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Does perimenopause cause belly fat – and what can I do to combat it?
Written byLiz Connor
Reviewed byDr Emma Ross
As you approach or go through menopause, it’s totally normal to notice extra weight settling around your midsection. We asked some women’s health experts why and what you could do about it
Summary
1Why does weight gain happen during perimenopause?
“During this time in life, researchers have found that chaotic hormone fluctuations dramatically change how your body stores fat,” says Dr Ross...
2What can help perimenopausal weight gain?
The good news? If healthy weight loss happens to be one of your goals, there are science-backed tips that can help...
3How to lose belly fat during perimenopause
If you’re looking to sustainably lose belly fat during perimenopause, here are a few positive changes you could build into your lifestyle...
Recently found yourself frustrated because your usual weight loss strategies aren't working as well as they used to? Then you’re not alone.
Many women find that despite sticking to their regular diet and exercise routine, their body shape changes to some degree during perimenopause – the months and years leading up to their final period. In fact, researchers estimate1 that the average person gains roughly 1.5kg (3lbs) per year during this transition, totalling 10kg (22lbs) of extra weight by the time full menopause kicks in.
So, what’s driving this weight gain? Is it hormonal? Could lifestyle changes and disrupted sleep patterns be playing a part?
We talk to Dr Emma Ross, physiologist and chief scientific officer, and Baz Moffat, women's fitness coach to answer all your questions. Plus, we share essential strategies to support your fitness goals.
Why does weight gain happen during perimenopause?
The internet is chock full of weight loss tips and advice, but when it comes to perimenopause there’s still a big gap in the conversation.
“If you think back to puberty, when levels of the female sex hormone were riding high, you probably noticed that your body started storing fat around your hips and breasts, creating a curvier silhouette. That’s because oestrogen was busy interacting with specific receptors in your fat cells, essentially telling them, ‘Store it here,’” she says.
Scientists believe that this female-specific pattern of fat storage isn’t just a random genetic quirk; it’s actually an ancient evolutionary trait,2 designed to prepare the body for pregnancy and breastfeeding by creating energy reserves in just the right places.
Fast forward to the perimenopausal years when oestrogen levels start to dip and your body’s composition starts to shift more in line with male patterns as you prepare for your final period. Suddenly, the fat that once settled on your hips and thighs migrates to your abdomen, leading to the familiar ‘middle-aged spread.’
Insulin resistance and perimenopause
Here’s an interesting observation: a recent study3 found that while the number of fat cells actually decreases during perimenopause, the amount of fat stored in each cell actually increases. “This switch can sometimes lead to insulin resistance, a condition where the hormone insulin, which helps control blood sugar by moving glucose into cells, becomes less effective,” explains Dr Ross.
“When insulin levels run high, it encourages fat storage – especially around the belly. So, while your fat cell count might technically be going down, the visceral fat that remains in each cell is higher, adding to stubborn perimenopausal belly fat,” she says.
And, if all that wasn’t tricky enough to contend with, some emerging research in a small group of women found that during perimenopause, levels of ghrelin – the hormone that makes you feel hungry – tend to rise.4 While there's more research needed to confirm these findings, if this holds true, you might find yourself reaching for snacks more often, while your body’s ability to feel full becomes less reliable too.
“This means that you’re not just battling hormonal changes and (potentially) insulin resistance – you may also up against a greater appetite and a more unpredictable sense of satiety,” she says.
“Not only can midlife be a naturally stressful time with lots to juggle, but the hormonal roller coaster that’s happening beneath the surface can disrupt the normal release of cortisol”
Can my lifestyle play a role too?
Yep, it can. Along with natural hormonal shifts diverting fat to new areas of your body, there are other factors that can contribute to weight gain during perimenopause.
“By the time we hit our 40s and 50s, busy lives, family responsibilities, work deadlines and time pressures usually mean we exercise less,” adds Baz. “And, when we move less, we’re more likely to gain weight.”
Feeling extreme fatigue is common during perimenopause, thanks to night sweats and anxiety that can keep you awake at night. “We know that consistent poor sleep can lead to comfort eating, higher stress levels and a higher probability that you’ll bail on your gym session – all of which can add to the weight gain equation,” Baz says.
“Not only can midlife be a naturally stressful time with lots to juggle, but the hormonal roller coaster that’s happening beneath the surface can disrupt the normal release of cortisol, causing high levels to course through the body,” says Dr Ross. And guess what? Chronically elevated levels of this hormone have been linked to both inflammation and weight gain.5
Emerging research in the field of gut health suggests6 that the diversity of your microbiome could be linked to oestrogen levels. So, the hormonal changes happening in the body during menopause may be able to throw off the balance of bacteria in your gut, affecting how your body’s metabolism responds to food. Although, more research is required to establish this link.
