Many women notice weight gain as they get older, especially into their 30s and 40s. This can be frustrating, especially when you think you're doing the right things for your body but still not seeing the results you want.
The truth is, sometimes it's not a matter of willpower, discipline, or knowledge alone. And if you're in perimenopause, there are several other factors that can affect weight loss efforts.
At Genesis Lifestyle Medicine, we often see women with these same concerns. In many cases, weight changes during this life stage are associated with hormonal changes and shifts in metabolism. With an understanding of these factors, you and your clinician can have an informed conversation about strategies that may be appropriate for your individual situation.
What's the Relationship Between Perimenopause and Weight Gain?
Perimenopause is a transition period that occurs before menopause. During this time, the body experiences fluctuations in estrogen levels, eventually leading to a gradual decrease in estrogen production over time. Perimenopause is also characterized by changes in progesterone production. These changes can lead to a relative shift in the ratio of testosterone (and other androgens) to estrogen.
Perimenopause has been associated in published research with weight and body-composition changes. Reported estimates vary by study population and methodology; some sources report that a substantial proportion of women experience weight gain during this period, with reported averages of approximately 3 lbs per year in certain cohorts. Individual experiences vary.
Many factors may contribute to weight gain during perimenopause, including physiological, hormonal, lifestyle, and psychological influences. Some factors are modifiable through lifestyle choices; others (such as hormonal changes) are not. Understanding these factors helps inform a discussion with your clinician about approaches that may be appropriate for you.
Declining Estrogen (and Progesterone) as a Reported Risk Factor
One factor frequently discussed in connection with perimenopausal weight gain is diminished estrogen and progesterone production. Estrogen and progesterone have many roles in the body, and changes in their levels may affect processes related to weight regulation.
Decreased estrogen levels have been associated in research with increased muscle protein breakdown and altered protein synthesis. This may increase the body's protein requirements; if intake does not meet those requirements, total caloric intake may rise as appetite for other macronutrients increases.
A decline in estrogen and progesterone has also been associated with body-composition shifts. Some perimenopausal women experience an increase in body fat — particularly visceral fat — and a reduction in lean tissue. These shifts may also affect metabolic markers in ways that make weight loss more challenging.
Estrogen also plays a role in appetite regulation. Lower estrogen levels have been associated with increased hunger signals in published research.
Metabolic Changes
Some women experience changes in metabolic rate during perimenopause. The body may become less efficient at using calories for energy, which can make it easier to consume a caloric surplus. This is one reason some women may notice weight changes even when caloric intake has not noticeably changed.
Estrogen has roles in the pancreas, liver, intestines, muscles, and other organs involved in metabolic regulation. Diminished estrogen levels during perimenopause may affect fat and glucose metabolism, insulin sensitivity, and other metabolic factors.
Other Factors Associated with Weight Gain During Perimenopause
Diet and lifestyle factors associated with weight changes include:
- Excessive calorie intake
- Low protein intake
- Low fiber intake
- Decreased physical activity
- Disrupted sleep
- Chronic or high stress
- Sedentary lifestyle
Perimenopausal women may also experience depression, anxiety, elevated stress, or other mental health conditions, which can be associated with changes in appetite and emotional eating.
Could Perimenopause Be Contributing to Your Weight Gain?
There are many possible factors associated with weight gain. To help identify whether perimenopause may be a contributing factor in your situation, consider whether you are also experiencing other common signs of perimenopause. Only a qualified clinician can evaluate your specific situation.
Commonly reported signs of perimenopause include:
- Irregular periods
- Hot flashes
- Night sweats
- Mood changes (e.g., depression, mood swings, irritability)
- Changes in libido
- Vaginal dryness, which may cause discomfort during intercourse
- Disrupted sleep
- Changes in urinary frequency or urgency
- Bone-density changes
- Changes in fertility
The specific signs and symptoms vary from person to person. If you are experiencing several of these symptoms, an evaluation by a qualified clinician can help identify potential causes.
At Genesis Lifestyle Medicine, hormone therapy decisions are individualized to each patient based on symptoms, laboratory findings, medical history, and clinical evaluation. When appropriate, hormone therapy may be considered alongside other interventions, which can include FDA-approved weight management medications and diet and lifestyle approaches.
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Hormone Therapy and Perimenopausal Weight: What the Research Suggests
Hormone therapy is approved by FDA for the treatment of vasomotor symptoms (hot flashes), genitourinary symptoms of menopause, and prevention of postmenopausal osteoporosis in appropriate patients. FDA-approved labeling for menopausal hormone therapy does not include weight loss or weight management as an indication. Some published research has examined associations between hormone therapy and body-composition changes; those findings are discussed below for educational purposes.
Reported Effects on Fat Distribution and Body Composition
Some published research has reported associations between menopausal hormone therapy and changes in body fat distribution, including reduced visceral fat and a less pronounced shift toward central adiposity. Some studies have also reported associations with preservation of lean mass. Findings are mixed across studies and depend on the patient population, type of hormone therapy, and duration of follow-up.
Reported Metabolic Effects
Research has reported associations between hormone therapy and certain markers of metabolic health, including measures of insulin sensitivity, in some populations. The relationship to weight loss specifically is not consistently demonstrated and is not an FDA-approved indication for hormone therapy.
Symptom Management
By addressing vasomotor and other approved indications, hormone therapy may indirectly support overall wellness; for example, improvement in sleep and mood may, in turn, affect lifestyle factors associated with weight. Whether hormone therapy is appropriate for any individual is a clinical decision made between patient and clinician based on a full evaluation of risks and benefits.
