Why You’re Gaining Weight in Perimenopause (And 5 Things to do About it)

If you’re in your 40’s and thinking, “I’m pretty much eating the same as I always have, but suddenly, my jeans won’t button,”, you’re not imagining it.

But, before you channel your inner 20-year old and cut back to 1200 calories per day and cut out all carbs, I want you to hear this:

Your body is changing… (IKYK) But your metabolism isn’t broken. It doesn’t need to be fixed. But it does need to be protected.

You’re Not Imagining the Change

Something I hear over and over in the 20 years of helping women protect their metabolism and lose weight is, “I haven’t changed anything, but cutting out junk food doesn’t help me lose weight anymore!”

We can blame menopause, but midlife weight gain isn’t caused by menopause alone.

Changes in physical activity, body composition, hormonal changes, sleep, appetite, our eating environment, and social environment can all play a role.

The biggest change being the fact that we’re losing muscle mass every decade, starting in our 30’s and 40’s.

At first, the loss is slow, at about 1-2% each year.

Then, the rate increases to 3% per year by age 60.

But, on average, if you’re not strength training, women can expect to lose 4-6 pounds of muscle per decade.

And, if you’re not seeing the number on the scale decrease, then you’re replacing muscle mass with fat. – Not what you want, I know.

Fast-twitch fibers, which provide bursts of power, are lost at a greater rate than slow-twitch fibers, which means you’re not only growing weaker but also getting slower.

Research on women during midlife shows that body composition changes during this period, including an increase in body fat and a decrease in lean mass. There’s also a tendency for fat to become more centrally distributed around the abdomen. So if you feel like your body has changed—even though your routine hasn’t changed dramatically—you aren’t imagining it.

Your Metabolism isn’t Suddenly Broken

Your metabolism didn’t change overnight. It was a gradual physiological process – and changes in your own habits or environment probably changed a bit, too.

Not only does maintaining muscle become more challenging, but physical activity decreases and we don’t even realize it.

Then there are the changes in hormones that are associated with changes in body composition and fat distribution.

Muscle matters because maintaining muscle supports strength, physical function, glucose metabolism, and healthy aging. Resistance training is one of the most effective tools we have for preserving and improving muscle strength and mass as we age.

So instead of asking:

“How can I eat as little as possible to lose weight?”

I want you to start asking:

“How can I protect my muscle and metabolic health as I age?” (And this can help lead to weight loss)

What Should You Actually Do?

As an expert dietitian in weight loss for over 20 years, I want you to focus on these 5 things.

1. Make protein a priority

I know, protein is everywhere, but it’s highlighted for good reason. The first thing I do with my clients is assess their protein intake – nto just amount, but also source and timing.

Think Greek yogurt, cottage cheese, fish, chicken, legumes, tofu. First.

Adequate protein, combined with resistance exercise, supports the maintenance of muscle as we age.

2. Increase fiber

Most Americans do not reach the 25-35 grams per day of recommended fiber.

Fiber is especially important when you’re focusing on heart health (which many of my perimenopause and menopause patients are focusing on), or if you’re on a GLP-1…or if you’d like to improve your gut health.

3. Strength train

Strength training needs to be a part of your plan. Keep your cardio, but you should add resistance training if you’re able to do so safely. Already incorporating weights in your workout routine? It might be time to add some metabolic resistance training and compound moves.

4. Don’t respond to weight gain by restricting your diet further

This one has some nuance because I individualize all my recommendations and, sometimes, there are ‘extras’ that are preventing you from losing weight.

But restricting calories more than you need will leave you exhausted and thinking about food all day. This will further drive your metabolism in the dumps and you’ll think you don’t have any willpower. (But, really, you’re just hungry.) And then all those counterregulatory hormones will cause you to crave all the goodies and you’ll give in, which starts the cycle all over again.

You also have to have a good understanding of why you eat the way you do. It’s only then that you can change your eating behaviors. Are you eating out of stress? Boredom? Fun? Hunger? Those all require different strategies to ensure you’re eating mindfully.

