Perimenopause & Weight Gain: Myths & Strategies for Maintaining a Healthy Weight

Written and edited by Sarah Bonza MD, MPH, FAAFP, DipABLM, NBC-HWC

Woman in perimenopause healthy eating

As a board-certified family physician and lifestyle medicine physician, I frequently encounter women dealing with stubborn weight gain — a concern that becomes particularly pronounced during perimenopause. The transition into perimenopause brings with it unique challenges, primarily due to fluctuating hormone levels and metabolic shifts that many are unprepared to manage. Through my practice, I have developed a comprehensive approach combining FDA-approved hormone treatments with tailored lifestyle changes to help these women achieve their health goals.

One such case that stands out is that of Shannon, a vibrant woman in her late 40s who came to my office feeling frustrated with persistent weight gain despite her best efforts at dieting and exercise. Like many women in perimenopause, Shannon was experiencing metabolic changes that made weight loss significantly more challenging than it had been in her earlier years.

Recognizing the complexity of her situation, we discussed various options and decided to start a hormone replacement therapy to address her symptomatic hormonal imbalances. This treatment was aimed at stabilizing her hormone levels to improve her overall metabolic health. Alongside this medical intervention, Shannon engaged in the B-Cut program, which emphasized counting macros and increasing protein intake — adjustments designed to optimize her nutrition for better hormonal balance and weight management.

Woman perimenopause relaxing

Moreover, understanding the impact of stress on hormonal health, we worked on integrating more relaxation techniques into her daily routine. These changes were not just about losing weight; they were about improving her quality of life. As a result, Shannon began to feel more energetic and noticed a gradual improvement in her weight and overall health.

Understanding Perimenopause

Perimenopause marks the transition period leading up to menopause, typically beginning in a woman’s late 30s or early 40s. During this time, the body undergoes significant hormonal shifts, primarily involving estrogen and progesterone. These changes can influence various bodily functions, including metabolism, potentially leading to weight gain.

Debunking Myths about Perimenopause and Weight Gain

Myth 1: Weight gain is inevitable during perimenopause.
Many women believe that weight gain is an unavoidable part of perimenopause. This misconception stems from widespread anecdotes and some general observations about changes in body composition during this life stage.

Truth: While hormonal changes can affect metabolism, weight gain isn’t a foregone conclusion. Lifestyle adjustments can play a crucial role in maintaining a healthy weight. It’s essential to shift the focus from weight loss to overall health and wellness.

Myth 2: All fat gain during perimenopause is due to hormones. Many women attribute all weight gain during perimenopause solely to hormonal changes, disregarding other contributing factors.

Truth: While hormones do play a role in weight gain, other lifestyle factors can also contribute, such as decreased physical activity and changes in diet. It’s crucial to adopt a holistic approach to managing weight during perimenopause.

Myth 3: Fad diets and extreme exercise are the solution to weight gain during perimenopause. Some women turn to fad diets or extreme exercise routines in an attempt to combat weight gain. They erroneously believe extremely low-calorie diets are the best way to lose weight during perimenopause.

Truth: Drastic diets can harm metabolic health. A balanced, nutritious diet, preferably with plant-based protein, is key to managing weight effectively.

Myth 3: Weight gained during perimenopause can only be fat, not muscle.

Truth: With the right exercise regimen, including strength training, it’s possible to gain muscle and improve overall body composition.

Strategies for Managing Weight During Perimenopause

Dietary Recommendations

A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support weight management. Incorporating foods high in fiber can aid in digestion and help maintain a feeling of fullness, reducing the likelihood of overeating.

• Quality Over Quantity: Focus on nutrient-dense foods rather than restrictive dieting. Incorporating a variety of fruits, vegetables, whole grains, and proteins can help manage cravings and provide essential nutrients.
• Mindful Eating: Pay attention to hunger and fullness cues to avoid overeating. This practice can help mitigate the common tendency to consume more calories than needed.

Perimenopausal woman eating mindfully

• Meal sequencing suggests that consuming protein and/or fat before carbohydrates can improve postprandial glucose responses, aiding in weight management.
• Balanced Macronutrients: Adjust macronutrient intake to support hormonal balance and energy levels. For instance, increasing protein and fiber can enhance satiety and support muscle maintenance.

