Perimenopausal Weight Gain

Understanding what’s really happening and how a naturopathic approach can help. Perimenopause can begin as early as the late 30s and may last anywhere from two to ten years. For many women, it arrives quietly at first subtle changes in cycle length, sleep quality, mood, or energy. Over time, however, the physiological shifts can become more pronounced.

During this transitional phase, the body is exposed to significant hormonal fluctuations, particularly a decline in progesterone in the earlier stages. These changes influence far more than reproduction alone. They affect metabolism, blood sugar regulation, stress hormones, liver function, and how the body stores and utilises energy.

Alongside menstrual and neurological changes, many women experience unexpected weight gain, most noticeably around the abdomen. This can be deeply frustrating, especially when strategies that once worked eating less, exercising more, “being good”, suddenly stop delivering results.

Quite simply — the rules have changed.

Why does weight gain occur during perimenopause?

One of the key physiological drivers of perimenopausal weight gain is the development of insulin resistance, a process that becomes more common with age and hormonal transition.

Insulin is the hormone responsible for moving glucose out of the bloodstream and into cells for energy. When insulin sensitivity declines, the body becomes less efficient at managing blood sugar and less flexible at switching between burning glucose and fat, a concept known as metabolic flexibility.

As insulin resistance develops, the liver also becomes more metabolically burdened. This is one reason why blood lipids may rise during perimenopause, and why fatty liver changes can begin to emerge, often silently, long before they are formally diagnosed.

When this system becomes compromised, women may experience:

• Increased cravings, particularly for carbohydrates or sugar

• Brain fog and difficulty concentrating

• Weight gain, especially around the middle

• Low or unstable energy throughout the day

• Reduced tolerance to alcohol

• Subtle signs of liver strain, such as bloating, fatigue after meals, or elevated cholesterol on blood tests

These symptoms are often misinterpreted as a lack of discipline or motivation. In reality, they reflect underlying metabolic and hepatic shifts that require a different, more supportive approach.

Why “eat less and move more” stops working

During perimenopause, traditional calorie restriction can actually backfire. Eating too little, especially too little protein, further destabilises blood sugar, increases cortisol, and signals to the body that it needs to conserve energy.

The result is often greater fat storage, particularly centrally, alongside fatigue, frustration, and worsening metabolic markers such as cholesterol and triglycerides.

At this stage of life, the metabolism often needs to be recalibrated rather than restricted. The focus shifts from pushing harder to working more intelligently with physiology including liver and detoxification pathways that are under increased demand.

Recalibrating metabolism through nutrition

Targeted dietary changes can significantly improve perimenopausal weight gain when they are designed to stabilise blood sugar, support hormones, reduce metabolic stress, and support liver function.

A Green Keto–Mediterranean framework

At this stage of life, I often implement a Green Keto–style approach with Mediterranean diet influences. This is not an extreme ketogenic diet, but a metabolically supportive framework that emphasises:

• Plenty of leafy greens, herbs, and fibrous vegetables

• High-quality protein

• Healthy fats such as olive oil, avocado, nuts, and seeds

• Reduced refined carbohydrates and sugars

• Minimal ultra-processed foods

This approach supports insulin sensitivity, reduces inflammation, and places far less strain on the liver than highly processed or high-sugar diets. The Mediterranean influence keeps the approach heart-protective, anti-inflammatory, and sustainable long-term.

Protein at breakfast: a foundational shift

One of the most impactful changes many women can make is prioritising protein at breakfast.

A protein-rich breakfast:

• Improves blood sugar stability across the day

• Reduces afternoon and evening cravings

• Supports muscle mass, which is essential for metabolic health

• Helps regulate appetite hormones

• Reduces metabolic load on the liver

For many women, this may look like eggs, Greek yoghurt, protein-rich smoothies, or savoury breakfasts rather than toast, cereal, or fruit alone.

Starting the day with adequate protein sets the metabolic tone for the hours that follow.

Insulin-friendly meal timing and intermittent fasting

Meal timing becomes increasingly important during perimenopause. Long gaps between meals, erratic eating patterns, or constant grazing can all disrupt blood sugar regulation.

