Weight Gain During Perimenopause: The Gut Connection You Might Be Missing

Mood changes, hot flushes, insomnia, the struggles of perimenopause are all too familiar. But for many women, unwanted weight gain is the symptom that hits hardest. It can leave you feeling uncomfortable, frustrated, and like you’re no longer in control of your body.

On average, women gain 2 to 2.5kg over three years during the menopausal transition [1]. And while hormones do play a role, new research is revealing a deeper connection between your gut and your weight, especially in perimenopause.

Let’s take a closer look at why this happens and what you can do about it,  including how gut health could be the missing link.

What causes weight gain in perimenopause?

1. Hormonal shifts [2]

During perimenopause, oestrogen levels begin to fluctuate and eventually decline. Oestrogen plays a critical role in glucose and lipid metabolism, so as levels drop:

• Your metabolism may slow down

• Fat is more likely to be stored around the abdomen

• Muscle mass naturally declines, reducing energy needs

Even if your eating habits haven’t changed, your body’s response to food has, meaning weight gain can happen without any major dietary changes.

2. Lifestyle, sleep, and stress [3, 4]

It’s not just about hormones. Perimenopause often coincides with:

• Sleep disturbances

• Increased stress

• Changes in mood or motivation

And all of these can impact food choices and appetite-regulating hormones (like ghrelin, which increases with poor sleep). It’s not your imagination, you do feel hungrier, crave more sugar, and have less energy to prepare balanced meals or move your body.

3. The gut–weight connection

Emerging science shows that the gut microbiome plays a key role in body weight regulation. Here’s how:

• Microbial diversity drops in perimenopause, especially with stress, lack of fibre, and hormone shifts. Lower diversity is linked with increased weight and fat mass.

• Some gut bacteria are more efficient at extracting calories from food, increasing energy harvest and promoting fat storage.

• Certain bacteria can influence appetite, cravings, inflammation, and insulin sensitivity, all of which impact weight regulation.

When the gut is out of balance, it creates a ripple effect: disrupted metabolism, more gut symptoms (like bloating and constipation), and higher risk of insulin resistance, especially around the midsection.

What can you do about it?

Here are science-backed strategies that support both weight regulation and gut health during perimenopause:

1. Focus on plant diversity for your microbiome

Aim for 30+ different plant foods a week, including vegetables, fruits, whole grains, legumes, nuts, and seeds. These support a diverse, balanced microbiome and promote short-chain fatty acid (SCFA) production, which improves metabolic health and appetite regulation.

Bonus: High-fibre foods help keep you fuller for longer, reducing snacking and improving blood sugar control.

2. Include protein at every meal

Muscle mass declines with age, but protein can help preserve it, support your metabolism, and improve satiety.

Aim for:

• 20–30g of protein at each main meal

• Include leucine-rich proteins like dairy, lean meat, tofu, legumes, and eggs

3. Choose a Mediterranean-style eating pattern [5,7]

The Mediterranean Diet is anti-inflammatory, gut-supportive, and associated with:

• Lower fat mass

• Better management of menopausal symptoms

• Improved mood and heart health

Build meals around vegetables, legumes, extra virgin olive oil, seafood, fermented foods (like yoghurt and kefir), and herbs/spices for extra polyphenols.

4. Support your gut motility

Constipation is common in perimenopause and can make you feel bloated, sluggish, and heavier, even when your weight hasn’t changed.

To support regular bowel movements:

• Stay hydrated

• Prioritise daily movement

• Include fibre from oats, legumes, fruits, and psyllium husk

• Consider fermented foods like yoghurt, kefir, or sauerkraut

5. Rethink hidden kilojoules

During perimenopause, your body may require less energy than it used to, but hidden kilojoules from alcohol, sugary drinks, oversized portions, and mindless snacking can still creep in.

