Weight and body changes in perimenopause

Your waistband feels tighter, even though you don’t think you’re eating or moving any differently. The NHS lists weight gain as a common perimenopause symptom, and says it often happens around the stomach and upper body. Women’s Health Concern, the patient arm of the British Menopause Society, describes it as one of the most common and distressing symptoms women report, affecting over half of them.

So if your shape is shifting, you’re in very large company.

What is changing in your body

Several things happen at once. As oestrogen falls, the body becomes more likely to store fat inside the tummy, around the organs. Before perimenopause, any weight gained tended to spread out more evenly.

The National Institute on Aging (NIA) in the US adds that during this transition the body begins to use energy differently, and the way fat is spread around the body changes. Your waist could get larger. You could lose muscle and gain fat. NIA also mentions skin that becomes thinner and drier, and joints and muscles that feel stiff or achy.

Muscle matters here. The body loses some muscle as part of getting older, and that slows the rate at which it uses energy. Women’s Health Concern calls the overall picture a “perfect storm”, with hormonal, metabolic and lifestyle changes all playing a part.

NIA points out that researchers are still exploring how these changes relate to hormones and to growing older. The Menopause Society links midlife weight gain to both.

Why it can feel harder right now

Perimenopause rarely brings just one change. Insomnia, low mood and aching joints all make managing weight harder, both physically and emotionally, and Women’s Health Concern suggests weight is easier to tackle once other menopause symptoms are under control.

That’s a useful order of things. If night sweats are wrecking your sleep, or your mood is low, treating those first is a reasonable place to start. A GP or doctor can talk you through the options.

Eating for comfort is very common too, especially when you don’t feel like yourself. Things that can help include cognitive behavioural therapy (CBT), breathing exercises and simple distraction.

HRT and weight

This is one of the most common worries about starting HRT (hormone replacement therapy, called hormone therapy or HT in the US). The main UK and US sources agree on the answer, though they word it differently.

• Women’s Health Concern (UK): there is no evidence that HRT is responsible for weight gain. Some people get bloating and fluid retention with some types of HRT, but this usually settles over time.
• The Menopause Society (US): weight gain is a common problem in midlife, linked to both ageing and hormone changes, but hormone therapy is not associated with weight gain.

If bloating bothers you after starting HRT, mention it at your review. Don’t stop a prescribed medicine without talking to your doctor.

Bloating that doesn’t settle, or that’s new, is worth getting checked rather than put down to HRT. The NHS lists a swollen tummy or feeling bloated frequently (roughly 12 or more times a month) as one of the main symptoms of ovarian cancer, along with feeling full quickly or having no appetite, pelvic pain, and needing to pee more often or urgently. Losing weight without trying is on its list too. These symptoms are very common and can be caused by many different conditions, but the NHS still says to see a GP if you have any of them. In the US or elsewhere, see your doctor.

Why the middle gets attention

Fat stored around the middle can affect health more than fat stored around the hips. The body can become less sensitive to insulin, and unhelpful changes in blood sugar, cholesterol and blood pressure become more likely.

Treat it as a nudge to look after your heart. You can ask your GP or doctor about blood pressure and cholesterol checks.

Building strength

Strength exercise is a good place to start. Women’s Health Concern says regular, gentle strength exercise helps build new muscle. It doesn’t have to mean a gym: exercises using your own body weight, simple moves with weights such as squats, and resistance bands all count.

The benefits go beyond weight. NIA says that after menopause it matters to keep eating a healthy diet, stay active, and get enough calcium and vitamin D for bone health. It’s also a good time to add something restorative, like yoga, Pilates, stretching or breathing exercises.

Start with one thing, then add others as you feel more confident. Doing a little more activity on most days helps more than overdoing it once a week. If walking is hard, swimming or cycling are options. Talk to a healthcare professional before starting a new exercise routine if you’re unsure what suits you.

Progress can show up long before the scales move, or without them moving at all. Try noting how much energy you have and how confident you feel. Your shape may also change before your weight does, especially once you add strength work.

Eating without a strict diet

Women’s Health Concern is clear that fad diets often lead to a cycle of quick weight loss followed by more weight gain. It doesn’t recommend very low-calorie diets, long periods without eating, or cutting out whole food groups. Your body needs good nutrition, and your bones and heart need particular care around menopause.

What it does suggest is a way of eating you can keep up for years, more like a lifestyle than a quick fix. Small, steady changes help, such as eating at regular times and eating slowly until you feel satisfied. Slip-ups are expected, and doing a bit better counts.

If food or weight worries are taking over

Changes in your body can be hard to live with. If thinking about eating, your weight or your shape is taking up a lot of your day, there’s support for that.

In the UK, Beat’s helplines are free from landlines and mobiles. The numbers are 0808 801 0677 for England, 0808 801 0432 for Scotland, 0808 801 0433 for Wales and 0808 801 0434 for Northern Ireland. Beat also offers webchat and email. You don’t need a diagnosis to use it. For medical advice, Beat suggests contacting your GP or 111.

Your body can show strain too. The NHS lists feeling your heart racing, fainting or feeling faint among the physical signs of an eating disorder. If that’s happening and you’re eating very little, making yourself sick or taking laxatives, contact your GP or NHS 111 today, or your doctor in the US.

In the US, the National Alliance for Eating Disorders runs a free helpline on 866-662-1235. Its therapists can help you find treatment. It isn’t a crisis line: for crisis support, call or text 988.

Getting help

Book a GP appointment in the UK, or see your doctor in the US and elsewhere, if changes in your body or other perimenopause symptoms are worrying you. Bring a note of your symptoms, how you’re sleeping and anything you’d like to ask about HRT. A log of these over a few weeks, in Ruva or on paper, can make the conversation easier.

See a GP or your doctor soon, too, if bloating, feeling full quickly, pelvic pain, peeing more often or losing weight without trying keeps happening.

Call 999 now in the UK or 911 in the US, or your local emergency number, if you or someone else is in immediate danger or having a medical emergency. If you’re in a mental health crisis or having thoughts of suicide, Samaritans are available on 116 123 at any time of day or night in the UK, and in the US you can call or text 988.