How to Lose Weight in Perimenopause

Maybe this sounds familiar: You move your body regularly, you eat your protein, you try your best to get enough sleep. But while your habits haven’t changed, it’s clear that your body has. As a woman in my 40s in perimenopause, I know the feeling all too well: I’m doing all the same things as I did in my 30s, and yet my body is still changing. So it's only natural to wonder how to lose weight in perimenopause when it can feel like an impossible code to crack.

Weight changes in perimenopause are driven largely by shifting hormones, which can create a variety of bodily changes. For example, hormone shifts can hamper your sleep and leave you with less lean body weight, reducing how efficiently your metabolism works. You might also notice that, along with the weight creeping up on the scale, your body composition may change, leaving you with more fat stored around your middle. 

That said, with the right approach—one that takes hormonal changes into consideration—it’s definitely possible to lose weight in perimenopause. Below, we’ll demystify midlife weight gain and run through the strategies that can help you meet your personal health goals. And we’ll tell you how a Midi clinician can help you feel like your best self in midlife—because you deserve nothing less.

Why Is Losing Weight in Perimenopause So Hard?

Losing weight in perimenopause can be difficult largely due to hormonal shifts. Perimenopause—the years before menopause—is a transitional phase starting in your early-to-mid 40s when hormone levels start to fluctuate. Eventually, estrogen and progesterone will decrease to menopausal levels, but during the perimenopause phase, hormone levels jump around, possibly triggering some unwanted changes. Common symptoms like sleep disruption, mood changes, and fatigue are factors that can affect your activity levels and cravings for certain foods. Sometimes these changes are so under-the-radar, you don’t even realize that you’re moving less or eating just a little bit extra.

But we also need to talk about the specific effect estrogen loss has on our body. Estrogen shifts are responsible for the following, according to a review in the journal Maturitas:

• Increase in weight
• Redistribution of fat from areas like your butt and legs into your abdominal area (ncreasing insulin resistance)
• Decrease in muscle mass

There are differences in changes from woman to woman, of course. As the research above points out, some women won’t add pounds, but they’ll still see body composition changes, with more mid-section fat and less muscle. Even if you have what’s considered a healthy BMI, you can still have excess visceral (deep abdominal) fat, which is a risk to your heart and metabolic health.

Yes, your body’s physiology is changing. But it just calls for a different strategy. 

How Shifting Hormones Drive Perimenopause Weight Gain

Estrogen is one of many critical  hormones that play a role in regulating your metabolism. It helps keep blood sugar steady—it makes your body more responsive to insulin and helps keep your pancreas (the organ that makes insulin) working well, per a research review in the Journal of Mid-Life Health. Estrogen also has an effect on how fats are metabolized, which has an impact on cholesterol levels and your risk of cardiovascular problems.

As you near menopause, your body—which has typically been storing fat in your butt and thighs—starts shifting that to your belly. It’s why “central obesity” (the name for obesity around one’s abdominal section) can be so common among menopausal women. 

On top of that women in perimenopause also tend to have a lower resting metabolic rate (the rate at which your body burns calories outside of exercise). We also tend to have less random movement (fidgeting, getting up and down) and eat more calories than we used to. That disrupts the “calories-in, calories-out” balance that has an impact on your weight.

Likewise, during this time chronic stress and poor sleep (oh, those sleep-busting night sweats) raise levels of cortisol, a hormone that’s necessary for your health but is damaging in excess. Cortisol encourages abdominal fat storage, a term that’s been dubbed “cortisol belly.” Studies have also suggested that poor sleep can influence the type of food you eat: sleep deprivation is linked to an increase in ghrelin (the hunger hormone), which can lead to consuming more sweet, salty, and starchy foods.

Finally, thyroid disease is common in women in perimenopause, according to information from the European Menopause and Andropause Society. The thyroid directs metabolic functioning, and when it’s underactive (hypothyroidism), it can lead to mild weight gain. Symptoms of both perimenopause and thyroid disease can overlap, such as irregular periods, irritability, sleep disturbances, and skin and hair issues, making them difficult to untangle from each other.

Can You Really Lose Weight During Perimenopause?

