If the scale has crept up despite you doing “all the right things,” you’re not imagining it—and you’re not alone. Weight gain in perimenopause and menopause is real, and hormones play a key role. But the good news is: it’s not hopeless.
Why Weight Gain Happens
- Estrogen Declines = Body Composition Shifts
As estrogen drops, your body redistributes fat—especially to the belly and midsection. This isn’t about willpower; it’s biology. - Slower Metabolism
Muscle mass naturally declines with age, and that lowers your resting metabolism. You burn fewer calories even if your habits haven’t changed. - Poor Sleep, High Stress, and Cortisol
Sleep disturbances and stress increase cortisol, a hormone linked to fat retention and cravings. - Insulin Resistance
Hormonal changes can lead to increased insulin resistance, making it harder to maintain stable blood sugar and easier to gain weight.
What Doesn’t Work (Anymore)
Crash diets, skipping meals, or killing yourself with cardio may have worked in your 20s—but now they often backfire, triggering more stress, fatigue, and hormone imbalance.
What Does Work
- Strength training – Build muscle to boost metabolism
- Protein-rich meals – Helps with satiety and lean mass
- Sleep support – Prioritize sleep hygiene and hormone balance
- Manage stress – Mind-body tools, therapy, boundaries
- Consider hormone therapy – For some women, estrogen therapy can reduce fat accumulation and support lean body mass
The Bottom Line
Midlife weight gain isn’t just about calories—it’s about hormones, metabolism, and giving your body the right tools to thrive. The goal? Strength, energy, confidence—not skinny jeans from 2006.
👉 Your body isn’t betraying you. It’s just asking for something different. Let’s figure out what that is—and get you feeling strong again.
Need support or want to learn more about treatment options? Schedule a free 15-minute call to see how we can work together.
Dr. Aoife O’Sullivan is a family physician, board certified by the American Board of Family Physicians and a menopause specialist, certified by the North American Menopause Society, dedicated to empowering women through their midlife health journeys. She is the founder of Portland Menopause Doc, co-founder of the Portland Menopause Collective, podcaster on The Dusty Muffins, and an expert speaker, frequent podcast guest and active contributor to midlife women’s health research.
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