Updated 19th March 2024

How to tackle perimenopause weight gain

Share this article

  • Share on Facebook
  • Share on Twitter
  • Print this page
  • Email this page

When you’ve stopped having your period for 12 months in a row, you’ve been through menopause. 

Perimenopause, which translates as “around menopause,” is the time leading up to menopause.

On average, perimenopause lasts about 4 years, but it differs greatly from person to person. It usually happens between the ages of 45 and 55. 

During perimenopause, there are fluctuations and a gradual decline in levels of reproductive hormones. 

These changes cause symptoms, which can vary significantly between people. But weight gain is common.

In this article, we’ll explore the changes that can happen during perimenopause, including weight gain.

We’ll also outline how you can help prevent and address weight gain during this time.

Body changes and perimenopause

Women may start to experience symptoms and physical changes during perimenopause. Some examples are:

  • irregular periods, which may be heavier or lighter than usual

  • weight gain

  • hot flashes and night sweats

  • mood changes

  • vaginal dryness

  • brain fog

  • sleep disturbances

  • incontinence

  • joint pain

  • changes in sexual function, such as a low sex drive

Our own unpublished research, which involved over 25,000 women, found that sleep problems, night sweats, mood changes, and hot flashes are the most common symptoms. 

We also found that women with obesity experience hot flashes, mood changes, and sleep problems — as well as chills and thinning of hair or dry skin — more often than women without obesity.

Why we put on weight during perimenopause

Studies have found that our body composition changes when we go through perimenopause. 

This includes an increase in fat mass and waist circumference and a decrease in muscle mass. Fat is also more likely to accumulate around the abdomen.

These shifts likely stem from several factors, including changes in reproductive hormones. 

In fact, experts know that estrogen plays a role in energy metabolism, and studies have shown that the way the body metabolizes fat and other lipids changes during the menopause transition.

For example, shifts in energy metabolism caused by fluctuations in estrogen may lead to the accumulation of body fat around the abdomen and an increase in “bad” blood fats. 

These changes, in turn, are linked to health conditions such as type 2 diabetes and heart disease.

Fluctuations in reproductive hormones may also affect your hunger and appetite.

For example, research has shown that levels of a hormone called ghrelin are higher in women during perimenopause, compared with women before and after menopause. 

Experts call ghrelin the “hunger hormone” because it helps regulate appetite. It’s produced in the stomach and increases the sensation of hunger, prompting us to eat. 

In addition, aging itself is linked with natural changes in body composition. For example, we lose muscle mass as we age, which is called sarcopenia. This results in a decreased metabolic rate — the amount of energy your body uses. 

Both of these factors can contribute to weight gain.

Genetics may also play a role. For example, if members of your close family tend to carry excess weight around their abdomens, you’re more likely to, as well. 

And lifestyle factors, such as an unhealthy diet, a lack of physical activity, and not getting enough sleep, can also contribute to weight gain.

Research has highlighted a link between lower body weight and improved symptoms associated with perimenopause. We’ve also seen this in our own research.

Does HRT cause weight gain?

Hormone replacement therapy (HRT) is sometimes called menopausal hormone therapy, or MHT. It’s an effective way to relieve symptoms during perimenopause and menopause. 

It often comes as tablets, but it’s also available as skin patches, skin implants, or a spray or gel that you apply to your skin. 

A common misconception is that HRT causes weight gain. However, research has shown that it doesn’t have this effect. 

In fact, HRT may help prevent weight gain. In our own research, we’ve seen that women who take HRT after menopause have lower levels of body fat than their peers who don’t take it.

What you can do about weight gain

There are several ways to help prevent excess weight gain during perimenopause.


Having a healthy, diverse diet rich in fresh produce can help reduce the chances of weight gain.

It’s a good idea to have a plant-based diet that includes a variety of fruits, vegetables, whole grains, nuts, seeds, beans, and other pulses.

