Weight Gain in Perimenopause
What Every Woman Should Know Before Trying New Year Diets
By Dr. Natalie Barriball
One of the most popular New Years resolutions is to lose weight. People will often start a January diet that doesn’t make it to February, and then feel defeated when the diets aren’t sustainable and the weight won’t come off. Especially for perimenopausal women, weight gain happens quickly and weight loss seems impossible.
But what if I told you there is a much healthier and effective way to work toward weight loss? If you’re in perimenopause and noticing weight gain—especially around the midsection—it’s not a lack of discipline. It’s physiology. This is why quick fixes and extreme diets often fail women, they work against your physiology. Instead, understanding why it’s happening helps you choose strategies that are realistic, sustainable, and actually supportive of your hormone health.
Before you jump into a new diet this New Year, here’s what you should know.
Cortisol: The Stress Hormone (1)
During perimenopause, ovarian hormone levels fluctuate dramatically. This makes the brain more sensitive to stress and can increase baseline cortisol levels.
High cortisol can cause:
Weight gain, particularly around the mid-section.
High cravings, especially for sugar and carbs.
Waking up at 2–4 a.m.
Fatigue.
Brain fog and memory issues.
Bloating and digestive issues.
Afternoon crashes.
Difficulty losing weight despite eating well.
Chronic stress, both emotional and physiological, increases cortisol even further. Cortisol tells the body to store rather than burn energy. This means that intensive diets and over-exercising can actually have the opposite effect, leading to increased weight gain or inhibited weight loss.
Gentle shifts are more helpful than strict ones. Such as:
Daily 10–20 minute walks.
20–30 grams of protein in the morning.
Not drinking coffee on an empty stomach.
Breathing techniques that activate the vagus nerve.
Consistent sleep/wake times.
Insulin: The Master of Blood Sugar (2, 3)
As estrogen declines in perimenopause, the body naturally becomes more insulin resistant. Blood sugar is high after meals but is less absorbed by tissue, causing insulin to go higher and higher. Insulin promotes the growth of fat tissue, increasing weight and making weight loss more difficult. On top of this, high cortisol increases blood sugar and promotes insulin resistance too!
Signs that insulin resistance may be occurring include:
Afternoon fatigue.
Sugar cravings after dinner.
Weight gain around the abdomen.
Feeling shaky or irritable from skipping meals.
Needing more caffeine to function.
Brain fog.
Insulin resistance isn’t treated with intense restriction, but rather gentle stability.
25–35 grams of protein at each meal.
Fiber-rich foods, the goal is 35 grams per day.
No naked carbs: always pair carbs proteins, fiber, and/or fats.
Light movement after meals.
Estrogen: The Hormone You Don’t Want to Leave (4, 5, 6)
Most people only think about estrogen in relation to reproductive health, but it also plays major roles in metabolism and overall weight.
As estrogen fluctuates and trends downward:
Metabolism slows down.
Appetite signaling becomes less predictable.
Fat is redistributed from hips/ thighs to the abdomen.
Sleep becomes lighter.
Mood swings impact eating patterns.
Muscle mass is lost.
Insulin sensitivity goes down.
Weight loss that seems sudden or out of proportion to diet and lifestyle factors could be due to estrogen—so it’s not your fault! However, there are still ways to support this hormone and have it work for you, not against you, in your weight loss journey.
Support metabolism of estrogen in the liver through fiber, cruciferous vegetables, and regular bowel movements.
Reduce xenoestrogen exposure: minimize plastics, fragrances, and endocrine-disrupting chemicals.
Ensure adequate intake of proteins and fats. Insufficient intake is common in intense dieting, but these macros are needed to build hormones, muscle, and stabilize metabolism overall.
Manage stress as high cortisol directly suppresses healthy estrogen signaling.
Strength train regularly because muscle increases estrogen sensitivity and metabolic response.
Consider individualized hormone therapy or herbal support. Check out these blog posts for more information on hormone replacement therapy and natural menopause support.
Muscle Decline: The Silent Driver of Metabolic Slowdown (7, 8)
Beginning in our 30s and accelerating in our 40s and 50s, women lose muscle mass faster than men. Estrogen decline speeds this up even further.
Why this matters:
Muscle is metabolically active.
Less muscle means a slower metabolism.
Reduced muscle causes poorer glucose control and increase insulin resistance.
Muscle loss increases the risk of injury.
Many women unintentionally reduce strength training during this phase because of fatigue, joint pain, or uncertainty about where to start; but building muscle is one of the most powerful ways to support hormones and weight in midlife. And the good news is that you don’t have to become a body builder to get the benefits!
Aim for:
2–3 non-consecutive sessions per week.
30–60 minutes per session, but even starting with 10 minutes can yield meaningful results.
Compound movements like lunges, squats, deadlifts, etc. work multiple muscle groups at one time, making workouts more efficient.
Start with bodyweight and resistance bands, and gradually move up in weight and resistance.
Consistency is key over intensity. Keep workouts sustainable, even if that means starting slow.
The Bottom Line: If you’ve been feeling frustrated or confused about your body during perimenopause, you’re not alone and you’re not doing anything wrong. Weight loss can be burdensome but it doesn’t have to be. Understanding your body is the key to making meaningful and long-term changes that not only help you achieve a weight you feel great at, but enhance your overall health, wellbeing, and longevity. This New Year, instead of shame or punishment, focus on support. Gentle, consistent habits that regulate stress hormones, stabilize blood sugar, support estrogen balance, and rebuild muscle lead to sustainable changes and benefits that last for many new years to come.
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