Carbohydrates

45–60% of daily caloric intake: Prioritize complex carbohydrates like whole grains, vegetables, and fruits over simple sugars. Complex carbs are more beneficial for maintaining stable blood sugar levels and providing longer-lasting energy.

Proteins

15–30% of daily caloric intake: Protein is essential for preserving muscle mass, which tends to decline with age. Good sources include lean meats, fish, dairy, legumes, and plant-based proteins like tofu and tempeh. Aim for 20g of protein per meal

Fats

20–35% of daily caloric intake: Focus on healthy fats from sources like avocados, nuts, seeds, and olive oil. Omega-3 fatty acids, found in fatty fish and flaxseeds, are particularly important as they can help manage inflammation and support hormonal balance.

Physical Activity

Exercise during perimenopause is crucial not just for weight management, but also for combating the physical and hormonal changes that occur during this stage. Regular activity helps in maintaining muscle mass, supporting cardiovascular health, and improving emotional well-being, which can be significantly impacted by hormonal fluctuations.

Types of Exercise:

1. Aerobic Exercise (Cardiovascular):

Recommendation: At least 150 minutes of moderate-intensity aerobic activity per week, or 75 minutes of vigorous-intensity activity. This can include activities like brisk walking, jogging, cycling, swimming, or even dancing.

Benefits: Improves heart health, aids in weight management, and enhances mood. Aerobic exercise also increases VO2 max, which is the maximum amount of oxygen the body can utilize during intense exercise. A higher VO2 max is associated with better cardiovascular fitness and has been linked to longer life expectancy.

2. Strength Training:

Recommendation: Engage in muscle-strengthening activities on two or more days a week. This includes lifting weights, using resistance bands, or performing body-weight exercises such as push-ups, squats, and lunges.

Benefits: Essential for preserving and increasing muscle mass, which naturally declines with age. Strength training also helps in maintaining bone density, reducing the risk of osteoporosis — a significant concern during and after perimenopause.

3. Flexibility and Balance Exercises:

Recommendation: Incorporate flexibility exercises like stretching, yoga, or Pilates into your routine several times a week.

Benefits: Improves joint range of motion, reduces the risk of injuries, and can alleviate stress and tension in the body. Balance exercises are crucial for preventing falls, which can become a concern as balance might deteriorate with age.

Exercise during perimenopause should be viewed as a comprehensive strategy to enhance overall health, manage symptoms, and improve quality of life. It’s beneficial to develop a well-rounded exercise routine that includes aerobic, strength, and flexibility training, tailored to one’s individual needs, fitness level, and medical history. Consulting with fitness professionals who understand the unique needs of perimenopausal women can also provide valuable guidance and motivation.

Sleep and Stress Management

During perimenopause, maintaining adequate sleep and managing stress are not just beneficial for overall well-being but are crucial for managing weight. Hormonal fluctuations common during this period can disrupt sleep and heighten stress levels, both of which can contribute to weight gain if not managed properly.

The Impact of Sleep on Weight Management

1. Hormonal Regulation

Sleep affects various hormones including cortisol, ghrelin, and leptin. Cortisol, the stress hormone, can increase with sleep deprivation, leading to enhanced appetite and cravings for unhealthy foods. Similarly, inadequate sleep alters ghrelin and leptin, hormones that regulate hunger and satiety, often leading to overeating.

2. Metabolic Effects

Lack of sleep can lead to a slower metabolism. When the body is deprived of sleep, it conserves energy by slowing down the metabolic processes, which can result in weight gain over time.

Recommendations for Improved Sleep:

1. Consistent Sleep Schedule: Going to bed and waking up at the same time every day helps regulate your body’s internal clock, which can improve the quality of your sleep.
2. Optimizing Sleep Environment: Ensure your bedroom is conducive to sleep — keep it cool, dark, and quiet. Investing in a comfortable mattress and pillows can also enhance sleep quality.
3. Pre-sleep Routine: Engaging in calming activities such as reading or taking a warm bath before bed can help signal to your body that it’s time to wind down.

Stress Management and Its Role in Weight Management

Hormonal Balance: Chronic stress elevates cortisol levels, which can not only increase appetite but also encourage fat storage in the abdominal area, a common issue for perimenopausal women.

