What’s Up with the Perimenopause Weight Gain? Managing Metabolic Change in the Menopause Transition

Perimenopausal women frequently describe weight gain as one of the most common and frustrating symptoms of the menopause transition. If this sounds like you, you’re in the right place. 

Let’s demystify the effects of perimenopause on body weight, and most importantly, learn what you can do to manage them.

How does perimenopausal weight gain happen?

The metabolic changes of perimenopause are more than just “putting on a few extra pounds." The average person gains 5-7 pounds during the menopause transition, but some people will gain far more. 

Five to seven pounds may not sound like much, but here’s the kicker: most of that extra weight comes in the form of increased fat, particularly around the abdomen. When fat accumulates in this region, it increases the risk of heart disease.

Why belly fat matters

Even folks who don’t gain much weight according to their bathroom scales need to be aware of these changes. During the menopause transition, most female bodies lose muscle mass and replace that weight with fat cells.

By the time the average woman becomes postmenopausal, 15-20% of her total body fat will be visceral adipose tissue—a substantial increase from the 5-8% it was before menopause.

Visceral adipose is a particularly troublesome form of abdominal fat that deposits around the internal organs. It’s associated with increased risk of cardiovascular disease, such as hardening of the arteries. Another reason why weight gain during the menopause transition really does matter!

Deep breaths, don’t panic. 

These changes in weight and fat percentages may sound daunting, but there’s a lot you can do to reduce your risks and maintain good health in perimenopause. Let’s consider what’s going on behind the scenes to drive these changes.

What causes weight gain in perimenopause?

First things first: don’t beat yourself up over menopausal weight fluctuations. It helps to understand what causes weight gain during perimenopause (and no, it’s not just a “lack of willpower”).

Contrary to popular belief, a “slower metabolism” isn’t an inevitable part of the aging process. In fact, a given human body burns calories at roughly the same rate from the age of 20 to 60 (assuming body size stays relatively consistent).

So if your metabolism doesn’t really slow down with every birthday… why does it feel so much harder to maintain or lose weight as you age?

There are many factors beyond baseline metabolism that can contribute to weight gain over time. While there isn’t space here to list them all, it’s worth considering some common variables. 

For example, reduced physical activity—a habit change common to many women in this life stage—can lead to weight gain.

Hormonal changes can also cause you to gain weight. As you enter the menopause transition, your levels of circulating estrogen hormones, particularly estradiol, decrease dramatically. At the same time, levels of follicle-stimulating hormone (FSH) increase.

This combination of hormonal changes is associated with a positive energy balance: basically, your body is burning fewer calories while simultaneously signaling you to eat more food. It’s a recipe tailor-made for weight gain. 

How does perimenopausal weight gain affect other symptoms? 

We don’t need to tell you that excessive weight gain isn’t great for your health: women and femme folks are already inundated with more than enough messaging to this effect (much of which is just body-shaming disguised as “wellness advice”). 

However, excess weight does increase the risk of cardiovascular disease and other types of chronic disease. It’s also important to appreciate how weight changes interact with other menopausal symptoms.

Heart and metabolic health 

Increased fat mass, particularly visceral adipose, increases your risk of cardiovascular problems, such as heart disease. It also elevates metabolic risk—the likelihood of developing problems such as insulin resistance and type II diabetes.

Some people carrying excess weight develop metabolic syndrome, a cluster of co-existing metabolic changes consisting of abdominal obesity, high blood pressure, elevated blood sugar, and high cholesterol. 

Peri- and postmenopausal people with metabolic syndrome experience the transition and its symptoms differently from those without metabolic syndrome. 

Changes in sleep patterns

Metabolic syndrome has a clear negative impact on sleep, which is already a problem for many during perimenopause. Sleep studies demonstrate that perimenopausal women with metabolic syndrome experience less efficient sleep than their peers without the syndrome.

Hot flashes and night sweats

Increased visceral adipose is also associated with more severe hot flashes and night sweats. In addition to being annoying and disruptive, these symptoms negatively affect sleep quality. It’s all connected!

What can you do to combat perimenopausal weight gain? 

Enough doom and gloom: time to talk about what you can do to work with your body and prevent the negative effects of weight gain during perimenopause.

Physical activity: preserving healthy habits

As it was earlier in life, exercise is still good for you during and after the menopause transition. However, many people become less physically active during this life stage. Staying active as you age means beating the odds.

The American College of Sports Medicine recommends that all adults participate in a combination of aerobic exercise and muscle-strengthening activities. Here’s a breakdown of the current guidelines:

• Aerobic exercise:

  • 2.5 hours of moderate intensity physical activity: this is exercise in which you can say a whole sentence but can’t sing.

  • 75 minutes of vigorous intensity activity like running: you can only say a couple of words at a time.

• Resistance training: 

  • At least 2 days per week, perform strengthening of all major muscle groups. Aim to do these workouts on days that aren’t back-to-back so your muscles can recover.

Multiyear studies such as the Women’s Healthy Lifestyle Project Women’s Healthy Lifestyle Project have proven the value of adding regular physical activity to a weight loss program: this allows perimenopausal people to lose fat without losing muscle or bone density.

Two important details to remember here:

• These studies added exercise to healthy dietary changes—you need both pieces of the puzzle to maintain a healthy body composition.

• Regular exercise is crucial, but it doesn’t completely prevent all changes in body composition that occur during perimenopause. Your 55-year-old body cannot and should not look just like your 25-year-old body!

A healthy diet: more than cutting calories

Nutrition in perimenopause deserves a conversation all its own, but here’s the TL;DR: 

• Most major studies of midlife weight management investigate the effect of calorie reduction. Because the perimenopausal body is burning less energy, it doesn’t need as many daily calories to maintain energy balance.

• A plant-based diet has promise: a randomized clinical trial of 80+ postmenopausal women found that those on a plant-based diet lost significantly more weight than those eating animal products. Bonus: the plant-based eaters also experienced fewer severe hot flashes!

For many women in perimenopause, focusing on a healthy diet is one of several lifestyle changes crucial to maintaining a healthy weight. For more on nutrition during the menopause transition, check out our full article on the topic here.

The role of weight tracking

Let’s be clear: logging your weight with Amissa is meant to empower you with information, not shame you with ever-fluctuating numbers. The last thing you need is one more thing to stress about!

Tracking weight with Amissa will help you see what’s working and what’s not, and adjust your routines accordingly. Whether you’re focused on losing weight or maintaining a healthy weight, tracking is one tool to help you improve your overall health in perimenopause. Use the numbers to inform your choices, but don’t let them rule your life.

Questions to ask your doctor

Asking about weight gain doesn’t make you vain: it means you’re monitoring all aspects of your health during the menopause transition. Here are some ideas to start the conversation with your healthcare provider:

• I’ve gained weight over the past few months, but I haven’t changed my eating habits or my exercise routine. Could this be connected to perimenopause?

• As I age, I’d like to make sure I maintain my weight without losing muscle mass or bone density. Knowing that I’m postmenopausal, do you have suggestions to help me achieve this?

DISCLAIMER

This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.