It’s common to gain weight during perimenopause, the time leading up to menopause. Menopause is the stage in your life when you have stopped menstruating for 12 months in a row and are no longer able to get pregnant. Perimenopause usually begins in your mid to late 40s and lasts about four years.
During this transition period, hormone levels change, introducing perimenopausal symptoms such as irregular periods, hot flashes, and sleep problems. Many people also notice weight gain, especially around the stomach, even if they haven’t changed their eating or exercise habits.
A variety of factors can contribute 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 adapt to them—can help you navigate perimenopausal weight gain with more confidence and control.
Hormonal changes and a slowing of metabolism lead to weight gain in perimenopause. Related factors, such as stress, sleep problems and a less active lifestyle, may also play a role.
Hormonal Shifts
During perimenopause, levels of the sex hormone estrogen begin to decline as ovarian function declines. Levels of the hormone progesterone also begin to change. These hormonal imbalances can have a variety of effects, including slowing metabolism, increasing appetite, and water retention, all of which can contribute to weight gain.
Slowing down of metabolism
As you age, your metabolism (your body’s ability to turn food into energy) naturally slows. This change is one of the reasons why weight gain becomes more common in middle age. You may also experience a slowed metabolism when your estrogen levels drop, which can cause your body to store fat around your belly.
Appetite and food choice
Estrogen helps regulate hunger hormones, including leptin (which signals satiety) and ghrelin (which causes hunger). When estrogen levels drop, an imbalance of these hunger hormones can occur. You may experience stronger hunger signals and cravings for high-calorie foods. When this 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.
The 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
As you age, your body naturally becomes less sensitive to insulin, the hormone that regulates blood sugar. Lower estrogen levels also decrease adiponectin, a hormone that helps control blood sugar and burn fat. This combination can make it harder for your body to manage blood sugar, which often leads to more fat storage.
Loss of muscle mass
Muscle burns more calories than fat. However, as you age, your muscle mass naturally decreases. Less muscle mass means you can burn fewer calories at rest, making it easier to convert extra calories into body fat and gain weight.
Sedentary lifestyle
Balancing aspects of life such as work, family and care in the 40s and 50s often leaves little time for self-care. Mental fatigue can make rest more appealing than exercise. As a result, some people replace physical activity with sedentary behavior 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 deal with stress by watching TV or scrolling through devices. Diet and inactivity caused by stress can make weight management more challenging.
Sleep disorders
Perimenopause can lead to insomnia and night sweats that disrupt your sleep. Poor sleep and fatigue can increase your desire 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
Medical conditions that can occur along with perimenopause can sometimes affect your weight. For example, depression can change how much you eat and how active you are. Certain antidepressants, which your healthcare provider may prescribe for mood swings and other symptoms, can also lead to weight gain.
Gaining weight during perimenopause isn’t just about looks. It also carries an increased risk of health problems such as:
- Worsened hot flashes
- Increased risk of urinary incontinence, or difficulty “holding in” 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 diseases
- Metabolic syndrome (high blood pressure, high blood sugar, and high cholesterol)
Managing your weight during perimenopause can be complicated due to factors both within and outside of your control. A personalized approach focuses on lifestyle strategies and may include medical treatment.
Stick to a well-balanced diet
A well-balanced diet with the following nutrient-dense foods can help give you energy, manage cravings, and balance your blood sugar:
- 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, walnuts and chia seeds
Many people thrive on 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 make sure you’re getting enough healthy calories during meal times.
One approach to making sure you’re eating the right parts of your well-balanced diet is to follow the pie plate method. To do this, divide the board into three parts. Fill half of the plate with vegetables, a quarter with lean proteins, and the other quarter with a mixture of fruits, legumes and healthy fats.
Stay hydrated
Helping 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 per day, or more if you’re active.
Avoid sugary drinks, which add empty calories and can raise blood sugar. Instead, choose low-calorie options like herbal teas, sparkling water, or water with lemon or cucumber if you prefer something other than plain water.
Be active
Staying physically active can help burn extra calories, build muscle, and relax your mind, which can limit how weight gain affects you.
Here are recommendations for weekly exercise for adults:
- 150 minutes of moderate aerobic activity, starting with light walks and gradually adding options such as cycling, dancing, running or swimming
- Two to three sessions of weight lifting or resistance exercise
- Two to three sessions of balance and flexibility, such as 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 track your activity and see your progress.
Consider taking supplements
Some supplements can help manage weight during perimenopause. Other supplements can help maintain hormonal balance, improve 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 can help reduce mood swings and hot flashes, while St. John’s wort can help elevate mood and improve sex drive.
A healthcare professional such as a nutritionist can talk to you about different supplements for perimenopause, including which ones may be safe and beneficial for you.
Manage stress
Keeping stress under control 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 doing 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 the bedroom comfortable and cool, and following a regular sleep schedule with a calming bedtime routine.
Some medications can help prevent or manage perimenopausal weight gain. If you are 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 drug can help reduce a number of menopausal symptoms such as hot flashes and vaginal dryness, but the evidence for the effect of HRT on weight gain or loss is mixed. HRT may also not be recommended for everyone, such as those with a history of breast cancer.
Other medicines
Non-hormonal weight loss medications can help control weight by helping to block fat absorption, control appetite, or improve blood sugar. Some of these medications include:
- Ali, Xenikal (orlistat)
- Contrave (bupropion and naltrexone)
- Ozempic, Vegovi (semaglutide)
- Victoza, Saxenda (liraglutide)
Consider talking to your doctor if a healthy diet or exercise isn’t helping you maintain your weight. A health care professional can also help if you have other symptoms of perimenopause, such as insomnia, fatigue, mood changes, or swelling. They can check for other health conditions, such as those affecting your hormones or thyroid gland, 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. Hormonal changes, slower metabolism, stress and quality of sleep are factors that contribute to weight gain in perimenopause. You can support your body during this menopause transition by eating healthy foods, staying active, managing stress and prioritizing sleep. If you want additional support, a healthcare professional can offer personalized guidance and discuss options such as supplements, hormone therapy or non-hormonal medications to help you feel your best during this transition.