Yes, weight loss during perimenopause is possible, but it can take more time, a change in strategy, and a more deliberate approach with your hormones in mind. 

It’s hard to ignore the scale—and the scale can be useful. But improvements in body composition and metabolic health are the main goals for better health. 

What to Eat for Perimenopause Weight Loss

There’s no perfect perimenopause weight loss diet, and you can follow an eating plan that works with your cultural foods, the foods you prefer, and your schedule. Keep in mind these few guidelines:

• Prioritize protein at each meal to preserve lean body mass and keep fullness high and cravings at bay, studies show. Midi clinicians generally recommend that women aim to eat around 1.2 to 1.3 grams (g) of protein per kilogram of bodyweight daily, though that can vary depending on your workout routine.
• Fill your plate with fiber-rich foods, which include fruits, vegetables, beans, lentils, nuts, seeds, and whole grains. These stabilize blood sugar and help keep you full. The recommended fiber intake for perimenopausal and menopausal women is at least 25 to 35 g per day. For managing weight in midlife, a good balanced option is the Mediterranean diet, research shows.
• Reduce calories modestly—severe restriction will backfire and will likely make you feel lousy. For guidance, a healthcare professional can help you set up a specific plan.
• Limit your intake of “extras” like alcohol, foods high in added sugar, and ultra-processed foods. These add extra calories without good nutrients. 

Strength Training and Movement That Protect Your Metabolism

Preserving muscle mass helps prevent perimenopause weight gain. (Bonus: More muscle mass is associated with less severe menopause symptoms, according to a study in Frontiers in Endocrinology.)

Muscle burns calories even when you’re not moving. So the more muscle you build and preserve, the higher your metabolism typically runs and the better your body responds to insulin. You can improve muscle growth and strength with resistance exercise, which can be done with body weight moves, free weights, weight machines, and exercise bands. 

In addition, cardio workouts will burn calories and strengthen your heart health. And daily movement adds up too—whether that’s when doing your usual tasks like lugging the laundry basket up the stairs, or making it a point to take regular breaks to move around as you work or watch a show.

Another bonus with any weight-bearing exercise: It puts a good stress on bones, improving their density to protect against bone-weakening conditions like osteopenia and osteoporosis as you age.

According to the Centers for Disease Control and Prevention (CDC), the official physical activity guidelines are 150 minutes a week of moderate-intensity aerobic activity (such as brisk walking, jogging/running, cycling), as well as at least 2 sessions a week of muscle-strengthening activity. But to lose pounds or maintain your weight, you may need to get more. 

How Sleep and Stress Affect Your Weight

When you’re low on sleep or under heightened stress, you may make choices you wouldn’t otherwise, whether that’s eating foods you’d usually skip or cancel your regular workout. Research suggests that lack of sleep disturbs hormones that regulate your appetite and affect your brain so that you seek out more crave-worthy foods.

But a trial in JAMA Internal Medicine showed how shifting your habits can make a difference: People who were overweight and regularly slept less than 6.5 hours a night reduced their calorie intake by 270 calories a day simply by sleeping about an hour longer each night. 

There’s also evidence that stress changes how your brain responds to food, making you more vulnerable to cravings. 

These suggestions that may help:

• Managing perimenopause symptoms can make weight loss easier, as sleep-disrupting symptoms like night sweats can contribute to some negative downstream effects on your eating habits. 
• Stress management can help bring cortisol levels down, so make time for mindfulness and fun. 
• Healthy sleep habits really make a difference: Experts encourage keeping set bed and wake-up times, avoiding alcohol in the evening, and skipping scrolling on your phone before bed.

Do HRT and GLP-1 Medications Help You Lose Weight?

To put it simply: GLP-1 medications directly cause weight loss. Hormone replacement therapy (HRT, now commonly referred to as menopause hormone therapy, or MHT) does not directly cause weight loss; however, it can help set the stage for weight loss to happen.