When appropriate, intermittent fasting can be rotated in strategically, rather than used continuously. This may support insulin sensitivity and metabolic flexibility when the nervous system is well regulated and stress levels are stable.

An insulin-friendly approach often includes:

• Regular meals spaced to prevent blood sugar crashes

• Avoiding skipping breakfast when under stress

• Reducing late-night eating when insulin sensitivity is lowest

• Thoughtful, non-rigid use of intermittent fasting

This is not about rigid rules, but about supporting the body’s natural rhythms and avoiding excessive metabolic stress.

Strategic dietary rotation and gentle detoxification support

During perimenopause, dietary rotation can be particularly valuable. The body may respond differently to the same foods and patterns as hormones fluctuate.

Rotating:

• Carbohydrate intake

• Meal composition

• Periods of intermittent fasting

• Short, gentle detoxification-style dietary resets

can help prevent metabolic stagnation while supporting liver detoxification pathways — without triggering stress responses.

These detoxification phases are food-based and supportive, not aggressive cleanses. Their role is to reduce inflammatory load, improve digestion, and assist the liver at a time when its workload is often increased.

Liver health, alcohol tolerance, and metabolic warning signs

Perimenopause is a time when liver function support becomes increasingly important.

Many women notice that their tolerance to alcohol diminishes — even small amounts may lead to fatigue, poor sleep, headaches, or inflammation. This is often an early signal that the liver is under increased strain.

It is also during this phase that:

• Blood lipids may become elevated

• Insulin resistance worsens

• Signs of fatty liver may begin to appear

Often these changes occur quietly, making early nutritional and lifestyle support essential for long-term metabolic and cardiovascular health.

Stress, cortisol, and the perimenopausal “tipping point”

Perimenopause is widely recognised as a time of increased vulnerability to physiological “tipping points.”

Underlying anxiety often intensifies during this phase, leading to elevated cortisol, the body’s primary stress hormone. Chronically raised cortisol contributes directly to abdominal weight gain, worsens insulin resistance, increases liver fat deposition, and disrupts sleep — all of which make weight loss more difficult, even with good nutrition.

Addressing stress is therefore not optional when weight loss is the goal — it is metabolically essential.

Thyroid health and midlife weight gain

Thyroid dysfunction is increasingly common during midlife. As with the postpartum period, perimenopause can act as a trigger for previously mild or dormant thyroid issues.

Even subtle changes in thyroid function can lead to:

• Fatigue

• A slowed metabolic rate

• Difficulty losing weight

• Reduced motivation

Supporting thyroid health is often a crucial piece of the perimenopausal weight-loss puzzle.

A personal note: why I understand this deeply

I share this information not only as a naturopath, but also from personal experience. I began to gain weight at 51, despite doing all the “right” things I had advised for years. The strategies that had worked reliably in my 30s and 40s, eating less, exercising more, being disciplined, simply stopped working. The weight crept on, particularly around my middle, and no amount of effort seemed to shift it. It was only when I changed the rules, supporting blood sugar, prioritising protein (especially at breakfast), adjusting meal timing, reducing metabolic and liver stress, and working with my changing hormones rather than against them, that my body finally responded.

In time, I lost 11 kilograms sustainably, without extreme restriction or deprivation, and with a far deeper understanding of what the perimenopausal body truly needs. This lived experience now informs how I support the women I work with, realistically, compassionately, and without blame.

A multifaceted — and achievable — approach

Perimenopausal weight gain is rarely caused by a single factor. Hormones, metabolism, liver function, stress, sleep, thyroid health, and nutrition all intersect.

There is no magic bullet but there is a clear, achievable path forward.

With thorough case taking, carefully tailored dietary strategies, and ongoing monitoring of response, meaningful and sustainable weight loss is very achievable.

A naturopathic approach works by addressing the underlying drivers, hormonal, metabolic, hepatic, and stress-related, while working complementarily with mainstream medicine to support long-term health and wellbeing.

Ready for personalised support?

If you are struggling with perimenopausal weight gain and feel that your body is no longer responding the way it once did, you don’t have to navigate this alone.

If you would like individualised guidance, I invite you to book a consultation so we can work together to support your metabolism, liver health, and hormones and help you feel at home in your body again.