Perimenopause and menopause bring significant hormonal changes that can affect metabolism, appetite, body composition, and long-term health. As estrogen levels decline, the body undergoes changes that may contribute to weight gain, increased abdominal fat, reduced muscle mass, and a higher risk of metabolic and chronic diseases. However, nutrition and lifestyle can play an important role in managing these changes.
Estrogen influences several systems involved in energy balance. It helps regulate appetite and basal energy expenditure through the central nervous system, supports insulin sensitivity and glucose uptake in skeletal muscle, and contributes to healthy pancreatic beta-cell function.
As estrogen declines, these protective effects may weaken. Basal metabolic rate can decrease, while appetite regulation may become less effective. If food intake and physical activity remain unchanged, this can contribute to gradual weight gain.
Importantly, weight gain during midlife is not solely caused by menopause. Women may gain an average of around 10 kg between ages 40 and 60 due to a combination of ageing, hormonal changes, lifestyle, and declining energy expenditure.
One of the most important changes during menopause is where fat is stored. Fat tends to shift toward the abdominal and visceral region, while skeletal muscle and fat-free mass may decline. In some women, the combination of increased fat mass and reduced muscle mass can progress to sarcopenic obesity.
An increase in visceral fat is particularly important because enlarged adipose tissue can become metabolically active and promote low-grade inflammation. This inflammatory environment may contribute to insulin resistance and increase the risk of cardiovascular disease and type 2 diabetes.
Perimenopause can also bring symptoms such as hot flashes, night sweats, headaches, joint discomfort, irritability, emotional changes, and difficulty concentrating. Around 75–80% of women experience menopausal symptoms, although their severity varies considerably.
Nutrition and exercise may not completely eliminate these symptoms, but they can improve metabolic health, physical functioning, and overall quality of life. In women who are overweight or obese, even modest weight loss may improve the tolerability of hot flashes.
The goal during perimenopause is not extreme restriction, but sustainable, balanced nutrition. Very-low-calorie diets, particularly those below 1,200 kcal/day, can increase the risk of micronutrient deficiencies and are generally inappropriate without clinical supervision. Sustainable, individually tailored calorie deficits are more effective for long-term weight management.
A Mediterranean-style dietary pattern is one useful model because it emphasises vegetables, fruits, whole grains, legumes, nuts, seeds, healthy fats, and minimally processed foods. It can support cardiovascular health, blood sugar regulation, and weight management.
Protein becomes particularly important as muscle mass naturally declines with age. A daily intake of approximately 1-1.2 g/kg body weight, combined with resistance training, can help preserve skeletal muscle during weight loss. Rather than simply reducing food intake, focus on building meals around protein-rich foods such as pulses, dairy or fortified alternatives, eggs, fish, poultry, soy, and other minimally processed protein sources.
A practical approach is to include:
A good source of protein at every meal
Plenty of vegetables and fruits
Whole grains and other high-fibre carbohydrates
Healthy fats from nuts, seeds, and appropriate oils
Adequate calcium and vitamin D to support bone health
Sufficient fluids throughout the day
Portion control is useful when weight loss is required, but skipping meals or following highly restrictive diets is rarely sustainable.
Hormonal changes during menopause may reduce the sensation of thirst. Adequate hydration supports temperature regulation, digestion, circulation, cellular metabolism, and mucous membrane health. A practical general target is approximately 33 mL/kg of body weight per day, adjusted for climate, activity, diet, and individual needs.
Perimenopause is a transition, not a reason to fear food or chase rapid weight loss. The most effective approach combines a modest and sustainable calorie deficit when needed, adequate protein, resistance and aerobic exercise, good hydration, sufficient sleep, and a nutrient-dense dietary pattern. The goal should be more than a number on the weighing scale: preserve muscle, reduce excess visceral fat, support metabolic and bone health, and build habits that can be maintained well beyond menopause.