These foods are high in fiber, which can support your “good” gut bugs and help you feel fuller for longer.

Also, make sure to stay hydrated throughout the day. This might involve drinking plenty of water, milk, tea, and coffee. 

Try to avoid highly processed foods and keep high-fat, high-sugar, and high-salt options to a minimum.

ZOE’s scientists are currently exploring how diet affects the symptoms of perimenopause, including weight gain.

At ZOE, we believe that no food should be off the table. Restrictive diets don’t work because they’re unsustainable. Read more about how to eat during perimenopause here.

Physical activity 

Adding physical activity into your daily routine can be easier than you might think. It doesn’t have to be a hard slog at the gym or a marathon. Your exercise routine should be manageable and sustainable.

Most importantly, choose something you enjoy. Maybe that’s a yoga or Pilates session, a salsa class, or a swim at your local sports center. 

Remember, physical activity also includes everyday things like walking, housework, and gardening.

Ideally, aim for around 150 minutes of physical activity each week. 

Research has shown that a mix of aerobic and strength-based exercise can help with perimenopause symptoms like hot flashes and night sweats. It can also help manage weight and provide mental health benefits. 


Sleep is essential for every bodily process, and it influences our physical and mental health. 

So, making sure you get enough quality sleep is important. Ideally, aim for 7–9 hours each night, but your personal requirement may be a little more or a little less.

During perimenopause, many women report difficulty with sleep. In fact, sleep disturbances affect an estimated 39–47% of women at this time in their lives. 

What’s at the root of poor sleep during perimenopause isn’t entirely clear. This is an area that clearly needs more attention from researchers.

With this in mind, here are some general tips for a good night’s sleep:

  • Keep your bedroom cool to mimic the drop in body temperature during sleep.

  • Limit screen time that’s stimulating before bed. 

  • Encourage relaxation by practicing mindfulness, breathing exercises, or gentle stretching. 

  • Avoid long naps during the day.

  • Avoid stimulants, such as caffeine, later in the day.

  • Keep the lights dim to encourage sleepiness.

  • Have a warm bath, read a book, or listen to your favorite music to relax.

Join our mailing list

Sign up for fresh insights into our scientific discoveries and the latest nutrition updates. No spam, just science.

Gut health 

Scientists have identified differences in the gut microbiome before and after menopause.

Interestingly, the relationship between gut bugs and hormones goes both ways: Your gut microbiome influences levels of reproductive hormones, and levels of reproductive hormones influence the gut microbiome.

For instance, certain bacteria affect estrogen levels. These bacteria can “recycle” estrogen and release it back into circulation in the body.

Experts have also linked gut problems such as irritable bowel syndrome to changes in reproductive hormones. These problems also seem to be more common during the menopause transition. 

Look after your gut by keeping our nutrition tips above in mind. And if you have ongoing gut symptoms, contact your doctor.

At ZOE, we understand the importance of the gut microbiome in health. Our research has identified 15 “good” gut bugs associated with positive health markers. We’ve also identified 15 “bad” bugs linked to negative health markers, such as increased belly fat.

If you’d like to know which bugs live in your gut, start by taking our free quiz. With our at-home test and personalized nutrition program, you can find out how to nourish your body and the gut bugs that call it home.


While many supplements claim to help with weight loss, there is no solid evidence to back this up.

More specifically, the evidence that probiotic supplements can help with weight loss is limited and mixed.


Going through perimenopause can involve many physical and psychological changes.

Weight gain is common during this time. It likely stems from a combination of things, including changes in your reproductive hormones and body composition, as well as genetics and lifestyle factors. 

Good nutrition, physical activity, and sleep may help prevent excess weight gain during perimenopause.

If you want to understand how to eat for your body, start with our free quiz.