“Sarcopenia – the medical term for age-related muscle loss – means we shed up to 8% of our muscle mass7 per decade after 40,” she says. As muscle mass naturally declines, a knock-on effect is a slower metabolism, so your body burns fewer calories at rest.8
During perimenopause, many women and non-binary folk find that alcohol hits harder. “It can disrupt sleep, increase stress levels and slow down fat burning,” says Dr Ross. Plus, reaching for a glass of wine to unwind from symptoms can sneak extra liquid calories into your diet.
What can help perimenopausal weight gain?
The good news? If healthy weight loss happens to be one of your goals, there are science-backed tips that can help. By simply understanding the changes that are going on, you can fine-tune your weight loss strategy and work with your body in a new way.
Before we dive in though, it’s worth asking yourself if weight loss is really necessary. There’s absolutely no need to worry if you’ve noticed you’ve gained a few extra pounds recently.
“Lean into your body’s natural fluctuations, take the pressure off and rethink everything we’ve been taught about toxic diet culture”
“As long as you’re still within a healthy BMI range, weight gain and changes in fat distribution are natural parts of ageing,” reminds Baz. “Recognising this can help you to lean into your body’s natural fluctuations, take the pressure off and rethink everything we’ve been taught about toxic diet culture.”
How to sustainably lose belly fat during perimenopause
Ditch the diet
When you start to notice weight gain, it’s tempting to go on an extreme diet. “Crash dieting is not the key to effective weight loss, though” stresses Dr Ross. “In fact, slashing your calorie intake can actually backfire, undermining your efforts to lose weight.” Studies9 have shown that calorie restriction not only slows down your metabolism, but it could also put your body in a stressed state and leads to muscle loss, all of which can increase belly fat.
Instead of opting for juice cleanses and fasts, focus on eating a healthy balanced diet, with plenty of wholegrains, protein sources, fruits, nuts, vegetables and ‘gut-friendly’ fermented foods.
“Fibre is super important as it helps to control your blood sugar and regulates insulin resistance, while protein becomes essential for rebuilding and replenishing lost muscle mass,” she says.
Switch to strength training
When we hit our 30s, our muscle mass decreases by 3-8% each decade.7 Instead of adding stress to the body with all-out HIIT sessions, you’ll reap bigger gains by switching to slow and focussed strength work.
Not only can lifting weights increase lean muscle mass, which in turn can help boost metabolism and burn more calories at rest, it’s statistically more likely to help you avoid belly fat.
A two-year study which looked at perimenopausal women who regularly weight trained10 – as opposed to aerobic activities like running or cycling – found that they gained around three times less stomach fat on average than their non-weightlifting peers.
Schedule active recovery days
Rest days can often feel like a waste of time, but research underscores12 their importance; all the gains from exercise are basically made in the ‘repair’ phase. Plus, our body needs longer amounts of it during the perimenopausal phase, when our growth hormones are dwindling.
Recovery doesn’t have to mean sitting on the sofa all day though. Going for a walk with a podcast, foam rolling, stretching and gentle swimming are all great ways of increasing blood flow to muscles, which can help to speed up the healing process.
Reduce stress
The timing of menopause can coincide with a whole raft of midlife stresses like relationship issues, divorce, illness and caring for young kids or teenagers. Added to this, turbulent menstrual cycle hormones can leave our bodies in a stressed and inflamed state.
When your Slack notifications are popping off and you can feel your stress levels rising, tap into somatic exercises to shift some of the pressure. A short round of box breathing (inhaling for a count of four, out for a count of four), sitting in child’s pose for a few minutes or closing your eyes and taking a mental body scan can halt stress from tipping you over into overwhelm.
Practise ‘clean sleeping’
The NHS-recommended eight hours of sleep13 can be notoriously harder to come by during perimenopause, when we're battling hot flashes and racing nighttime thoughts.
“Tee yourself up for the best night’s rest possible by implementing sleep hygiene strategies, like keeping your room cool, limiting clutter, setting a consistent sleep schedule and unplugging devices an hour before dark,” suggests Dr Ross.
“Lots of people find that having a wind down routine, like a hot bath followed by a cup of chamomile tea, helps to create a smoother transition from waking to sleeping.”
Cut down on alcohol
Did you know that the average glass of wine contains around 120 calories? So if you’re regularly enjoying half a bottle in the evening, you could be adding up to 400 extra calories to your daily intake.
“Alcohol can massively exacerbate your perimenopausal symptoms too,” says Baz.
“So it’s a good idea to think about practising mindful drinking, especially in the luteal phase of your menstrual cycle, where we can be more sensitive to alcohol.” 14
Challenge yourself to drink-free days and track your progress using apps like Drinkaware. Stocking the cupboard with low or no-alcohol options means you can still enjoy a post-work tipple without the hangover – just check they’re not loaded with too many sugary ingredients first.
