Why perimenopause weight gain happens - and what you can do about it
Why perimenopause weight gain happens - and what you can do about it
Perimenopause weight gain is common but not inevitable. Learn why hormonal changes affect your metabolism and discover proven strategies - from protein and strength training to HRT and stress management - to feel strong and energised again.
Oct 2, 2025
Struggling with weight gain during perimenopause? You’re not alone. As hormones shift, your body changes - and old weight loss strategies may no longer work. But here’s the good news: it has nothing to do with you or your willpower. On average, both men and women gain around 1.5 kg per year as they age, while also losing about 1 kg of muscle mass (bad news, we know). During perimenopause, this process can feel even more noticeable.
Luckily, with the right insights, you can support your metabolism, protect your muscle mass, and feel strong in your body again. Let’s dive into why weight gain happens in perimenopause, and what really helps.
Table of contents
Why do you gain weight in perimenopause?
Why old diets and workouts don’t work anymore
What actually works against perimenopause weight gain
Considering hormone replacement therapy (HRT)
What about GLP-1 medications?
Final thoughts: shifting the focus from weight to wellbeing
Why do you gain weight in perimenopause?
Many women notice weight creeping up in their 40s, especially around the belly. Again, it doesn’t mean you’re doing anything “wrong” - it’s linked to hormonal changes.
Oestrogen and progesterone, the two main female hormones, play a big role in body composition. When oestrogen drops, fat storage tends to shift towards the abdomen. Progesterone decline can also trigger water retention and bloating, which makes you feel heavier.
Add in sleep disturbances (another common perimenopause symptom), higher cortisol levels from stress, and a naturally slowing metabolism - and the scales start tipping upward. By around age 40, women also begin to lose muscle mass unless they actively work to maintain it. Less muscle means fewer calories burned at rest, which makes it easier to fall into a calorie surplus.
💡 Quick reminder: Weight gain is not specific to perimenopause. Ageing in general changes metabolism, but hormones make the process more pronounced for women.
Why old diets and workouts don’t work anymore
If you’ve tried eating less or running more without results, you’re not failing - your body has simply changed.
Traditional approaches like skipping meals, low-fat diets, or endless cardio can backfire during perimenopause. They often raise cortisol, worsen insulin resistance, and don’t prioritise muscle health. Instead of burning fat, your body ends up storing more of it - especially around the middle.
What actually works against perimenopause weight gain
It’s important to know that weight gain during perimenopause isn’t inevitable. But the strategies that work best now may be a bit different from what worked in your 20s.
Focus on protein
Protein builds and protects lean muscle, which is crucial for metabolism. It also keeps you fuller for longer and helps regulate blood sugar.
👉 Aim for 20-30 grams per meal - think eggs, Greek yogurt, legumes, tofu, fish, or meat.
Eat enough fibre
Fibre supports digestion, balances blood sugar, and helps clear excess oestrogen from the body.
👉 Target 25-35 grams per day through veggies, beans, whole grains, and seeds.
Prioritise strength training
Muscle is your metabolic engine. Lifting weights, using resistance bands, or even bodyweight exercises helps prevent age-related muscle loss, improves insulin sensitivity, and supports hormone balance.
👉 Try for 2-3 strength sessions per week, alongside daily movement like walking or stretching.
Sleep and stress management
Poor sleep and high stress increase cortisol and insulin resistance – two big drivers of midlife weight gain. Improving sleep quality and reducing stress aren’t just “nice to have”; they’re essential tools for weight balance.
🫶 Gentle reminder: Sleep is one of the first things disrupted during perimenopause. If this feels frustrating, you’re not alone - and it’s worth exploring strategies or support options to help.
Considering hormone replacement therapy (HRT)?
HRT isn’t a weight loss tool, but for some women, it can support metabolic health indirectly. By easing hot flushes, improving sleep, and stabilising mood, HRT may make it easier to maintain healthy habits. Some studies also suggest it can reduce visceral fat and protect muscle mass.
But it’s not for everyone. Always talk to a knowledgeable healthcare provider to weigh up the potential benefits and risks for your individual situation.
What about GLP-1 medications?
GLP-1 receptor agonists, such as semaglutide (Ozempic) or liraglutide (Saxenda), are medications originally designed for diabetes but now widely used for weight management. They work by regulating appetite and blood sugar.
For some, they can be helpful - especially in cases of obesity, insulin resistance, or PCOS. But they’re not a first-line solution for perimenopause-related weight changes, and they come with side effects. Importantly, GLP-1 drugs can reduce muscle mass, which is the opposite of what you want in midlife.
