens during perimenopause. If you’re noticing changes in your body, please remember—you are more than a number on a scale.
Awareness of your symptoms allows you to make small, consistent changes–tracked and adjusted over time—to improve your energy, health, and body confidence.
FAQs
Does Hormone Replacement Therapy (HRT/MHT) help with weight loss in perimenopause?
Many studies have found that MHT positively impacts body composition. MHT may prevent central belly fat and visceral fat accumulation. However, it does not seem to help with overall weight loss (36). Factors like how you take your estrogen (pill versus patch) and your age when starting MHT could influence how MHT affects your body composition (36).
Is menopause changing your body shape?
It absolutely can! The hormonal changes during the menopause transition lead to more belly fat storage and less fat on the hips and thighs ( 3,13). This may lead to a more rounded belly shape and wider waistline. While it is a common result of changing hormones, it’s important to monitor abdominal weight gain. Greater abdominal body fat is linked to an increased risk of diabetes, heart disease, and cognitive decline (39).
Why am I suddenly gaining weight at 43?
Hormone changes during perimenopause, especially changes in estrogen hormones, affect weight management. Estrogen hormones impact metabolism, blood sugar control, appetite, and body fat storage. In addition, during midlife, you gradually lose muscle mass, which lowers your resting metabolic rate (RMR) (3). This means that even if you don't change your diet or activity level, you may still gain weight because you are burning fewer calories at rest.
When does "menopause" belly go away?
The “menopause belly” or “meno belly” body fat pattern is usually not a temporary change. It is caused by a lasting shift in hormone levels with age. Lower estrogen causes metabolic changes that lead to increased waist circumference throughout the menopause transition (3).
While it may feel discouraging, there are still things you can do to manage "menopause belly" at home. Regular exercise with both cardio and strength training is essential to maintain muscle mass, support metabolism, and promote bone health. Experts recommend at least 150 minutes of moderate-intensity cardio and at least two strength-training sessions per week (24).