Eat with your gut in mind
In recent years, there’s been a mindset shift in the scientific community, with most health experts now agreeing that a healthy gut is the key to overall health. If we specifically look at weight, recent research15 found that certain bad gut bacteria are linked to health issues, including an increase in belly fat.
Taking care of your microbiome is as simple and inexpensive as serving up a diverse range of whole plant foods, including fruits, vegetables, nuts and seeds, legumes and whole grains. According to the large study by the American Gut Project, people who ate more than 30 types a week had a more diverse microbiome.16 All the more reason to plate up those plant points.
Your gut thrives on plant foods that are loaded with anti-inflammatory polyphenols, the micronutrients that give fruit and veg their vibrant colours. If you haven’t got time to drill into the complicated science of gut health, simply eating the rainbow (aka plants of all hues) is one of the ways to help support the balance of good bacteria in your bod.
The final say
When you get to know how your hormones change from your 20s to your 40s, it’s easier to be kinder to yourself and understand why most weight loss techniques fail. With this knowledge, you can adjust your approach and find strategies that actually make a difference.
As with most things in life, there are no quick fixes or magic ingredients. Real results come from making long-term, sustainable lifestyle changes. With consistency and patience, you’ll not only see positive changes to your weight, but also reap benefits for your sleep, energy levels and overall wellbeing.
- British Menopause Society. Tool for clinicians Information for GPs and other health professionals. Menopause: Nutrition and Weight Gain [Internet]. Available from: https://thebms.org.uk/wp-content/uploads/2023/06/19-BMS-TfC-Menopause-Nutrition-and-Weight-Gain-JUNE2023-A.pdf
- Abrahim M. Gestational potential space hypothesis. Evolution, Medicine, and Public Health. 2021 Jan 1;9(1):332–7.
- Abildgaard J, Ploug T, Al-Saoudi E, Wagner T, Thomsen C, Ewertsen C, et al. Changes in abdominal subcutaneous adipose tissue phenotype following menopause is associated with increased visceral fat mass. Scientific Reports [Internet]. 2021 Jul 20;11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292317/
- Stojiljkovic‐Drobnjak S, Fischer S, Arnold M, Langhans W, Ehlert U. Menopause is associated with decreased postprandial ghrelin, whereas a history of anorexia nervosa is associated with increased total ghrelin. Journal of Neuroendocrinology. 2019 Feb;31(7).
- Hewagalamulage SD, Lee TK, Clarke IJ, Henry BA. Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domestic Animal Endocrinology [Internet]. 2016 Jul;56:S112–20. Available from: https://pubmed.ncbi.nlm.nih.gov/27345309/
- Becker SL, Manson JE. Menopause, the gut microbiome, and weight gain. Menopause. 2020 Nov 23;Publish Ahead of Print.
- Volpi E, Nazemi R, Fujita S. Muscle tissue changes with aging. Current opinion in clinical nutrition and metabolic care [Internet]. 2004;7(4):405–10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804956/
- Moon JH, Choo SR, Kim JS. Relationship between Low Muscle Mass and Metabolic Syndrome in Elderly People with Normal Body Mass Index. Journal of Bone Metabolism [Internet]. 2015;22(3):99. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572038/
- Most J, Redman LM. Impact of calorie restriction on energy metabolism in humans. Experimental Gerontology. 2020 May;133:110875.
- Figueroa A, Going SB, Milliken LA, Blew RM, Sharp S, Teixeira PJ, et al. Effects of Exercise Training and Hormone Replacement Therapy on Lean and Fat Mass in Postmenopausal Women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2003 Mar 1;58(3):M266–70.
- Berin E, Hammar M, Lindblom H, Lindh-Åstrand L, Rubér M, Spetz Holm AC. Resistance training for hot flushes in postmenopausal women: A randomised controlled trial. Maturitas. 2019 Aug;126:55–60.
- Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Frontiers in Physiology [Internet]. 2018 Apr 26;9(403). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932411/
- NHS . Insomnia [Internet]. NHS. 2024. Available from: https://www.nhs.uk/conditions/insomnia/
- Evans SM, Levin FR. Response to alcohol in women: Role of the menstrual cycle and a family history of alcoholism. Drug and Alcohol Dependence. 2011 Mar;114(1):18–30.
- Amabebe E, Robert FO, Agbalalah T, Orubu ESF. Microbial dysbiosis-induced obesity: role of gut microbiota in homoeostasis of energy metabolism. British Journal of Nutrition. 2020 Feb 3;123(10):1–11.
- McDonald D, Hyde E, Debelius JW, Morton JT, Gonzalez A, Ackermann G, et al. American Gut: an Open Platform for Citizen Science Microbiome Research. Greene CS, editor. mSystems [Internet]. 2018 May 15;3(3). Available from: https://journals.asm.org/doi/10.1128/mSystems.00031-18
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