Let’s start with HRT. It’s not a weight-loss drug, but it’s the gold-standard treatment for menopausal symptoms, especially hot flashes and night sweats. When uncomfortable symptoms aren’t wreaking havoc on your day-to-day life, you might have more energy and motivation to exercise and eat balanced meals. So while HRT isn’t designed for weight loss, it can indirectly help by making it easier to adopt and maintain healthy habits. It may also help reduce the buildup of visceral fat over time, so between that and its other effects, it works in a variety of indirect ways to support healthy weight changes in midlife and beyond.

On the other hand, there are a variety of oral and injectable medications which can help with weight loss. For example, GLP-1 medications (such as semaglutide) or GLP-1/GIP medications (such as tirzepatide) are FDA-approved for weight loss. These drugs generally help slow digestion, improve glucose metabolism, reduce appetite, and quiet food noise.

Either way, weight loss medications require a clinical evaluation, and they’re not right for everyone. A menopause-informed clinician, like one at Midi, can help evaluate whether HRT and/or weight loss medications could support your goals and well-being. 

Supplements and Other Support

While supplements aren’t a replacement for healthy habits or prescription medications, they can be used as an adjunct to your care, whether alongside prescription medications or as an alternative if those aren’t tolerated or desired. 

Evidence-informed supplements to support weight loss include protein powder and fiber. Berberine may also provide some benefits during the menopausal transition (it’s linked to modest weight loss, but may have more metabolic benefits). While it’s best to obtain protein and fiber sources from natural foods, if that’s not achievable, supplements are an option.

If you’re interested in supplements for perimenopause weight gain, ask a clinician about which options might be right for you, your medication list, and your health history.

How Midi Can Support Your Weight Loss Journey

Connecting with an expert—specifically someone who understands perimenopause—can provide the personalized guidance tailored to your hormones, history, and goals that you need to be successful in weight loss. 

Midi offers virtual, insurance-covered care for eligible patients from clinicians who specialize in perimenopause, menopause, and weight loss. You don’t have to navigate frustrating weight changes alone—book a visit any time you’re ready.

Key Takeaways

• Weight and body composition changes are common in perimenopause due to hormonal shifts. Many women feel as if they gain weight even if they haven’t changed their lifestyle. 
• Perimenopause weight loss is possible, but it requires time, patience, and a hormone-informed plan. 
• A protein- and fiber-rich diet, regular exercise including strength training, adequate sleep, and stress management are lifestyle changes that can support weight loss.
• Some women may be candidates for medication options, including HRT and/or weight loss medications. HRT lessens the symptoms of menopause, and that helps set the stage for healthy weight loss. Medications like GLP-1s reduce your appetite to directly cause weight loss. 
• Creating a personalized weight loss plan with a clinician specializing in perimenopause care can help you be successful in your perimenopause weight loss journey.

Frequently Asked Questions (FAQs)

How can I lose 20 pounds in perimenopause safely?

Talk to a clinician for personalized guidance for losing weight. A menopause-informed clinician understands the impact of hormones on weight, and can counsel you on safe and effective weight loss strategies. 

What is the 30/30/30 rule for perimenopause?

This weight loss tip, which went viral on TikTok, refers to eating 30 grams of protein at breakfast, eating it within 30 minutes of waking up, and getting 30 minutes of low-intensity steady-state exercise (like walking) after breakfast. This hasn’t been clinically studied, and science doesn’t support the idea that you need to eat within 30 minutes of waking up. But protein at breakfast is seen as a healthy option, and exercise is always a good move. So: no harm, but it’s not a magic bullet.

How do I lose perimenopause weight gain fast?

It’s understandable to want to drop pounds quickly. However, slow and steady weight loss tends to be more successful in the long run, rather than crash or restrictive diets, which can be unhealthy and even dangerous. 

How do I flatten a perimenopause belly?

During the menopausal transition, it’s common for women to notice an increase in abdominal fat. Eating a healthy, balanced diet packed with protein and fiber, combined with exercising regularly, can help reduce fat overall, including around the belly. 

How long does it usually take to lose weight in perimenopause?

It depends on the adjustments you’re making to your food and activity levels, and other lifestyle factors, along with your own metabolism. In perimenopause, many women notice that it takes them longer to lose weight, but it is possible by making consistent and healthy changes: making sleep a priority and reducing stress, along with healthy eating and regular exercise.