How to deal with weight gain in perimenopause

Needle’s story is not unique. For many women in their 40s and 50s, menopause brings not only physical symptoms like hot flushes and sleep disturbances but also a frustrating shift in metabolism and body composition.

“The combination of muscular and metabolic changes associated with ageing, in addition to the hormonal changes of the menopause transition, means weight management in our 40s and beyond is a different ball game,” says weight management and perimenopause dietitian Annie Barry.

Falling oestrogen levels can lead to an increase in visceral fat (stored around the abdomen), while a gradual reduction of lean muscle mass contributes to changes in metabolic rate. But, Barry says, this is only part of the picture.

“When you look at what women at this stage of life are juggling on a day-to-day basis – careers, children, ageing parents – they’re time-poor. On top of that, they may also be facing perimenopausal symptoms such as sleep disturbances, brain fog, joint pain,” she says.

“It’s no wonder they are struggling to stay consistent with nutrition and exercise patterns.”

Ageing well through menopause

Endocrinologist Dr Ramy Bishay says while stubborn weight gain may be a common side effect of menopause, women don’t have to simply accept it.

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“We cannot reverse ageing, but we can age well,” Bishay says.

He recommends starting with self-kindness, understanding and acceptance, shifting the focus from weight loss to building muscle mass, improving strength, and supporting overall metabolic health. “Muscle strengthening, balance training and overall fitness and health are the main targets, not strictly a number on a scale,” Bishay says.

He says resistance training in particular is key at this stage of life.

“There have been a number of studies showing that heavy resistance training leads to significantly more muscle mass and preservation – or even gains in – bone mass,” he says.

“It reduces the risk of weight regain as metabolically active tissue [muscle] is gained, reduces risk of fractures and falls later in life, and improves physical function and confidence.”

What should you eat?

“Prioritise protein and plants, consider carbs, don’t forget fibre,” says Barry, explaining small diet tweaks can help counteract menopausal weight gain.

“Protein will help preserve muscle mass and keep you satiated for longer,” she says.

While the popularity of the keto diet played a role in demonising carbs over recent years, Barry says there is a place for them.

“Periodise them around your exercise and opt for high-fibre, wholegrain options where possible.”

Barry says with ultra-processed foods comprising a larger portion of modern diets, it is especially important for women in menopausal transition to include fibre in their meal planning.

“Changing hormones lead to less-than-ideal changes to our gut microbiome,” she says. “Aim for at least 25 grams or more per day and try to include at least 30 or more different plants per week.”

‘Fifty and flying’

For Needle, starting a personalised plan focused on balancing metabolism and optimising health proved her turning point.

“I began at 74 kilograms in February of 2023, just before turning 50 in May, and by mid-May I was 59 kilos. I was 50 and flying,” Needle says.

“More than the weight loss, it was how I felt about myself and my body that was the revelation. It has unleashed a confidence physically I’ve never had.

“After battling with body and weight issues for 40 years, this is the first time where I have felt I am truly living life to my fullest. The feeling is priceless.”

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