Perimenopause Weight Gain: Why It Happens And How To Lose It Safely

Weight gain during perimenopause and menopause is very common. And it may feel like the things that used to work for you and your body aren’t quite working in the same way anymore.

Your body is likely trying to adjust to a ‘new normal’, and with changes in hormones, sleep, activity levels, appetite and body composition all possibly happening at once, it could be overwhelming. But the reality is everyone’s different and the effects of perimenopause vary from person to person.

A common symptom you might notice during this stage is that your body may begin to store more fat in certain areas, particularly around the stomach and upper body. In this article, our experts explore why perimenopause may cause weight gain, the role hormone replacement therapy (HRT) can play in weight loss and weight gain, and how to lose weight safely during perimenopause.

Article summary:

• Perimenopause weight gain is common and can be influenced by factors like hormonal shifts, sleep, changes in body composition and energy levels.
• HRT isn’t a weight loss treatment, but it may help manage perimenopausal symptoms and have an overall impact on your daily habits.
• You can still lose weight during perimenopause. Lifestyle changes such as adjusting your diet and increasing your physical activity could help support you on your weight loss journey.

What is perimenopause?

Perimenopause is the stage that typically comes before menopause, when your hormone levels (for oestrogen and progesterone) and menstrual cycles change.

This stage can last for a few years before your periods stop altogether. During perimenopause, you might notice irregular periods, hot flushes, night sweats, difficulty sleeping, mood swings, fatigue and lack of focus. [1]

For many people, these symptoms develop gradually rather than as a sudden “menopause moment.” It’s also worth noting that metabolic changes affecting weight and body composition can begin years earlier, around early 40s, during the pre-menopause phase. Perimenopause affects people differently, and not everyone experiences the same symptoms or intensity. [1]

Does perimenopause cause weight gain?

Weight gain during perimenopause is common, as your body is responding to a number of internal changes while your reproductive system starts to slow down. There are a few reasons why this happens, including:

Hormonal changes:

Oestrogen levels fluctuate as you grow older before they start to decline. These changes can contribute to lower energy levels, disrupted sleep and reduced physical activity, which may reduce the number of calories you burn each day and make weight gain easier. They can also affect body composition by shifting fat storage away from the hips and thighs and towards the abdomen. [2]

Changes in muscle mass:

Lean muscle mass may reduce during perimenopause. Your muscles help you complete daily movements and burn calories (known as energy expenditure) even while you’re resting. However, having less muscle mass can also lower energy expenditure and contribute to weight gain. [3]

Irregular sleep patterns:

Prioritising quality rest is always important, but experiencing symptoms like hot flashes or night sweats may make it harder to enjoy a good night’s sleep. Lack of sleep can leave you feeling more tired during the day and have an impact on both your metabolism and eating habits. [4]

Activity levels change:

Some people could notice a decrease in energy levels during perimenopause, which could make it more difficult to stay active. Keeping up with everything from work to family commitments, hobbies and regular exercise, alongside perimenopause symptoms may take a bit more out of you, so you may find you're moving less which means you're not burning as many calories. [5]

Overall, weight gain during perimenopause can’t be tied to one singular reason. There are a few key factors involved beyond hormonal changes.

Is it normal to gain weight during perimenopause?

Yes. However, this doesn’t necessarily mean that everyone will gain weight during perimenopause,or that there aren’t ways to manage it. The weight gain you may notice, if at all, usually happens gradually and is a combination of ageing, hormonal shifts affecting fat stores around the abdomen, reduced muscle mass and changes in physical activity. [1]

What is HRT and can it cause weight gain?

HRT stands for hormone replacement therapy and it’s used to substitute hormones including oestrogen as it declines during perimenopause or menopause. HRT is known to help relieve symptoms like:

• Hot flushes and night sweats
• Sleep irregularity
• Vaginal dryness or discomfort
• Mood swings

There’s no evidence or research to suggest that using HRT can directly lead to weight gain. Weight gain during perimenopause may happen whether you take HRT or not, because of the internal changes happening at the same time.

The role of HRT during this stage is to help make your symptoms feel easier to manage. If lack of sleep or discomfort are making it difficult to exercise, HRT may help you feel like you can get back on track with your weight loss goals, but HRT isn’t a weight loss treatment. [6]

How can you lose weight during perimenopause?

If losing weight during perimenopause is your goal, you can focus on the same core habits which may have supported weight loss at any age. However, the main difference would come from how you tailor your approach to the changes happening in your body. That’s why regular movement, eating protein-rich foods and strength training are good habits to maintain to address perimenopausal symptoms.