If you’re curious about them, discuss it with your doctor as part of a broader plan that includes nutrition, exercise, and hormone support.
Final thoughts
Instead of chasing the body you had at 20, think about what helps you feel energised, confident, and comfortable today. Perimenopause is an invitation to care for yourself more deeply - to fuel your body, protect your strength, and honour your changing needs.
Plenty of women find they feel fitter and more grounded at 50 than they ever did at 30. It takes self-compassion and a fresh approach, but it’s absolutely possible.
Key takeaways
Hormonal changes in perimenopause (especially oestrogen and progesterone shifts) drive changes in fat distribution and metabolism.
Old dieting strategies often backfire - strength, protein, fibre, sleep, and stress balance are more effective tools now.
HRT can indirectly support weight and metabolic health, but it’s not suitable for everyone.
GLP-1 medications may help in specific cases, but lifestyle and hormone care remain the foundation.
The real goal isn’t just weight loss - it’s feeling strong, energised, and at home in your body.
References:
Janssen, I., Heymsfield, S. B., Wang, Z. M., & Ross, R. (2000). Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. Journal of Applied Physiology, 89(1), 81–88. https://doi.org/10.1152/jappl.2000.89.1.81
Ko, S. H., Moon, S. D., Park, H. S., & Kim, J. (2024). Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes, Obesity and Metabolism, 26(Suppl. 4), 16–27. https://doi.org/10.1111/dom.15728
Lovejoy, J. C., Champagne, C. M., de Jonge, L., Xie, H., & Smith, S. R. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity, 32(6), 949–958. https://doi.org/10.1038/sj.ijo.0803774
Mikdachi, H., & Dunsmoor-Su, R. (2025). GLP-1 receptor agonists for weight loss for perimenopausal and postmenopausal women: Current evidence. Climacteric. Advance online publication. https://pubmed.ncbi.nlm.nih.gov/39970049/
Palacios, S. (2023). Obesity and menopause. Obesity Medicine, 34, 101759. https://doi.org/10.1016/j.obmed.2023.101759
Platt, O., Bateman, J., & Bakour, S. (2025). Impact of menopause hormone therapy, exercise, and their combination on bone mineral density and mental wellbeing in menopausal women: A scoping review. Frontiers in Reproductive Health, 7, 1542746. https://doi.org/10.3389/frph.2025.1542746
Struggling with weight gain during perimenopause? You’re not alone. As hormones shift, your body changes - and old weight loss strategies may no longer work. But here’s the good news: it has nothing to do with you or your willpower. On average, both men and women gain around 1.5 kg per year as they age, while also losing about 1 kg of muscle mass (bad news, we know). During perimenopause, this process can feel even more noticeable.
Luckily, with the right insights, you can support your metabolism, protect your muscle mass, and feel strong in your body again. Let’s dive into why weight gain happens in perimenopause, and what really helps.
Table of contents
Why do you gain weight in perimenopause?
Why old diets and workouts don’t work anymore
What actually works against perimenopause weight gain
Considering hormone replacement therapy (HRT)
What about GLP-1 medications?
Final thoughts: shifting the focus from weight to wellbeing
Why do you gain weight in perimenopause?
Many women notice weight creeping up in their 40s, especially around the belly. Again, it doesn’t mean you’re doing anything “wrong” - it’s linked to hormonal changes.
Oestrogen and progesterone, the two main female hormones, play a big role in body composition. When oestrogen drops, fat storage tends to shift towards the abdomen. Progesterone decline can also trigger water retention and bloating, which makes you feel heavier.
Add in sleep disturbances (another common perimenopause symptom), higher cortisol levels from stress, and a naturally slowing metabolism - and the scales start tipping upward. By around age 40, women also begin to lose muscle mass unless they actively work to maintain it. Less muscle means fewer calories burned at rest, which makes it easier to fall into a calorie surplus.
💡 Quick reminder: Weight gain is not specific to perimenopause. Ageing in general changes metabolism, but hormones make the process more pronounced for women.
Why old diets and workouts don’t work anymore
If you’ve tried eating less or running more without results, you’re not failing - your body has simply changed.
Traditional approaches like skipping meals, low-fat diets, or endless cardio can backfire during perimenopause. They often raise cortisol, worsen insulin resistance, and don’t prioritise muscle health. Instead of burning fat, your body ends up storing more of it - especially around the middle.
What actually works against perimenopause weight gain
It’s important to know that weight gain during perimenopause isn’t inevitable. But the strategies that work best now may be a bit different from what worked in your 20s.
