Weight gain during perimenopause is incredibly common. Between the ages of 50 and 60, on average patients will gain between five and seven pounds. While it can be harder to lose weight during this time, it doesn’t mean weight gain is inevitable.
“When feeling at our best, we can be really intentional and proactive,” said Yale New Haven Hospital gynecologist Catherine Salva, MD, MSEd, professor and vice chair of education in the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine. “Understanding the cardiometabolic changes that happen and the potential symptoms that might interfere with the ability to engage and adhere to dietary and exercise interventions, it’s quite possible to feel well and even great during this time period.”
What causes weight gain during perimenopause?
There are several factors associated with weight gain during perimenopause. Common symptoms such as hot flashes, sleep disturbances and mood changes can all contribute. Yet those symptoms are not entirely to blame.
“I think weight gain during that time frame is mostly related to age,” said Dr. Salva. “But as women get older, we tend to lose muscle mass, and the decrease in estrogen and overall change in hormone balance in perimenopause can contribute to the weight gain.”
“It also tends to accumulate in areas where it might not have been in the past. So, for women, during the premenopausal years, weight gain tends to happen more in the hips and thighs. During perimenopause, weight gain shows up more in the midsection.”
How to prevent weight gain during perimenopause
Following a healthy lifestyle is important for everyone as we age. That means paying attention to diet, exercise and maybe medication changes.
Exercise: Cardiovascular exercises are important for heart health, but as we age, it’s crucial to incorporate resistance training to combat the loss of muscle mass that happens naturally.
Diet: Dr. Salva says the Mediterranean diet, with its focus on whole grains, lean proteins like fish, fruits, vegetables and healthy fats like olive oil, is a good choice. During perimenopause, patients should also focus on getting enough protein to help support muscle mass and avoid processed foods and excess sugar intake.
Hormone therapy: Dr. Salva says a common misconception is that hormone replacement therapy impacts weight. Instead, hormone therapy is “weight neutral,” and can actually help combat weight gain because it alleviates other symptoms.
“It can help with the hot flashes and the sleep disturbance and maybe some mood changes. And so, if you're taking those off your plate and you're just overall feeling better, you tend to be in a much better position to either initiate or stick to a healthy diet and exercise regimen,” said Dr. Salva.
In addition, GLP-1 medications are safe to be taken alongside hormone therapy, and studies suggest they can be synergistic. Those interested in taking a GLP-1 medication for weight loss should speak with their clinician to find out if it’s right for them.
Menopause and heart health
While some patients may look at weight gain as just an annoying side effect of aging, it’s important to take it seriously because it can coincide with an increased cardiovascular risk.
“There is the traditional focus on men as the ones at risk of cardiovascular events. And I think it’s important to recognize that this is a time of vulnerability and discovery for women to understand what our risks are and to be proactive in mitigating those risks,” Dr. Salva said.
One way to assess those risks is to talk to a clinician who specializes in women’s heart health. For example, the Women’s Heart and Vascular Program offers evaluations and diagnostic testing to help assess changing needs during perimenopause and beyond.
