Nearly all women experience a change in their body shape during perimenopause and menopause and this often includes weight gain. Understanding the changes in your body and the implications for your weight and physical health, as well as having insight into your own eating habits, is key to maintaining a healthy weight and optimising your future health.
Why might your body change shape at menopause?
As a response to a lack of estrogen
When there is less estrogen from your ovaries, your body will try and get it from fat cells instead (which produce a different type of estrogen). There may be an increase in fat or a shift in the distribution of fat towards your middle, tummy area. There may also be an increase in the ‘internal’ visceral fat that surrounds your organs.
Your nervous system is supported by estrogen so when this hormone falls, your body may respond with a stress reaction that releases adrenaline and cortisol – the stress hormones. A cortisol imbalance can lead to a burst of glucose (energy in case you need to ‘flee the threat’) but if the glucose isn’t used up through physical activity, your body will store it away as fat instead. This stress reaction over time can cause insulin resistance and may lead to harmful fluctuations in your blood’s sugar levels that increase the risk of developing type 2 diabetes.
A lack of estrogen can cause widespread joint pains and muscle aches and many women reduce their regular exercise and other activities because of this.
Sleep is commonly affected by menopause due to night sweats or needing to use the toilet. But there is also a disruption to melatonin (the sleep hormone) which can in turn raise cortisol and cause you to wake up and perhaps feel anxious, have a racing heartbeat, or have food cravings. This can be very tiring and if cravings are acted upon, it may lead to weight gain.
A disruption to your hunger hormones
Poor sleep can also trigger the hunger hormone ghrelin and decrease the hormone leptin that makes you feel full. If your body’s fat levels increase, it can also disrupt the way leptin works and affect the signals that normally let you know you’re full, which can lead to overeating.
A slower metabolism
Testosterone is another hormone that declines at perimenopause and menopause. This may lead to a fall in energy levels and a lower metabolic rate meaning that you burn fewer calories than you did before. This can make it harder to lose weight when you try. A lack of testosterone will also influence how motivated you are to exercise and your stamina when doing so.
Benefits to staying a healthy weight
There are many diseases that are linked with weight gain and obesity such as type 2 diabetes, high blood pressure, heart disease, stroke, osteoarthritis and several types of cancer.
There are also benefits to your mental health, your mood and your quality of life when you maintain a healthy weight.
Perimenopause and menopause can lead to a drop in confidence and changes to your self-image; weight gain often exacerbates these negative feelings.
How to stay a healthy weight
Have a realistic mindset
Maintaining or reducing your weight does not have to be about diets and focusing on the scales. Think long term not quick fix, and aim for some small changes that are realistic for you. Start with just changing one thing about your diet or activity levels and focus on that.
Read our information for and base any nutrition plans and food choices on these principles.
Be kind to yourself
Watch how you talk to yourself and avoid the ‘you always fail at this’, or ‘you’ll always be overweight’ inner dialogue. If you don’t do what you had planned on one day, be gentle with yourself, figure out why it didn’t work and try again tomorrow.
Is it really hunger?
It’s easy to misinterpret sensations of hunger when it may be more due to boredom, unhelpful routines and associations, thirst, low mood or stress. Ask yourself what you’re really feeling and why, before reaching for a snack. Try having a drink, going for a short walk, or distracting yourself with a phone call or watching TV instead.
Plan ahead and keep a food diary
Have a weekly plan for your meals and stick to this when shopping. When you have time to make healthy food from scratch, batch cooking and freezing portions can be very useful.
In a food diary, list the ‘what, where, when and why’ of the foods you eat each day (and drinks). This will help you see if you have a healthy balance of food groups, notice what foods keep you fuller for longer. Spotting patterns in your diary will help you identify trickier times in the day or week when good intentions sometimes go out the window. Plan ahead for how you will manage these times, what types of snacks you will reach for, or a distraction you will turn your attention to instead.
Reduce alcohol and sugary drinks
It’s easy to forget about the calorie and nutritional content of drinks and focus solely on the food you consume. Look at what you drink too as this is often where additional calories lie and alternatives can be tried instead. There are many health benefits to reducing your alcohol intake in addition to reducing weight gain.
Eating within a set window of time
If you tend to eat snacks between every meal and late into the evening, your body is not having enough down-time from the work of eating and digesting. This downtime is needed to unlock physiological repair pathways that protect against illness and obesity.
Time-restricted eating is when you set, for example a 6, 8, or 10 hour window to eat in and the rest of the time you only have simple drinks like water or tea. This means stopping eating completely by 6pm and not having breakfast until 9 or 10am. You can work out any time window to suit you as long as your eating time is no longer than 10 hours max in duration.
Some studies show time-restricted eating can lower your daily calorie intake and help with weight loss. It may also increase daytime alertness, help your mood, prevent or reverse metabolic disease and improve liver function.
HRT including testosterone
Hormone replacement therapy can help reduce the effects described earlier that are caused by a lack of estrogen and testosterone in the body.
HRT usually brings relief from symptoms that may stop you exercising and being more active, and testosterone may bring benefits to your metabolic rate and improve levels of energy and motivation.
Some women feel so awful due to their perimenopausal or menopausal symptoms that eating healthily and doing regular exercise is extremely difficult, and it is not until their hormones are topped up with HRT that healthy lifestyle changes can occur.
Support from others
It can be hard to maintain healthy routines and the motivation to reduce weight or prevent weight gain. Support from a partner, family and/or friends can really make a difference to your chances of success, so speak with them about your intentions and outline the changes you would like to make. Having someone close to you who is also trying to make similar changes is beneficial too so you can support and encourage each other.
There are plenty of websites and apps that target weight loss too. This NHS web page lists many of them, including links to food plans, recipes and support services.
Last updated: June 2026