Try:

• Limiting alcohol to a few nights a week to support both gut and hormonal health

• Remembering the 80/20 rule - it’s not about restriction, but balance. Aim to nourish your body most of the time, while still leaving room for enjoyment.

• Practising mindful eating - slowing down at meals, tuning into hunger and fullness, and avoiding distractions where possible

6. Move your body, build strength

Exercise doesn’t just burn kilojoules, it improves insulin sensitivity, gut motility, and supports mental clarity. Include a mix of:

• Resistance training (weights, Pilates, yoga)

• Cardio (walking, dancing, swimming)

• Movement for joy - anything that helps you stay consistent

Aim for 30–60 minutes most days of the week. The key is consistency over intensity.

A final word

Weight gain during perimenopause can feel incredibly frustrating, especially when it seems like nothing has changed in your routine, yet your body feels different. This transition isn’t just about hormones or lifestyle; it’s about how your entire system is adapting, including your gut, your metabolism, and even your mood.

It’s important to know: this isn’t your fault. And it’s not just about eating less or exercising more. The truth is, your body has different needs now, and understanding those needs, without guilt or pressure, is a powerful first step.

If you’re taking menopausal hormone therapy (MHT), speak with your doctor to make sure your dose and type are right for you. Hormones can impact metabolism, gut function, and body composition, and small adjustments can make a big difference.

If you’re ready to take back a sense of control and learn how to support your gut, hormones, and overall wellbeing during this time, we’re here to help. Our Peri Gut Plan is a science-backed plan that fits your life, not the other way around.

You deserve to feel comfortable and confident again, and yes, that’s absolutely possible.

References

[1] Polotsky HN, Polotsky AJ. Metabolic implications of menopause. Semin Reprod Med. 2010 Sep;28(5):426-34. doi: 10.1055/s-0030-1262902. Epub 2010 Sep 23. PMID: 20865657.

[2] Silva TR, Oppermann K, Reis FM, Spritzer PM. Nutrition in Menopausal Women: A Narrative Review. Nutrients. 2021 Jun 23;13(7):2149. doi: 10.3390/nu13072149. PMID: 34201460; PMCID: PMC8308420.

[3] Papatriantafyllou E, Efthymiou D, Zoumbaneas E, Popescu CA, Vassilopoulou E. Sleep Deprivation: Effects on Weight Loss and Weight Loss Maintenance. Nutrients. 2022 Apr 8;14(8):1549. doi: 10.3390/nu14081549. PMID: 35458110; PMCID: PMC9031614.

[4] Miller C, Ettridge K, Wakefield M, Pettigrew S, Coveney J, Roder D, Durkin S, Wittert G, Martin J, Dono J. Consumption of Sugar-Sweetened Beverages, Juice, Artificially-Sweetened Soda and Bottled Water: An Australian Population Study. Nutrients. 2020 Mar 19;12(3):817. doi: 10.3390/nu12030817. PMID: 32204487; PMCID: PMC7146120.

[5] Flor-Alemany M., Marín-Jiménez N., Nestares T., Borges-Cosic M., Aranda P., Aparicio V.A. Mediterranean diet, tobacco consumption and body composition during perimenopause. The FLAMENCO project. Maturitas. 2020;137:30–36. doi: 10.1016/j.maturitas.2020.04.002. 

[6] Sternfeld B, Aradhana B, Wang H, Sharp T, Quesenberry CJ. Menopause, physical activity, and body composition/fat distribution in midlife women. Medicine & Social Science in Sports & Exercise. 2005;37(7):1195–1202.

[7] Vetrani C, Barrea L, Rispoli R, Verde L, De Alteriis G, Docimo A, Auriemma RS, Colao A, Savastano S, Muscogiuri G. Mediterranean Diet: What Are the Consequences for Menopause? Front Endocrinol (Lausanne). 2022 Apr 25;13:886824. doi: 10.3389/fendo.2022.886824. PMID: 35546996; PMCID: PMC9084275.