Weight Gain in Perimenopause: A Holistic Explanation

Weight gain in Perimenopause: A Holistic Explanation

By Remi Odisho

Why Your Body Is Changing (and why it’s not just about calories)

One of the best common issues I hear of clinically is that patients often feel like their body has changed seemingly overnight — particularly around the waist.
Many women enter perimenopause feeling like the strategies that once worked for their body suddenly stop working. You may be eating the same, exercising the same, and yet noticing:

• Weight gain (especially around the abdomen)
• Increased bloating
• Stronger cravings
• Energy crashes
• A sense that your metabolism has “slowed down”

This can feel frustrating, confusing, and at times disheartening.
But this shift is not a failure of willpower — it is a reflection of underlying hormonal and metabolic changes that occur during perimenopause.
Understanding why this happens is the first step toward supporting your body more effectively.

Hormonal Fluctuations: More Than Just “Low Oestrogen”

One of the best common issues I hear of clinically is that patients often feel like their body has changed seemingly overnight — particularly around the waist.
Many women enter perimenopause feeling like the strategies that once worked for their body suddenly stop working. You may be eating the same, exercising the same, and yet noticing:

• Weight gain (especially around the abdomen)
• Increased bloating
• Stronger cravings
• Energy crashes
• A sense that your metabolism has “slowed down”

This can feel frustrating, confusing, and at times disheartening.
But this shift is not a failure of willpower — it is a reflection of underlying hormonal and metabolic changes that occur during perimenopause.
Understanding why this happens is the first step toward supporting your body more effectively.

Insulin Changes and Metabolic Shifts

Insulin is one of the most important hormones involved in weight regulation — and it becomes increasingly relevant during perimenopause.
As oestrogen fluctuates, the body can become more insulin resistant, meaning it is less responsive to insulin’s signals. This can lead to:

• Increased fat storage (particularly visceral fat)
• Blood sugar instability
• Cravings for carbohydrates and sugar
• Energy dips throughout the day

This is one of the key reasons why weight gain can occur even when diet and exercise habits have not changed.
Importantly, insulin resistance is not just about sugar intake — it is influenced by hormones, sleep, stress, and inflammation.

Stress, Cortisol, and the “Progesterone Steal” Concept

Stress plays a significant — and often underestimated — role in perimenopausal weight changes.

During times of chronic stress, the body prioritises the production of cortisol, our primary stress hormone. Cortisol is essential in the short term, but when elevated over long periods, it can:

• Increase fat storage (particularly abdominal fat)
• Break down muscle tissue
• Disrupt blood sugar regulation
• Increase appetite and cravings

There is also a commonly discussed concept known as “progesterone steal.” While not a strict biochemical pathway, it reflects a clinically relevant idea: when the body is under stress, resources are prioritised toward cortisol production, often at the expense of reproductive hormone balance.

Given that progesterone is already declining during perimenopause, chronic stress can further exacerbate symptoms such as:

• Poor sleep
• Anxiety
• Hormonal imbalance
• Weight gain

This creates a feedback loop where stress worsens hormonal imbalance, and hormonal imbalance increases the body’s stress response.

Sleep Disruption and Weight Gain

Sleep changes are incredibly common in perimenopause — and they have a direct impact on weight.

Poor sleep affects key appetite-regulating hormones:

• Ghrelin (which increases hunger)
• Leptin (which signals fullness)

When sleep is disrupted, ghrelin tends to increase while leptin decreases, making you feel hungrier and less satisfied after meals.

At the same time, sleep deprivation worsens insulin resistance and increases cortisol levels, creating a perfect environment for weight gain — even without changes in food intake.

Gut Health, Bloating, and Oestrogen Recycling

Many women notice increased bloating or digestive changes during perimenopause and assume it is purely weight gain.

However, gut health plays a significant role in both how you feel in your body and how hormones are processed.

The gut microbiome helps regulate oestrogen through what is often referred to as the estrobolome — a collection of bacteria involved in oestrogen metabolism. When gut health is disrupted, oestrogen can be improperly recycled, contributing to hormonal imbalance.

At the same time, stress, dietary changes, and hormonal shifts can impact:

• Gut motility
• Microbial balance
• Inflammation

This can lead to bloating, discomfort, and changes in body composition that may feel like weight gain.

 herA More Supportive Approach to Weight in Perimenopause

Rather than focusing solely on weight loss, a more effective approach is to support the underlying systems driving these changes.

This may include:

• Supporting blood sugar regulation through balanced meals
• Prioritising nervous system regulation and stress management
• Improving sleep quality
• Supporting gut health and digestion
• Incorporating therapies such as acupuncture to regulate the nervous system and hormonal signalling

Acupuncture, in particular, can support stress regulation, sleep, and metabolic balance by influencing the nervous system and neuroendocrine pathways.

When these systems are supported, the body is often better able to find a more stable and sustainable weight.

The Takeaway

Weight gain during perimenopause is not simply about calories — it is about hormones, metabolism, stress, sleep, and overall physiological balance.

Your body is not working against you.
It is adapting to a new hormonal environment.

With the right support, it is possible to feel more stable, more energised, and more at home in your body during this transition.

Work With Me

If you are navigating weight changes, fatigue, or hormonal symptoms during perimenopause, I offer personalised, integrative support tailored to your body and your experience.

My approach focuses on understanding the underlying drivers of your symptoms, including hormonal fluctuations, stress, sleep, and metabolic health, rather than applying restrictive or one-size-fits-all strategies.

You can book a consultation with me here to explore a personalised plan that supports your body through perimenopause.