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Everyone has heard of menopause, regardless of whether they know the physiology or symptomology behind it. But few are familiar with or educated on perimenopause, the years leading up to menopause that bring cycle changes and many other potentially unpleasant symptoms. Aside from changing cycles, one of the biggest perimenopausal issues is weight gain and body composition changes.

I work with many women who are befuddled when they suddenly notice weight gain or an increase in belly fat with no changes in diet or lifestyle. This typically starts to happen in a woman’s 40s but can begin as early as mid-30s or later. Body composition changes can be gradual or quite sudden which can feel very deflating.

Weight gain is super common during perimenopause and can start up to 10 years before menopause (average age 51). It’s estimated that women gain 2–5 pounds during perimenopause and may continue to gain about 1.5 pounds per year as they age.
The main reason is the decrease in estrogen and progesterone that triggers metabolic changes in the body. Blood sugar naturally rises as we age, and this can trigger an increase in fat storage. Thyroid hormones may start to decline also. Your thyroid governs your metabolism, so hypothyroidism is a main cause of weight gain and fatigue.
A quick google search on perimenopausal weight loss will yield generic results like “eat less” and “move more.” This can be super frustrating because most women haven’t changed any diet or lifestyle habits. And the cause typically isn’t an increase in calories unless it’s cravings-driven, which also does happen. Because the underlying cause is fluctuating hormones and blood sugar, it’s best to address these root causes rather than cutting calories or extreme and often unpleasant diet or lifestyle changes.

A Word about Hormone Replacement Therapy

Before I get into the tips, I’d like to address hormone replacement therapy (HRT) which is used to ease menopausal symptoms. It involves using synthetic or bio-identical plant-based estrogen and progestin in a pill, patch, or cream (most commonly). Historically, HRT has been associated with increase breast cancer and cardiovascular disease risk.

The reason: In 2002, the Women’s Health Initiative (WHI) study prematurely ended its clinical trial on women taking estrogen and progestin HRT after finding possible increased risks of breast cancer, heart disease, stroke, and blood clots. The study focused on women over 60, not newly menopausal women, which is significant and could have altered the accuracy of the results. The media may have also misrepresented the data. The study is now considered flawed. There is convincing evidence that HRT may actually have a cardioprotective effect, prevent cancer, ease potentially massively disruptive symptoms, and support bone density in menopause. Read more here.

HRT may also ease peri- and menopausal weight gain and body comp changes. Most of my colleagues now heartily endorse HRT beginning in your late 40s/early 50s. I personally recommend bio-identical HRT (BHRT). BHRT is derived from plant sources that are chemically similar to the hormones your body naturally produces. Traditional HRT is synthetic.

Here are some of the conditions HRT can improve:

  • Weight gain
  • Mood swings
  • Hot flashes
  • Vaginal dryness
  • Night sweats
  • Low energy levels
  • Memory loss
  • Difficulty sleeping
  • Decreased interest in sex‌

Three Tips for Perimenopausal Weight Loss

If you’re noticing weight gain or body composition changes, these tips are for you. Addressing these metabolic shifts prior to menopause will help you transition into menopause with fewer symptoms like hot flashes, sleep disruptions, night sweats, depression, and weight gain. Even if you are not experiencing perimenopausal weight shifts, these tips will support balance as you move into menopause.

You won’t see these tips with a quick google search. And your doctor, who likely isn’t well educated on perimenopause, probably won’t have the knowledge on how to support a woman through this phase of life. For years, women’s peri- and menopausal symptoms have been dismissed or minimized, but there are many dietary, lifestyle, and supplemental/medication options that ease hormone fluctuations and combat debilitating symptoms.

These tips also help prevent bone loss, another major peri- and menopausal concern.

1. Increase protein: Protein requirements increase during peri- and menopause due to tissue protein breakdown and decreased muscle mass. Eating more protein can help postmenopausal women maintain muscle mass and protect bone health. Numerous studies show that increasing protein during perimenopause can ward off fat gain. Protein supports satiety so you’re less likely to be hungry or snacky, and it also helps balance blood sugar that can cause cravings and increase fat storage. Protein also gives you energy!
Most recs say peri women need 1-2 grams of protein per kilogram of bodyweight, but this is just a guideline. Your protein needs depend on your activity level and body mass. My personal rec for peri- and menopausal women is 30% of your calories from protein at the very least, 30% from fat, 40% from carbs. I recommend first boosting anti-inflammatory proteins like seafood (salmon, cod, tuna in particular) and legumes, and add beef and lamb once per week.
My recommended serving of protein per meal is 30 grams. This is a little bigger than a palm size of chicken, seafood, red meat, or 3 eggs (not quite 30g but close). Or a protein-rich protein powder like this one. I’ll also add collagen with it to beef up the protein and for collagen’s many benefits.
Make sure to balance your proteins with plenty of fiber-rich fruits, legumes, veggies.

2. Creatine: Creatine is a molecule that’s naturally found in muscle cells and helps the body produce energy during exercise. It’s common among the gym bro crowd for this purpose. It may be especially important during perimenopause because of hormone-related changes. Research finds that creatine supplementation can help counteract the menopause-related decline in muscle, bone, and strength by reducing inflammation, oxidative stress, and serum markers of bone resorption. May also support memory and cognition.

The studies I combed through show mixed results, but the majority were positive. Can’t hurt to try it because it’s extremely safe to take. Combine that with strength training for max results. Aim to get 5g per day! I use this one.

3. Strength training: great to combat menopausal bone loss, prevent heart disease (risk increases during menopause due to a drop in cardio-protective estrogen), support muscle mass that also declines during menopause, and help weight loss and metabolism. Boosts mood, reduces joint pain, and I found evidence that it may also reduce hot flashes. Getting started during perimenopause will set you up for better success as you transition into menopause.
You can use bodyweight or handheld weights. Try resistance bands also. Best types of strength training for women include plank (hold at least a minute and work up to several sets from there), squats, lunges, good old fashioned push ups (start on knees), sit-ups, bicycle crunches, tricep extensions, bicep curls, shoulder presses. You can start with 2 or 3 pound weights and move up from there. I use 5-8lb weights and try and do 3 sets of 15 reps of whatever I’m doing. You can start out with just 10 minutes 3 times a week. Or I love the barre fusion classes that combine bodyweight and light handheld weights. You can find these or any strength training classes online easily. I also love cardio barre and power yoga.


Perimenopause is the period leading up to menopause where women start to see changes in mood, sleep, cycle, and bodyweight. Get ahead of it by focusing on these three tips to help you avoid perimenopausal weight gain and support perimenopausal weight loss. Also try these supplements for perimenopause.

Menopause is inevitable, but suffering is optional. As the conversations around women’s health are changing and evolving, we now have access to so many wonderful resources to obtain HRT and supplements that can ease the transition into menopause. See this post for more.

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