Body composition changes with aging: The cause or the result of alterations in metabolic rate and macronutrient oxidation? Nutrition. (2010). https://www.sciencedirect.com/science/article/abs/pii/S0899900709002962

Change in adipocytokines and ghrelin with menopause. Maturitas. (2008). https://pubmed.ncbi.nlm.nih.gov/18280066/

Changes in body composition in women over six years at midlife: ovarian and chronological aging. Journal of Endocrinology and Metabolism. (2007). https://pubmed.ncbi.nlm.nih.gov/17192296/

Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? Gender Medicine. (2009). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322543/ 

Doctor, ask your perimenopausal patient about her physical fitness; association of self-reported physical fitness with cardiometabolic and mental health in perimenopausal women: the FLAMENCO project. Menopause. (2019). https://journals.lww.com/menopausejournal/Abstract/2019/10000/Doctor,_ask_your_perimenopausal_patient_about_her.11.aspx

Effects of exercise on vasomotor symptoms in menopausal women: a systematic review and meta-analysis. Climacteric. (2022). https://www.tandfonline.com/doi/abs/10.1080/13697137.2022.2097865

Effects of probiotics on body weight, body mass index, fat mass and fat percentage in subjects with overweight or obesity: a systematic review and meta-analysis of randomized controlled trials. Obesity Reviews. (2017). https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12626

Efficacy and safety of phytoestrogens in the treatment of perimenopausal and postmenopausal depressive disorders: A systematic review and meta-analysis. International Journal of Clinical Practice. (2021). https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.14360

Hormone replacement therapy dissociates fat mass and bone mass, and tends to reduce weight gain in early postmenopausal women: a randomized controlled 5-year clinical trial of the danish osteoporosis prevention study. Journal of Bone and Mineral Research. (2009). https://asbmr.onlinelibrary.wiley.com/doi/full/10.1359/jbmr.2003.18.2.333

Immunologic effects of vitamin d on human health and disease. Nutrients. (2020). https://www.mdpi.com/2072-6643/12/7/2097

Irritable bowel syndrome in midlife women: a narrative review. Women’s Midlife Health. (2021). https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-021-00064-5

Lifestyle and demographic factors in relation to vasomotor symptoms: baseline results from the study of women's health across the nation. American Journal of Epidemiology. (2004). https://pubmed.ncbi.nlm.nih.gov/15191936/

Longitudinal changes in weight in perimenopausal and early postmenopausal women: effects of dietary energy intake, energy expenditure, dietary calcium intake and hormone replacement therapy. International Journal of Obesity. (2003). https://www.nature.com/articles/0802283

Probiotics for weight loss: a systematic review and meta-analysis. Nutrition Research. (2015). https://pubmed.ncbi.nlm.nih.gov/26032481/

Sarcopenia: Aging-related loss of muscle mass and function. Physiological Reviews. (2018). https://journals.physiology.org/doi/full/10.1152/physrev.00061.2017

Sleep during the perimenopause: A SWAN story. Obstetrics and Gynecology Clinics of North America. (2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185248/

Spotlight on the gut microbiome in menopause: current insights. International Journal of Women's Health. (2022). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379122/

The effects and action mechanisms of phytoestrogens on vasomotor symptoms during menopausal transition: thermoregulatory mechanism. Current Drug Targets. (2019). https://www.ingentaconnect.com/content/ben/cdt/2019/00000020/00000002/art00008

The gut microbiome and sex hormone-related diseases. Frontiers in Microbiology. (2021). https://www.frontiersin.org/articles/10.3389/fmicb.2021.711137/full

Treatment: Menopause. (2022). https://www.nhs.uk/conditions/menopause/treatment/

Weight gain and hormone replacement therapy: are women’s fears justified? Maturitas. (2000). https://www.sciencedirect.com/science/article/abs/pii/S0378512299000730

Weight management module for perimenopausal women: a practical guide for gynecologists. Journal of Mid-Life Health. (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947726/

Share this article

  • Share on Facebook
  • Share on Twitter
  • Print this page
  • Email this page