The menopausal transition, often referred to as perimenopause, is the period leading up to menopause. The mid- to late-40s is the average age for most women to begin experiencing the signs of perimenopause, a transition that often brings significant changes in your body, mind and life.
Many common menopause symptoms, such as hot flashes or mood changes, happen during perimenopause as hormone levels shift. Menstrual cycles also change. Periods may become heavier or lighter, and menstrual bleeding may come and go at different times of the year. Pregnancy is also much less likely to happen during this time.
Weight gain is another concerning issue that spans the menopausal transition, which can be a challenge to manage. It is unclear whether weight gain is a direct result of menopause, or due to normal aging and lifestyle changes. Regardless of the cause, increased body weight and body fat can lead to many detrimental health conditions such as obesity, Type 2 diabetes, high blood pressure, osteoporosis and osteoarthritis, several types of cancers, and premature death.
Here are five things you need to know to address weight gain during perimenopause and post-menopause.
1. Metabolic Changes During Menopause Affect More Than Weight
The ovaries naturally produce both estrogen and testosterone. During perimenopause, your ovaries will begin to produce less estrogen while testosterone levels typically remain the same for several years. This hormonal imbalance can cause many changes in your metabolism, or how your body converts food into energy. Weight changes may be the most visible sign of this shift, but a lot more is happening in the body during this time.
In addition to weight gain, hormonal changes may cause:
- Decrease in lean body mass
- Increased insulin resistance, raising the risk for diabetes or prediabetes
- Higher levels of LDL cholesterol, sometimes called bad cholesterol, and lower levels of HDL, often called good cholesterol
Hormonal changes also cause new signals related to hunger and fullness, which may lead to overeating and weight gain. Awareness of these changes can help you be more mindful of hunger signals and eating patterns during perimenopause. Understanding what’s happening in your body can also help you to be kinder to yourself as you go through the transition.
2. Weight Redistribution Matters
Adding extra pounds isn’t the only weight-related menopausal concern. During perimenopause, fat is redistributed in the body. Even if you’ve always been more likely to carry weight in your bottom, hips or thighs, during perimenopause, fat will begin to move to your belly. This is also caused by those dropping estrogen and stable testosterone levels.
Adipose tissue, or fat, plays an essential role in metabolism and hormone production and regulation. It also comes in two forms:
- Subcutaneous adipose tissue (SAT), which sits just below the skin and may collect in many body parts.
- Visceral adipose tissue (VAT), which accumulates deep inside the body around organs in the abdomen.
Both SAT and VAT can be harmful in excessive amounts. However, in people with a healthy weight, SAT actually lowers the risk of Type 2 diabetes and other metabolic conditions. The body also needs some VAT to stay healthy, but even a moderate increase can lead to inflammation and raise the risk of diabetes, other metabolic disorders and heart and vascular issues.
Hormonal changes during perimenopause increase your VAT levels. Maintaining a healthy lifestyle—eating a balanced diet, exercising regularly and getting enough sleep—can help keep VAT levels down and decrease the risk of disease.
3. Your Stress Level Can Impact Your Weight During Perimenopause and Menopause
Responding to changes in your body during perimenopause can be challenging enough. Additionally, many women in their 40s and 50s also encounter other stressful challenges, including issues:
- Age-related health conditions
- Career or retirement planning
- Caring for aging parents
- Raising children or helping teens transition to adulthood
Living with a high amount of stress can affect your body’s chemistry and how you feel and act. High levels of stress may lead to:
- Brain fog, or difficulty with thinking, planning and problem solving
- Emotional eating
- Increased production of stress hormones, such as cortisol which can cause excess belly fat
These feelings, behaviors and chemical changes can all affect weight gain. For example, it may be harder to plan meals or turn down dessert. This may make it easier to let negative thoughts take up too much space if you feel bad about your lack of planning or food choices.
This cycle can lead to chronically high levels of stress hormones, making weight gain more likely. However, you can break the cycle. Awareness of your stress level and learning new ways to manage it are the first steps.
There are several excellent options for managing stress, including:
- Expressing yourself through art or music
- Getting regular exercise
- Getting enough sleep
- Participating in a hobby
- Spending time with friends
- Starting a mindfulness practice
- Ask for help when you need it
Feeling confident in your ability to regulate your emotions and actions may also help you lose weight or maintain a healthy weight during perimenopause.
4. How Well You Sleep May Affect Your Weight
Both stress levels and natural changes during perimenopause can affect your sleep. Hot flashes at night, also called night sweats, are a common symptom of perimenopause. Difficulty falling asleep or staying asleep can also be caused by changing hormone levels.
Poor sleeping habits have been linked to:
- Consuming a less nutritious diet
- Eating more
- Increased risk of cardiovascular disease
Being overweight or obese may also contribute to poor sleep quality. So, maintaining a healthy weight before and during menopause can be one way to help improve your quality of sleep.
To help yourself get a good night’s sleep, you can also:
- Follow a consistent sleep routine
- Sleep in layers that can be removed one by one during a hot flash
- Maintain an environment that promotes sleep
- Use a fan in your bedroom
- Turn off screens before bed
- Journal before bed to help organize your thoughts so they don’t keep you awake at night
- Try relaxation techniques that can promote sleep
- Avoid stimulants, such as caffeine and nicotine, and excessive alcohol intake
- Talk to your doctor about obtaining a sleep study to make sure you do not have a condition called “sleep apnea” which can impair normal sleep function
5. Weight Gain During Perimenopause Isn’t Inevitable
The best way to prevent weight gain during perimenopause is to develop healthy habits before it happens, but it’s never too late to improve your health. No matter where you are in the menopausal transition, a healthy lifestyle can help you prevent weight gain and increase your quality of life.
Here are a few ideas to get you started:
- Keep a journal or other record of your progress.
- Meet with a dietitian to learn tips for preparing quick, nutritious meals.
- Practice mindful eating.
- Eat a diet rich in vegetables and fruits, whole grains, and limited trans fats.
- Participate in weight-bearing exercises a few times a week.
- Aim for 150 minutes a week of moderate exercise for overall health. However, for weight loss, 300 minutes a week of moderate aerobic exercise may be more effective.
- Schedule a walk after dinner each day.
- For extra motivation, exercise with a friend.
Remember that developing healthy habits is a practice that gets easier over time. Be gentle with yourself and lean on friends, family members or a therapist for support. Be proactive in managing your stress and set time aside for activities you enjoy. The more active you are, the better you will feel at all stages of life.
More to Read
- Your Top Priority During Perimenopause? Your Health
- Strength Training for Women in Your 20s, 30s and Beyond
- How Exercise Helps Breast Cancer Prevention and Recovery
- Calcium Supplements for Osteoporosis
Medically reviewed by Mokerrum Fatima Malik, MD FACOG
