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Can you avoid excess perimenopausal weight gain?

Updated: Nov 3, 2023

The short answer is yes you can but as is often the way, it may not be that simple. During perimenopause it does become harder to maintain your happy weight. This happens because you become less sensitive to insulin and more likely develop insulin resistance and also you start to lose muscle mass (muscle is a metabolically active tissue). This leads to a decrease in your metabolic rate by upto 15% (your metabolic rate is the rate at which calories are burned whilst you are at rest). So even if you eat the same foods you always have and maintain your exercise levels, you may find that the weight creeps on.

However, there are things that you can do about it. Firstly let’s look at insulin resistance.

Glucose is a sugar and is the main fuel for the body, we need it to survive but both too much and too little are not a good thing and so blood glucose levels are tightly regulated by the hormones glucagon and insulin. When blood glucose levels are low, glucagon is released and stimulates the release of glucose from the body's stores. When blood glucose levels are high, insulin is released which stimulates the uptake of sugar by the cells where it is either used for energy or stored as fat. This is why excess sugar intake can lead to increased weight gain, in particular around the middle.

Estrogen plays a role in regulating the action of insulin which is why when women hit menopause and estrogen levels drop, they are more at risk of insulin resistance. Insulin resistance is a bit like when your small child says ‘mummy, mummy’ on repeat. If you don’t respond immediately the child shouts louder and louder to get your attention. In the same way, as the cells of your body become less sensitive to insulin, it’s like they are not hearing the message from the pancreas. So the pancreas starts to pump out higher and higher levels of insulin in order to get a reaction. The pancreas is now shouting at your cells to listen.

Insulin is one of the master hormones and has a huge impact on sex hormones causing imbalances that can exacerbate our symptoms but also increase the risk of heart disease, diabetes and dementia as well as gain weight. The other effect of insulin resistance is that despite plenty of insulin in the blood and plenty of glucose in the blood, the glucose cannot get your cells where it will be used to produce energy. Suddenly, your energy levels are all on the floor and weight starts piling on even though you are eating the same foods you have always done. So as you hit perimenopause and enter this new phase of life, you need to adopt a new way of eating that helps to balance blood glucose levels and avoids triggering a big insulin response.

A blood sugar balancing diet that maintains healthy insulin sensitivity focuses on whole, real foods such as meat, fish, eggs, tofu, lentils, beans, chickpeas, nuts, seeds, wholegrains and plenty of brightly coloured fruit and vegetables. The secret to making this way of eating work is to make sure you follow a low glycemic load diet (more on this in a moment) and include protein with each meal and snack.

The glycemic load or GL is the measure of how much a food will cause your blood sugar to rise. Although protein can have a small impact on blood sugar levels, it is the carbohydrate content of the diet that has a significant impact on blood sugar levels. Carbohydrates are all made of chains of simple sugars. Glucose is the sugar that is used as fuel by the body and triggers an insulin response. When we digest carbohydrates, these chains of single sugars are broken down and the single sugars are released. These are small, mobile molecules and are free to pass from the digestive tract into the blood stream.

Some carbohydrates are rapidly digested and release these sugars quickly. These are said to have a a high glycemic load. They are known as simple carbohydrates and are found in refined flours and foods such as white bread, sweets, cakes, biscuits, white rice, potatoes. Complex carbohydrates on the other hand have chains of simple sugars that are digested slowly and so the single sugar is released more slowly into the bloodstream. These are said to have a low glycemic load. Complex carbohydrates are found in foods such as wholegrains, vegetables, beans, lentils. As the release of glucose is much slower from complex carbohydrates, it has a lesser impact on blood sugar levels. The sugar slowly trickles into the bloodstream at a rate it can be used for energy rather than dumping excess which needs removing and storing as fat. Furthermore, because these foods are less processed they tend to be more nutrient dense and contain many of the nutrients that are needed to process the sugar efficiently and make energy.

But It is not just diet that causes blood sugar to rise. Watching a scary movie, a stressful day at the office or at home with the kids or a cup of coffee or having a cigarette can also cause blood sugar levels to rise. So as well as eating a low GI diet, it is also essential to reduce intake of stimulants (caffeine, nicotine) and avoid alcohol and reduce stress.

So we’ve talked about insulin resistance, the other factor I mentioned was declining muscle mass. The loss of muscle leads to a decline in your basal metabolic rate which means your daily energy requirement decreases. The type of exercise you do during perimenopause therefore becomes more important. NHS recommends that for general health you should do at least 2 session of muscle strengthening exercises a week but you may need more than this during perimenopause. Muscle building exercise includes lifting weights, using resistance bands, climbing the stairs, walking up hills, dancing, cycling, squats, push ups, yoga and pilates.

So yes whilst it is possible to avoid excess weight gain during perimenopause, you will need to change your diet and lifestyle to achieve it.

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