Weight management in perimenopause

Weight gain is one of the most common symptoms of perimenopause and menopause. Between the ages of 45 and 55, women can gain on average ½ - 2kg a year. This weight gain is driven by a combination of hormonal, metabolic, and lifestyle changes, and also the ageing process. Through the whole process, it's the hormonal changes that bring a hoard of other unpleasant symptoms - brain fog anyone? Night sweats? Insomnia? - that can augment weight gain. Lets take a look at these mechanisms and consider tweaks in your diet to mitigate them. 

Hormonal changes and fat redistribution

Through perimenopause, oestrogen levels begin a journey of wild fluctuations and eventual decline. There are three forms of oestrogen - estradiol (E2) is the primary estrogen hormone and the one that declines during perimenopause and menopause. Estradiol helps regulate fat metabolism and where fat is stored. As estradiol drops, the body shifts from storing fat in the hips and thighs to the abdominal area, leading to increased belly fat. Progesterone also decreases through perimenopause and though it doesn’t necessarily cause fat gain, it can lead to water retention and bloating. Meanwhile, testosterone becomes relatively higher, which contributes to increases in visceral fat (fat deposits in and around your organs).   

Skeletal muscle loss

Estradiol plays an important role in maintaining skeletal muscle mass and strength. As estradiol  reduces, it contributes to age-related decline in muscle mass too (sarcopenia). Estradiol actually contributes to numerous functions in skeletal muscle, from regeneration and repair, mitochondrial function, inflammation, and insulin sensitivity. A topic for another day! The decline in skeletal muscle may contribute to weight gain via changes in metabolism and burning less calories at rest.   

Insulin resistance

Estradiol helps to regulate insulin sensitivity. When it declines approaching menopause, insulin resistance increases compared to your younger self. To complicate things however, estradiol's effects on insulin sensitivity is concentration-dependent, with high levels potentially impairing insulin sensitivity too. Reduced insulin sensitivity means that the body becomes less responsive to insulin. This causes the body to store excess carbohydrates as fat. Plus it may also increase appetite and cravings. 

Changes in appetite-regulating hormones

Estradiol has sensors in the brain that regulate food intake and satiety. As estradiol levels decline, you may experience increased food intake and potentially weight gain via disruption of the brain's hunger and satiety signals. Estradiol may influence leptin, a hormone that signals satiety (feeling full), potentially reducing its effectiveness when estradiol levels are low. Additionally, estradiol may modulate the effects of ghrelin, a hormone that stimulates hunger, potentially increasing hunger signals. 

Reduced sleep quality

During perimenopause, progesterone levels gradually decline, which has significant effects on both sleep quality and weight gain. Progesterone has a natural sedative effect and helps regulate sleep cycles. As levels drop, you may experience insomnia, lighter sleep, and frequent awakenings. This can be worsened by night sweats and hot flushes caused by fluctuating estradiol. Poor sleep leads to increased cortisol (stress hormone) production, which can further disrupt sleep and create a cycle of fatigue and stress. Chronically higher cortisol promotes belly fat storage. Sleep deprivation also increases ghrelin and decreases leptin levels, increasing cravings for high carbohydrate and sugary foods. 

What you can do

Diet is the most important modifiable factor for weight management. As your hormone levels make the inevitable changes through perimenopause, you can see that these changes have far reaching effects. In particular, skeletal muscle declines and insulin sensitivity decreases. To help    

offset this, the relative amounts of protein and carbohydrates in your diet are crucial. Your requirements for these macronutrients are now changing compared to your younger self. I often hear “I’m eating exactly the same as I always have, yet still putting on weight!” This may indeed be the problem - your diet as it always was, no longer fits the today you.  

Increase protein intake 

Most women are not consuming enough protein. Adequate protein intake (along with resistance exercise) will help maintain/reduce the reduction of skeletal muscle mass. Both diet and exercise are important here. Adequate protein intake also helps with satiety, and reduces sweet cravings, leading to an overall reduction in total food intake. Protein also has a higher thermic effect compared to carbohydrate and fat. This means your body burns more calories digesting and metabolising it. 

How much protein you need is really based on your size, activity level, and goals, but a general starting point will be about 1.6g of protein per kg of body weight per day. So if your body weight is 70kg, this will equal 110g protein per day. The quality of protein is also important. Animal sources DO tend to be superior simply because of their complete amino acid profile, lower calorie-to-protein ratio, and higher digestibility. For managing weight, choose lean sources of protein. If plant based, sources such as tofu are excellent. But all plant sources also tend to contain not-so-insignificant quantities of carbohydrates and /or fats which increase their calorie-to-protein ratio. Plant sources of protein such as legumes, nuts, and seeds are actually not particularly high in protein - these are better described as great sources of carbohydrates (in the case of legumes) or fats (nuts, seeds). If you attempted to achieve most of your 110g protein per day from these sources you will be consuming far more calories from carbohydrate and fat than would support weight loss. Protein supplementation from whey or plant protein powders, or collagen peptides can be very helpful too, as part of an otherwise wholefoods diet. Plant based or not, consistently achieving optimal protein intake is easy, if properly planned. 

Review your carbohydrate intake

You will more likely require less intake of total carbohydrates. As insulin sensitivity decreases, your body will store excess carbohydrates as fat. That being said, the type of carbohydrate MATTERS. Not all carbohydrates are “bad” - vegetables and fruits are carbohydrates, so are wholegrains and legumes. These carbohydrates are all rich in fibre, which, admittedly important through the whole life cycle, is super important through perimenopause. Fibre is crucial for gut health, and also promotes satiety. However, refined carbohydrates and sugars tend to be more palatable, are easily over-eaten and feature heavily in many snacks, packaged foods, takeaways and restaurant foods. Think white bread, rice, noodles, pasta, most breakfast cereals, snack bars, confectionery, and bakery items. While I don’t agree that these need to be eliminated completely to manage weight, they can begin to contribute more to weight gain than previously, especially when they are being consumed on a regular basis. 

Don't skip meals!

While it may seem to be the intuitive thing to do (skip a meal = less calories), what that actually results in is a lost opportunity to consume sufficient protein and essential nutrients overall. Plus, skipping meals can disrupt hormonal imbalance (you don’t need more of this during perimenopause) and in the long term, slow your metabolism. More often than not, breakfast is the victim of this. Most of us are busy and rush out the door. You may not feel hungry for the first few hours after waking, and it’s relatively easy to make it to lunch time surviving on just coffee but this inevitably results in higher snacking behaviour later in the day, sugar cravings, overeating, and afternoon slumps. 

Reduce or eliminate alcohol  

I cannot stress this enough. Alcohol intake in women in their 40s and beyond has become increasingly normalised. Drinking alcohol, even just one or two drinks, can significantly exacerbate symptoms of perimenopause, especially sleep quality and mood swings. Regular alcohol intake not only adds to your total calories in, but it places extra stress on the liver to process it. This is important to note, as the liver plays a crucial role in processing and regulating hormones such as oestrogens, insulin, and thyroxine by metabolising and excreting them from the body. 

While it might seem overwhelming to think that an entire diet overhaul is necessary, in reality it might just be a few tweaks. Be honest with yourself about your food intake - keep a food diary for a few days to see what you are really consuming. Engage with a professional such as a Registered Nutritionist or Dietitian to assist with personalised recommendations to best support you during this inevitable lifestage.