Balanced meals:

You don’t need to be restrictive with your diet or cut out entire food groups for the sake of losing weight. Instead, try to aim for a balanced diet which includes a range of vegetables, fruits, whole foods and grains, protein-rich foods and healthier sources of fat. This is important for any weight loss journey, because your diet plays a key role in how your body stores and breaks down fat while hormonal shifts affect this process. [7]

Strength training:

Also known as resistance training, is a form of exercise that works your muscles by putting them against an external force like gravity or your own body weight. The goal isn’t to lift heavy weights or do resistance exercises your body may not feel prepared for. Regular movement with enough resistance to challenge your muscles and feel stronger over time is more sustainable. You could use resistance bands at home or even your own body weight with slow, controlled movements. [8]

Go for daily walks:

You may have tried a 10K step challenge at some point, but you don’t have to stick to this routine every day to see results. Walking is a great way to keep active because you can do it anywhere, any time. Either way, moving your body more as you enter perimenopause has lots of health benefits beyond losing weight. [9]

Can weight loss medication help during menopause?

Weight loss medication may help some people manage their weight during perimenopause or menopause. These treatments include medicines such as Wegovy (semaglutide) and Mounjaro (tirzepatide), which belong to a group of medicines called GLP-1 receptor agonists. They work by mimicking naturally occurring gut hormones that help regulate appetite and blood sugar. This can reduce hunger, increase feelings of fullness and support weight loss alongside a balanced diet and regular physical activity.

Before your healthcare professional can prescribe you a weight loss treatment, they’ll have to consider your BMI (or body mass index), existing health conditions, medical history and any other medication. Your healthcare professional can help you understand your options and recommend the most appropriate treatment.

In a recent study of women taking GLP-1 medication, the results suggested that it was more effective in women who were on HRT than not. [11]. While GLP-1s aren’t thought to directly improve common menopause symptoms, losing weight could help with hot flashes, sleep irregularity and night sweats. [11]

At MedExpress, we offer online consultations with regular clinical check-ins, and a range of weight loss treatments including Mounjaro Pen, Wegovy Pen, Wegovy Pill and Foundayo and our team can help you find the right treatment for you.

References

1. NHS website. Symptoms of menopause and perimenopause [Internet]. nhs.uk. 2026. Available from: https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/
2. Marlatt KL, Pitynski‐Miller DR, Gavin KM, Moreau KL, Melanson EL, Santoro N, et al. Body composition and cardiometabolic health across the menopause transition. Obesity. 2021 Dec 21;30(1):14–27. Available from: https://onlinelibrary.wiley.com/doi/10.1002/oby.23289
3. Ranjan P, Chopra S, Sharma KA, Malhotra A, Vikram NavalK, Kumari A. Weight management module for perimenopausal women: A practical guide for gynecologists. Journal of Mid-life Health. 2019;10(4):165. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6947726/
4. Sharma S, Kavuru M. Sleep and Metabolism: An Overview. International Journal of Endocrinology [Internet]. 2010 Aug 2;2010(270832):1–12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929498/
5. Fenton A. Weight, shape, and Body Composition Changes at Menopause. Journal of Mid-life Health [Internet]. 2021;12(3):187. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8569454/
6. NHS. Types of hormone replacement therapy (HRT) [Internet]. nhs.uk. 2023. Available from: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/
7. Prioritising protein during perimenopause may ward off weight gain [Internet]. The University of Sydney. Available from: https://www.sydney.edu.au/news-opinion/news/2022/10/13/prioritising-protein-during-perimenopause-may-ward-off-weight-gain.html
8. Bellicha A, Baak MA, Battista F, Beaulieu K, Blundell JE, Busetto L, et al. Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: An overview of 12 systematic reviews and 149 studies. Obesity Reviews [Internet]. 2021 May 6;22(S4). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365736/
9. Ungvari Z, Fazekas-Pongor V, Csiszar A, Kunutsor SK. The multifaceted benefits of walking for healthy aging: from Blue Zones to molecular mechanisms. GeroScience [Internet]. 2023 July 26;45(6). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10643563/
10. Nicolau J, Blanco-Anesto J, Bonet A, Félix-Jaume JJ, Gil-Palmer A. Effectiveness of Low Doses of Semaglutide on Weight Loss and Body Composition Among Women in Their Menopause. Metabolic Syndrome and Related Disorders. 2025 Jan 6;. Available from: https://pubmed.ncbi.nlm.nih.gov/39761057/
11. Castaneda C, Hurtado A, Tchang B, et al. The role of menopause hormone therapy in modulating tirzepatide-associated weight loss and cardiometabolic outcomes in postmenopausal women. Lancet Obstet Gynaecol Womens Health. 2026;2(2):e118. doi:10.1016/S3050-5038(25)00145-1 Available from: https://www.thelancet.com/journals/lanogw/article/PIIS3050-5038(25)00145-1/abstract