Perimenopausal Weight Gain: What You Need to Know

3 minute read

By: Vivian Manning-Schaffel|Last updated: May 11, 2022
Medically reviewed by: Sharon D. Malone

No matter how much self-love and self-acceptance we practice — and we do! — perimenopausal weight gain remains a common concern among women in midlife and beyond.

According to the Mayo Clinic, nearly two-thirds of American women, ages 40 to 59 years, and about three-fourths of us older than 60 years are overweight (with body mass index greater than 25 kg, or 55 lbs).

Indeed, Mayo shares the uplifting news that midlife women may gain up to 1.5 pounds per year. Multiply that by how long perimenopause can last (read: upwards of 10 years), the numbers can add up to more perimenopause weight gain than you bargained for by no fault of your own. 

Though a body positive attitude is a healthy attitude, as it turns out, we all should be a little concerned about any significant excess weight gain if only because of the impact it can have on our health outcomes. 

What are those health outcomes, you ask? We’re glad you asked. Here’s what you need to know about perimenopause weight gain.

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Increased blood pressure

According to the Mayo Clinic, blood pressure usually increases after menopause due to our shifting hormone levels and our higher BMI, or Body Mass Index, from perimenopause weight gain.

Weight gain and body fat distribution changes are responsible, at least in part, for a greater risk of cardiovascular disease in postmenopausal women compared with younger women with intact ovarian function. Cardiovascular disease is the leading cause of mortality in postmenopausal women, and the importance of risk factor modification cannot be overemphasized, warns the Mayo Clinic experts.

Insulin resistance

One major factor that contributes to excess weight gain in menopausal women is insulin resistance, caused by slower estrogen and progesterone production. 

Insulin resistance is what happens when our blood sugar begins to rise. Usually, what you eat is broken down into blood sugar, which signals your pancreas to release insulin, which goes into your body’s cells for energy. Once that happens, your blood sugar and insulin levels decrease. Insulin resistance happens when too much blood sugar enters the bloodstream and the pancreas pumps out as much insulin. 

Eventually, your cells become resistant to all of the insulin, the pancreas can’t produce enough insulin, and your blood sugar rises too high, which is damaging to the body. Left unchecked, it can potentially lead to Type 2 Diabetes, according to the CDC. This is why the menopause transition can be harder on women with diabetes

More intense hot flashes

Aside from perimenopausal weight gain, another symptom of perimenopause are hot flashes, or a sudden intense bout of body temperature dysregulation that can cause an intense bout of sweating — and there is some research out there that connects the two symptoms together. 

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A 2017 report published in Menopause — the journal of The North American Menopause Society (NAMS) — studied 749 Brazilian women, aged 45 to 60 and “showed that obese women suffered more severe consequences of hot flashes, which then caused them to stop certain activities and also decreased their work efficiency.” 

The study claims to support what’s called the “thermoregulatory theory,” or that BMI is positively associated with vasomotor symptoms (such as night sweats, hot flashes, and flushes because body fat “acts as a strong heat insulator.” 

Joint pain

Adding injury to the insult of a slowing metabolic rate and perimenopausal weight gain is joint pain, or menopausal arthritis, which weight gain can exacerbate. 

(Notably, a 2013 trial by the Women’s Health Initiative published in Menopause sought to learn if estrogen alone would ease joint pain, one of the most uncomfortable menopausal symptoms. Their findings did suggest that estrogen use in postmenopausal women with prior hysterectomy did, indeed, help to ease joint pain.)

Risk of UTIs/increased urinary urgency

During perimenopause and menopause, a lack of estrogen can put vaginal tissue through some changes. These sensitive tissues can weaken and become drier, leaving women at risk for vaginal dryness, painful sex, and an increased risk of developing urinary tract infections, or UTIs and increased urinary urgency. 

Perimenopausal weight gain can put added pressure on the bladder, compounding the problem. The Mayo Clinic finds, for example, that low-dose topical estrogen can be helpful in strengthening vaginal tissue,  soothing vaginal dryness , and decreasing UTI frequency. Talk to a menopause-trained doctor about your symptoms and figure out what might work best for you. 

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Clearly, perimenopausal weight gain isn’t the only symptom of the “change of life” that literally and metaphorically weighs on women. It can cause a domino effect of other menopause symptoms that make this stage of life uncomfortable. 

If you’ve noticed pounds starting to creep on and you think you’re perimenopausal, you can slow perimenopausal weight gain with the same approaches that work in your pre-perimenopausal days:

  • Upping your cardio through various forms of physical activity

  • Adding weight training to workouts to build muscle, burn fat cells, and maintain lean body mass

  • Consuming fewer calories

  • Decreasing the window of time spent eating throughout the day by intermittent fasting

  • Cutting down carbs

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None of these steps are a thrill but staving off significant perimenopausal weight gain will certainly be.

Vivian Manning-Schaffel

Vivian Manning-Schaffel is a women’s health writer and editor. She is currently a contributing writer at NBC Better and Shondaland.


  1. "Weight gain in women at midlife: Unique issues in management and the role of menopausal hormone therapy". Mayo Clinic.

  2. "Menopause and high blood pressure: What's the connection?". Mayo Clinic.

  3. "Insulin Resistance and Diabetes". CDC.

  4. "Diabetes and menopause: A twin challenge". Mayo Clinic.

  5. The North American Menopause Society (NAMS). "Obesity can lead to more severe hot flashes and other menopause symptoms: Study confirms that a higher body mass index is related to a higher prevalence of certain menopause symptoms." ScienceDaily. ScienceDaily, 31 May 2017.

  6. Chlebowski, Rowan T et al. “Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial.” Menopause (New York, N.Y.) vol. 20,6 (2013): 600-8. doi:10.1097/GME.0b013e31828392c4

  7. Bauer, Scott R et al. “Physical Activity, Diet, and Incident Urinary Incontinence in Postmenopausal Women: Women's Health Initiative Observational Study.” The journals of gerontology. Series A, Biological sciences and medical sciences vol. 76,9 (2021): 1600-1607. doi:10.1093/gerona/glab118

  8. "Bladder control: Medications for urinary problems". Mayo Clinic.

Written by:

Vivian Manning-Schaffel

Vivian Manning-Schaffel is a women’s health writer and editor. She is currently a contributing writer at, NBC Better and Shondaland.

Medically reviewed by:

Sharon D. Malone

Dr. Sharon Malone is among the nation’s leading obstetrician / gynecologists with a focus on the specific health challenges associated with menopause.