5. Pay attention to your environment and routines

In my group program, Ditch the Diets; a Metabolism Protection Program, I ask the women to draft out a whole day of exactly what they do and when they’re eating.

When you have a 3pm snack, are you sharing it with your child after school? Are you having cookies just because they’re in the office kitchen when you grab your 10am coffee? Is nighttime eating your weakness? (If so, this article on crushing nighttime snacking is for you!)

Not only are hormones, like cortisol, possibly at play here, but it’s likely repeated behaviors and habits.

We need to create an environment that makes healthy eating easier.

Let’s Change the Goal

And this brings me to what I think is one of the most important shifts women can make in midlife.

Yes, you may want to lose weight. There’s nothing wrong with wanting to manage your weight.

But I don’t want weight to be the only measure of your health. I want you to think about the bigger picture.

What is your strength like? Are you maintaining muscle? What are your blood pressure and cholesterol numbers doing?

How is your blood sugar? Are you getting enough fiber? Are you moving your body regularly? How is your sleep?

And perhaps most importantly:

What is your relationship with food?

Because if you lose 10 pounds but spend every waking minute thinking about food, feeling guilty about what you ate, and planning your next diet, I’m not sure we’ve accomplished what we actually wanted.

I want women to be able to manage their weight while also protecting their metabolic and cardiovascular health and having a healthy relationship with food.

And, yes, my friend…you can do it.

Metabolic Protection

Midlife isn’t the time to start fighting your body. You’ve probably already been doing that most of you life.

This is a time when you need to understand what’s changing and adjust the way you care for yourself accordingly. I want you to use your changing hormones in a way that works for you, not fight them.

So, start with the basics: Protein, fiber, strength training, regular movement, sleep and recovery.

Let’s reframe the way we treat our bodies, look at our bodies, and the way we talk about our bodies.

Accept your body. Respect your body. Then, you can love your body.

When to Contact Your Doctor About Weight Gain in Perimenopause

Not every change in weight or body composition during perimenopause is a cause for concern. However, new, rapid, or unexplained weight gain deserves a closer look, particularly if it is accompanied by other symptoms.

Consider talking with your healthcare provider if:

• Your weight is increasing quickly or unexpectedly, despite no significant changes in your eating or activity habits.
• You have significant swelling or fluid retention, particularly in your legs, ankles, or abdomen.
• Weight gain is accompanied by shortness of breath, chest pain, or unusual fatigue. These symptoms warrant prompt medical attention.
• You have symptoms that could suggest a thyroid problem, such as persistent fatigue, feeling unusually cold, constipation, dry skin, or changes in your hair.
• You are experiencing very heavy, prolonged, or unusual bleeding during perimenopause.
• You have significant changes in blood pressure, blood glucose, or cholesterol, or you have risk factors for cardiovascular disease.
• You feel that changes in your weight, appetite, sleep, mood, or menstrual cycle are significantly affecting your quality of life.

It’s also worth remembering that perimenopause isn’t automatically the explanation for every change that happens in your 40s. Medications, thyroid disorders, sleep problems, changes in activity, insulin resistance, and other health conditions can contribute to changes in weight and body composition.

Your healthcare provider can help determine whether additional evaluation or blood work is appropriate—and you don’t have to figure that out by yourself.

References:

Hurtado MD, Saadedine M, Kapoor E, Shufelt CL, Faubion SS. Weight Gain in Midlife Women. Current Obesity Reports. 2024;13(2):352-363. doi:10.1007/s13679-024-00555-2.
Correia JC, Mavromati M, Pataky Z. Weight gain during menopause: physiology and practical implications. Rev Med Suisse. 2024;20(866):580-583. doi:10.53738/REVMED.2024.20.866.580.
El Khoudary SR, et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American US Department of Health and Human Services.Physical Activity Guidelines for Americans, 2nd edition.
Palacios S, Chedraui P, Sánchez-Borrego R, Coronado P, Nappi RE. Obesity and menopause. Gynecological Endocrinology. 2024;40(1):2312885. doi:10.1080/09513590.2024.2312885.