Why Weight Gain Can Occur
Many women notice weight gain during perimenopause and menopause, even when their eating and activity habits haven’t changed. This can be frustrating and impact confidence. Understanding the biological reasons behind these changes can help you take effective, sustainable action.
1. Declining Oestrogen
Oestrogen plays a role in how the body stores and uses energy. As levels fall:
- Fat distribution shifts from hips and thighs towards the abdomen
- The body becomes more insulin-resistant, encouraging fat storage
- Appetite and satiety hormones fluctuate
This pattern of central weight gain is common and is linked with increased cardiometabolic risk.
2. Slowing Metabolism
From midlife onwards, resting metabolic rate naturally declines, mainly due to:
- Gradual loss of lean muscle mass
- Reduced overall activity
- Age-related metabolic changes
An underactive thyroid can also contribute to weight gain, so thyroid function may sometimes need checking. However, for most women, hormonal changes, ageing and lifestyle factors are the main drivers.
3. Sleep Disturbance
Night sweats, hot flushes and anxiety can disrupt sleep. Poor sleep increases:
- Cortisol levels
- Cravings for carbohydrates
- Fatigue and reduced motivation to exercise
4. Mood & Emotional Changes
Low mood, stress and anxiety may lead to:
- Emotional eating
- Irregular eating patterns
- Reduced physical activity
5. Midlife Lifestyle Factors
Busy jobs, caregiving responsibilities and reduced time for exercise all contribute to gradual weight gain over time.
Evidence-Based Weight Management
There is rarely a quick fix, but small, consistent lifestyle changes have a powerful impact on weight, hormonal symptoms and long-term metabolic health.
1. Nutrition That Supports Midlife Metabolism
A Mediterranean-style approach is strongly supported in research for improving weight regulation and reducing inflammation. It emphasises:
- Vegetables and fruit
- Whole grains
- Beans, lentils and pulses
- Oily fish
- Nuts and seeds
- Olive oil
Aim to limit:
- Processed foods
- Refined carbohydrates and sugars
- Excess saturated fats
- High-salt foods
- Ultra-processed snacks
Protein becomes especially important in midlife. Include a good source at each meal (e.g. chicken, fish, tofu, eggs, Greek yoghurt, beans).
2. Eating Patterns & Portion Awareness
Helpful strategies include:
- Eating regular, balanced meals
- Increasing fibre for satiety
- Reducing mindless snacking
- Using smaller plates
- Avoiding eating late in the evening
3. Monitoring Your Metabolic Health
A helpful midlife review may include checks of:
- Blood sugar or HbA1c
- Cholesterol profile
- Thyroid function (if symptoms suggest underactivity)
- Blood pressure
- Waist circumference
4. The Role of HRT
Many women worry that HRT will cause weight gain. Current evidence shows:
- HRT is generally weight-neutral
- It may slightly limit abdominal fat gain after menopause
- It can improve sleep, mood, joint pain and energy, which often makes it easier to maintain healthy habits
HRT is not a weight-loss treatment, but it can support overall wellbeing and metabolic health as part of a broader lifestyle approach.
5. Behavioural Tools
You may find it useful to:
- Keep a food or activity diary
- Identify emotional triggers for overeating
- Practise mindful eating
- Seek structured weight-management support if needed
Exercise & Strength Training
Exercise supports metabolic health, weight management and overall physical and emotional wellbeing.
1. Strength Training: A Key Midlife Strategy
Strength training becomes a key part of looking after your health in perimenopause and menopause.
Benefits include:
- Preserving and building lean muscle
- Supporting a healthy metabolic rate
- Improving bone density
- Enhancing joint stability
- Improving mood and sleep
Aim for:
- At least two strength-training sessions per week
- Whole-body movements such as squats, lunges, push-ups, resistance band or dumbbell exercises
- Gradual increases in resistance or duration
Beginners can start with body-weight exercises.
2. Cardiovascular Exercise
Cardio exercise supports heart health and helps manage weight.
Good options include:
- Brisk walking
- Cycling
- Swimming
- Dancing
- Jogging or interval training
Aim for 150 minutes of moderate activity per week, or 75 minutes of vigorous activity.
3. NEAT: Daily Movement Matters
NEAT (Non-Exercise Activity Thermogenesis) refers to everyday movement outside of structured exercise. Increasing NEAT can significantly boost daily energy expenditure.
Ideas include:
- Taking the stairs
- Standing for part of your working day
- Walking during phone calls
- Parking further away
- Short walks after meals
4. Flexibility & Balance
Yoga, Pilates or simple stretching:
- Reduce injury risk
- Improve posture
- Support overall mobility
When to Seek Medical Advice
Speak to a clinician if you experience:
- Unexpected or rapid weight gain
- Severe fatigue
- Persistent sleep disturbance
- Symptoms of low mood or anxiety
- Signs of thyroid dysfunction (e.g., cold intolerance, constipation, hair changes)
A personalised assessment can help identify contributing factors and guide appropriate treatment.
Summary
Weight changes during perimenopause and menopause are common, driven by real physiological changes – not a lack of discipline. The positive news is that targeted lifestyle strategies, strength training, good sleep routines and, for many women, HRT, can help support metabolic health and sustainable weight management.
If you would like personalised support, our menopause specialists can help you review your weight, metabolism and overall wellbeing as part of your menopause care.