Focus on protein
Protein builds and protects lean muscle, which is crucial for metabolism. It also keeps you fuller for longer and helps regulate blood sugar.
👉 Aim for 20-30 grams per meal - think eggs, Greek yogurt, legumes, tofu, fish, or meat.
Eat enough fibre
Fibre supports digestion, balances blood sugar, and helps clear excess oestrogen from the body.
👉 Target 25-35 grams per day through veggies, beans, whole grains, and seeds.
Prioritise strength training
Muscle is your metabolic engine. Lifting weights, using resistance bands, or even bodyweight exercises helps prevent age-related muscle loss, improves insulin sensitivity, and supports hormone balance.
👉 Try for 2-3 strength sessions per week, alongside daily movement like walking or stretching.
Sleep and stress management
Poor sleep and high stress increase cortisol and insulin resistance – two big drivers of midlife weight gain. Improving sleep quality and reducing stress aren’t just “nice to have”; they’re essential tools for weight balance.
🫶 Gentle reminder: Sleep is one of the first things disrupted during perimenopause. If this feels frustrating, you’re not alone - and it’s worth exploring strategies or support options to help.
Considering hormone replacement therapy (HRT)?
HRT isn’t a weight loss tool, but for some women, it can support metabolic health indirectly. By easing hot flushes, improving sleep, and stabilising mood, HRT may make it easier to maintain healthy habits. Some studies also suggest it can reduce visceral fat and protect muscle mass.
But it’s not for everyone. Always talk to a knowledgeable healthcare provider to weigh up the potential benefits and risks for your individual situation.
What about GLP-1 medications?
GLP-1 receptor agonists, such as semaglutide (Ozempic) or liraglutide (Saxenda), are medications originally designed for diabetes but now widely used for weight management. They work by regulating appetite and blood sugar.
For some, they can be helpful - especially in cases of obesity, insulin resistance, or PCOS. But they’re not a first-line solution for perimenopause-related weight changes, and they come with side effects. Importantly, GLP-1 drugs can reduce muscle mass, which is the opposite of what you want in midlife.
If you’re curious about them, discuss it with your doctor as part of a broader plan that includes nutrition, exercise, and hormone support.
Final thoughts
Instead of chasing the body you had at 20, think about what helps you feel energised, confident, and comfortable today. Perimenopause is an invitation to care for yourself more deeply - to fuel your body, protect your strength, and honour your changing needs.
Plenty of women find they feel fitter and more grounded at 50 than they ever did at 30. It takes self-compassion and a fresh approach, but it’s absolutely possible.
Key takeaways
Hormonal changes in perimenopause (especially oestrogen and progesterone shifts) drive changes in fat distribution and metabolism.
Old dieting strategies often backfire - strength, protein, fibre, sleep, and stress balance are more effective tools now.
HRT can indirectly support weight and metabolic health, but it’s not suitable for everyone.
GLP-1 medications may help in specific cases, but lifestyle and hormone care remain the foundation.
The real goal isn’t just weight loss - it’s feeling strong, energised, and at home in your body.
References:
Janssen, I., Heymsfield, S. B., Wang, Z. M., & Ross, R. (2000). Skeletal muscle mass and distribution in 468 men and women aged 18–88 yr. Journal of Applied Physiology, 89(1), 81–88. https://doi.org/10.1152/jappl.2000.89.1.81
Ko, S. H., Moon, S. D., Park, H. S., & Kim, J. (2024). Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes, Obesity and Metabolism, 26(Suppl. 4), 16–27. https://doi.org/10.1111/dom.15728
Lovejoy, J. C., Champagne, C. M., de Jonge, L., Xie, H., & Smith, S. R. (2008). Increased visceral fat and decreased energy expenditure during the menopausal transition. International Journal of Obesity, 32(6), 949–958. https://doi.org/10.1038/sj.ijo.0803774
Mikdachi, H., & Dunsmoor-Su, R. (2025). GLP-1 receptor agonists for weight loss for perimenopausal and postmenopausal women: Current evidence. Climacteric. Advance online publication. https://pubmed.ncbi.nlm.nih.gov/39970049/
Palacios, S. (2023). Obesity and menopause. Obesity Medicine, 34, 101759. https://doi.org/10.1016/j.obmed.2023.101759
Platt, O., Bateman, J., & Bakour, S. (2025). Impact of menopause hormone therapy, exercise, and their combination on bone mineral density and mental wellbeing in menopausal women: A scoping review. Frontiers in Reproductive Health, 7, 1542746. https://doi.org/10.3389/frph.2025.1542746
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