Mitigating Techniques:

1. Meditation: Regular meditation can significantly reduce stress levels by enhancing mindfulness and promoting a state of relaxation.
2. Yoga: Combining physical postures, breathing exercises, and meditation, yoga is particularly effective in reducing stress and can also improve flexibility, strength, and balance.
3. Deep Breathing Exercises: Simple breathing techniques can be a quick and effective way to reduce stress levels instantly.
4. Lifestyle Integration: Integrating stress management techniques into daily routines can provide ongoing relief from chronic stress. Even short sessions can be beneficial, such as a 10-minute meditation during a lunch break or practicing deep breathing exercises during stressful moments.

Combining Strategies for Optimal Effect

The interaction between sleep, stress, and weight is complex, especially during perimenopause. By addressing both sleep and stress, you can better manage weight and improve your overall health during this transitional period. For example, regular physical activity can enhance sleep quality at night and reduce stress levels, while a healthy diet can improve both sleep and the body’s response to stress.

Medical Interventions

While lifestyle modifications such as diet, exercise, and stress management are crucial in managing weight during perimenopause, some women may find these changes insufficient to address their weight gain. In such cases, consulting a healthcare provider can open the door to additional interventions that can be tailored to individual needs. This may include hormone replacement therapy (HRT), other medications, and specific supplements designed to support metabolic and hormonal health.

Menopause Hormone Therapy

Role of MHT:

HRT involves the administration of estrogen or a combination of estrogen and progesterone to balance hormone levels. This can alleviate many symptoms of perimenopause, including hot flashes, night sweats, mood swings, and weight gain.

Impact on Weight Management:

By stabilizing hormone levels, MHT can potentially normalize metabolism rates, which might slow down due to hormonal imbalances during perimenopause. It can also help reduce the accumulation of abdominal fat by counteracting the effects of decreasing estrogen levels.

Considerations:

MHT is not suitable for everyone and carries potential risks, such as an increased risk of certain types of cancer, blood clots, and heart disease. Therefore, it should only be considered after a thorough evaluation and discussion with a healthcare provider who can assess the benefits and risks based on individual health history.

Other Medications

Prescription Options:

Apart from MHT, doctors might prescribe medications to target specific symptoms or underlying issues contributing to weight gain. Glucagon-like-1 Receptor Agonists (GLP-1 inhibitors) are the go-to medication for women who have comorbidities such as diabetes or heart failure. In addition, medications that enhance insulin sensitivity, manage depression, or control thyroid disorders could indirectly help manage weight.

Customized Treatment:

Each medication must be chosen based on the individual’s specific health needs and in conjunction with an overall health plan.

Supplements for Metabolic and Hormonal Health

1. Chromium: Chromium is a mineral known for enhancing insulin action and improving glucose metabolism. This can be particularly beneficial during perimenopause when insulin resistance might increase. Chromium supplementation can support the maintenance of a healthy weight by improving the body’s response to insulin and reducing cravings for sugary foods.
2. Myo-Inositol: Myo-Inositol, part of the vitamin B complex, plays a significant role in cell membrane formation. It is often recommended for managing PCOS and is beneficial in perimenopause for its role in insulin signaling and hormone balance. By improving insulin sensitivity and hormone signaling, Myo-Inositol can aid in weight management.

Integrating Medical Interventions with Lifestyle Changes

• Effective management of weight during perimenopause often requires a comprehensive approach. While medical interventions can provide necessary support, integrating these with lifestyle changes ensures the best outcomes. Regular follow-ups with healthcare providers are crucial to monitor the effectiveness and adjust treatments as needed.

There are countless narratives of women who have successfully managed their weight during perimenopause by adopting a holistic approach that includes diet, exercise, stress management, and sometimes medical intervention. These success stories offer inspiration and proof that taking proactive steps can lead to positive outcomes.

Conclusion

Perimenopause is a complex period marked by significant changes, but it also presents an opportunity to adopt healthier lifestyle habits. By debunking myths and applying evidence-based strategies for weight management, it’s possible to navigate this transition with confidence and well-being. Remember, you’re not alone in this journey, and support is available, from healthcare professionals to communities of women sharing similar experiences. Take the first step towards a healthier you today.

Your thoughts and experiences are valuable to us. Feel free to share your own perimenopause and weight management stories or questions below to foster a supportive community dialogue.