FDA-Approved Weight Management Medications: An Overview
Several classes of FDA-approved medications are used in weight management. The decision whether any medication, and which specific product, is appropriate is an individualized clinical decision made between patient and clinician. The classes most commonly encountered include:
- Dual-action incretin agonists (GLP-1 / GIP). Members of this class are FDA-approved for chronic weight management in adults meeting clinical criteria, as well as for type 2 diabetes under separate labeling. The dual mechanism is described in more detail elsewhere on our site.
- Single-action GLP-1 receptor agonists. Members of this class are FDA-approved for chronic weight management in adults (and, in certain products, adolescents) meeting clinical criteria, as well as for type 2 diabetes under separate labeling.
- Sympathomimetic amine appetite suppressants. These medications are FDA-approved as a short-term adjunct (typically a few weeks) in a regimen of weight reduction. Medications in this class include Schedule IV controlled substances and are not appropriate for all patients.
Dual-action GLP-1/GIP agonists act on both the GLP-1 receptor and the GIP receptor. Activation of these receptors has been associated in clinical trials with reduced appetite, slower gastric emptying, and effects on glucose and lipid metabolism.
Single-action GLP-1 receptor agonists act on the GLP-1 receptor. Activation has been associated in clinical trials with delayed gastric emptying, reduced appetite, and effects on glucose metabolism.
Sympathomimetic amine appetite suppressants act primarily by suppressing appetite. They are FDA-approved for short-term use only and, as Schedule IV controlled substances, carry specific regulatory restrictions and clinical contraindications.
Important safety information. Medications in the GLP-1 receptor agonist class and the dual-action GLP-1/GIP agonist class carry a boxed warning regarding the risk of thyroid C-cell tumors observed in rodent studies; they are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. Reported risks across these classes include pancreatitis, gallbladder disease, severe gastrointestinal adverse reactions, acute kidney injury (often related to volume depletion), hypoglycemia when used with insulin or insulin secretagogues, hypersensitivity reactions, diabetic retinopathy complications in patients with type 2 diabetes, and reports of suicidal ideation or behavior during postmarketing surveillance of GLP-1 receptor agonists. Sympathomimetic amine appetite suppressants are Schedule IV controlled substances; they are contraindicated in patients with cardiovascular disease, hyperthyroidism, glaucoma, agitated states, or a history of drug abuse, and carry risks of dependence, pulmonary hypertension, and valvular heart disease. This is not a complete list of risks for any class or product. Risk profile, labeling, and contraindications differ by individual product. Patients should review the full FDA-approved prescribing information and Medication Guide for the specific medication prescribed, discuss benefits and risks with a qualified clinician, and report side effects to their healthcare provider and to FDA MedWatch at 1-800-FDA-1088.
At Genesis Lifestyle Medicine, treatment decisions, including whether any medication is appropriate and which specific product to prescribe, are made on an individualized basis by a qualified clinician following a comprehensive evaluation.
Diet and Lifestyle Strategies
Diet and lifestyle approaches are a foundation of healthy weight management at any life stage. Some strategies that research has associated with improved metabolic markers include:
Adequate Protein Intake
Consuming adequate protein has been associated with greater satiety in published research and supports the maintenance of lean muscle mass with aging.
Moderate Caloric Deficit
Weight loss generally requires a sustained caloric deficit. Appropriate caloric targets vary by individual, body composition, activity level, and health status, and should be discussed with a qualified clinician or registered dietitian.
Healthy Meals
Diets emphasizing fruits, vegetables, whole grains, healthy fats (such as olive oil and avocados), fish, lean poultry, lean beef, and certain dairy products have been associated with favorable nutrient profiles.
Regular Exercise (Including Strength Training)
Regular physical activity supports metabolism and overall health. General guidelines suggest at least 150 minutes per week of moderate activity or 75 minutes of vigorous activity, or a combination. Strength training supports muscle mass, which may support metabolic health. The appropriate exercise program for any individual should be discussed with a clinician.
Adequate Sleep
Quality sleep supports mood, stress management, and hormonal balance, all of which are relevant to weight regulation. Most adults need 7 to 9 hours per night, though individual needs vary.
Stress Management
Stress can affect cravings and food choices. Approaches that may support stress management include mindfulness practices, regular physical activity, time outdoors, time with supportive people, and other enjoyable activities.
A Healthier You
Perimenopausal weight changes are common, and many factors can contribute. Working with a qualified clinician to evaluate your individual situation is the first step in identifying which approaches may be appropriate for you.
At Genesis Lifestyle Medicine, evaluation is individualized to each patient. If you are looking to address perimenopausal symptoms or related weight concerns, schedule a consultation with us.
Educational Information; Not Medical Advice
The information in this article is provided for general educational purposes only and reflects the professional opinion of the authors as of the date of publication. It does not constitute medical advice, does not establish a clinician-patient relationship with Genesis Lifestyle Medicine or any of its providers, and is not a substitute for individualized evaluation, diagnosis, or treatment by a qualified healthcare professional who has reviewed your personal medical history, current medications, and clinical circumstances. References to classes of medications — including single-action GLP-1 receptor agonists, dual-action GLP-1/GIP agonists, and sympathomimetic amine appetite suppressants — are educational only. Specific products in these classes are approved by the FDA only for the indications described in their respective FDA-approved labeling. FDA-approved labeling for menopausal hormone therapy does not currently include weight loss or weight management as an indication. Any use of any medication for a purpose other than an FDA-approved indication is off-label and is a clinical decision to be made between the patient and the treating clinician based on an individualized evaluation. Always read the FDA-approved prescribing information and Medication Guide for any medication prescribed, and discuss potential benefits and risks with your healthcare provider. Report side effects to your healthcare provider and to FDA MedWatch at 1-800-FDA-1088.
Medically reviewed by Dr. Alex Spinoso
