Weight Gain (and Loss) During Menopause and Perimenopause: Here’s What It Means for Your Health

If you’re a woman in your 40s or 50s, you may have noticed changes in your body’s size and shape. Maybe you’ve gained or lost some weight. Or maybe it feels like your clothes are fitting differently. You may also notice that your muscles don’t feel as strong as they used to. Any of these changes can be frustrating — especially if you’re doing the things you’ve always done to be healthy. 

Changes in weight are common during menopause — the time of life after menstrual periods stop. Weight can also be a challenge during perimenopause — the years leading up to menopause. These changes are natural. But sometimes they can affect your health. So it’s important to know how to maintain a weight that’s healthy for you as you go through perimenopause and menopause.

Can perimenopause and menopause cause weight gain?

Around 70% of women will experience weight gain during perimenopause and menopause.  When estrogen levels decrease, the amount of fat and muscle in the body begins to change. This can affect the shape and weight of your body in different ways:

• You may start to notice weight gain around the middle of your body. This change often starts in perimenopause, about 2 years before menstrual periods stop. 

• Even though fat increases, muscle mass decreases. And decreased muscle mass means you burn fewer calories.

“Many women experience weight gain as they enter perimenopause and menopause,” said Katie Klingberg, MD, a family physician who’s board certified in lifestyle and obesity medicine. Noting that hormones play a big role in this, Klingberg said that there are other changes that can lead to weight gain as you get older. Midlife is also a time of “change and increased personal stress. One’s kids become teens or young adults. Career shifts occur. And new worries emerge with aging parents.”

These stressors sometimes mean having less time, opportunity, or motivation to be active. And if you exercise less, you’re using fewer calories. This adds to estrogen’s effects on muscle and fat. 

The combination of stress and hormone changes may also affect eating patterns. People may eat more calories or rely more on comfort foods. Over time, that may lead to weight gain.  

Can perimenopause and menopause cause weight loss?

As women tend to gain fat during the menopause transition, they also tend to lose muscle. Fat increases by about 1.7% per year. At the same time, muscle mass decreases by 0.5% each year.  

So even though hormone changes can lead to weight gain, this isn’t always the case. For some women, less muscle means they lose weight in menopause. 

Your metabolism, or the rate you burn calories, doesn’t change much until around the age of 60. But women start to lose muscle at a younger age. And it tends to happen faster than it does for men. 

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Many people associate weight gain with health risks. But weight loss can also be a problem for aging women. It can lead to balance and movement problems. And in a recent large study of older adults, researchers found that weight loss of over 5% to 10% of body weight was associated with a 26% increased risk of death in women. That risk was more than four times higher with over 10% of weight loss. 

So, if you’re going through menopause, it’s important to address both weight gain and weight loss.

6 tips to help maintain a healthy weight during menopause and perimenopause

Many people find that losing weight happens more slowly during and after menopause. But that’s OK. And if you’re trying to lose weight, remember that small changes can have a big impact. Losing just 5% to 10% of extra body weight, especially around the middle, can help lower the risk of diabetes and cardiovascular disease. 

But weight isn’t always the best predictor of health. Many people with larger bodies are healthy. And weight management is just one part of a healthy approach to menopause.

“We don’t control how fast our estrogen levels change — or many of the stressors that can influence our personal lifestyle habits,” Klingberg said. She recommends the following six pillars of lifestyle medicine as a guide “for all aspects of life, but particularly as you age and your body changes.”  

Below are tips for how these six pillars can help with weight and health during menopause.

1. Prioritize protein and eat nutritious foods 

To lessen how much weight you gain around the middle — and the associated inflammation in the body — focus on eating:

• Whole foods, like fresh produce, rather than packaged foods

• A plant-based diet

• Less sugar and processed foods 

Also pay attention to how much protein you eat. Getting at least 0.8 g of protein daily for every kilogram (around 1.8 g per pound) of body weight helps to maintain muscle. Some experts recommend eating even more protein during perimenopause and menopause — 1 g to 1.2 g of protein per kilogram of body weight. This helps to maintain muscle mass, but it may also slow down weight gain in the form of body fat.

2. Do exercise and physical activity

During menopause, exercise is about more than weight management. Your bones, muscles, and brain will also benefit.

Aim for an average of 30 to 60 minutes of physical activity each day. Choose an activity that you enjoy. This might be going for a walk outside or attending a dance class. And be sure to add stretching, balance, and strength training to your cardio routine.

3. Get quality sleep

Hot flashes, sleep apnea, and insomnia may affect sleep during menopause. Here are some tips to improve your sleep quality:

• Go to bed at the same time each night.

• Lower your room temperature so that it’s between 65°F and 68°F (18°C and 20°C).

• Create a calming bedtime routine, like taking a bath or reading an enjoyable book.

If sleep problems are affecting your ability to function during the day, talk with a healthcare professional. There are effective treatments for different kinds of sleep problems. 

4. Don’t smoke, and limit alcohol 

Smoking adds to the risk of cardiovascular disease in menopause. It might even cause menopause to happen at a younger age. 

And having more than 1 drink per day tends to increase weight around the middle. That’s a risk factor for diabetes, cardiovascular disease, and some kinds of cancer. Alcohol also triggers hot flashes for some people.

5. Focus on mental health

Hormonal ups and downs can affect your mood, stress level, and sleep. And many life changes tend to happen at the same time as menopause.

Chronic stress may affect hormones and eating patterns, which, in turn, can affect your weight. Try adding a few of these activities to your routine: 

• Move your body.

• Relax your muscles.

• Spend time in nature.

• Connect with friends.

Some women are more at risk for depression and anxiety during perimenopause and menopause. If you’re feeling sad or overwhelmed, talk with your healthcare team about therapies that can help.

6. Practice mindfulness and stay connected

In addition to mental health, there are other mindful practices that can help with anything from diet to sleep:

• Mindfulness and meditation can help with healthy and balanced eating, better sleep, and motivation.

• Mindful eating will support your efforts in good nutrition during menopause. And it can help you feel more comfortable with your changing body. 

• Yoga and meditation are also great practices to relax your body for better sleep. 

Going through big life changes is healthier when you have a supportive social network. Connecting with family and friends goes a long way during times of stress. 

Connecting with yourself is important, too. Self-compassion is a vital ingredient in supporting your health when life is in flux.

Talking to a healthcare professional about weight gain in menopause and perimenopause

Bodies change with age. And those changes are often more noticeable around the time of menopause. Being satisfied with your body image at every age can improve your physical and mental health. 

At the same time, there are some health risks associated with weight change and menopause. As mentioned above, weight around the middle increases cardiovascular risk. Weight gain in general worsens inflammation and arthritis. And loss of muscle, which can be associated with weight gain or loss, can lead to falls and less physical activity.

Some changes in weight are expected during menopause. Klingberg encourages talking with a healthcare professional about any changes you notice — especially weight gain or weight loss that is sudden, unexplained, or significant. 

Your primary care provider can help guide testing to make sure nothing more serious is going on. They can also make sure you’re getting the right screening for any weight or age-related conditions. 

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Written by:

Anne Jacobson, MD, MPH

Anne Jacobson, MD, MPH has been a board-certified physician since 1999. She was a full-scope family physician (inpatient, outpatient, obstetrics, and office procedures) in the Cook County Ambulatory Health Network for 15 years.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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