4 diets to try if you want to tackle perimenopause weight gain (2024)

Haven't changed your diet but still struggling with perimenopausal weight gain? You're not alone. 'We see women in clinic every day who say, “I haven’t changed anything but I can’t stop putting on weight,”’ says functional nutritionist Pippa Campbell. ‘They often blame themselves. But how you live in your 20s and 30s just doesn’t work in your 40s and beyond.’

Here, we explore the hormone rollercoaster with health experts, who reveal their top mid-life tips and four diets to try if you're struggling with perimenopausal weight gain.

What is the average weight gain in perimenopause?

Research suggests women put on an average of 1.5kg (3.3lb) a year during the perimenopause: 10kg (1st 8lb) in total. But of course, not everyone will put on weight. If you do, how much you put on is, naturally, personal. Some women might want to embrace a new body shape; others might not be bothered about putting on weight at all. It also depends on genetics and other things you can control: your activity level, what you eat and when, stress and sleep.

‘You could argue these aren’t strictly perimenopausal risk factors – but they interact with hormonal symptoms,’ says Campbell. ‘For example, a lot of women report bad sleep due to hot sweats and/or insomnia, as well as more fatigue and joint aches. And who wants to work out when you’re exhausted and sore?’

Why is it hard to lose weight during perimenopause?

Hormones tend to follow a pattern over five to 15 years leading up to menopause. From the age of around 40, progesterone starts to decline. A few years later, rather than going up and down rhythmically throughout your menstrual cycle, oestrogen levels start to fluctuate wildly high and low until, at actual menopause, they remain low.

The critical period for weight gain is when oestrogen levels drop, later in perimenopause. This brings about a fundamental shift in your metabolism, says Dr Federica Amati, head nutritionist at Zoe.

A trial compared women’s responses to the Zoe ‘metabolic challenge’ test – eating muffins that are high in fat or sugar, to see how well their body processed and stored that energy.

‘We saw that peri- and postmenopausal women had a worse blood glucose and blood fat response,’ says Dr Amati. ‘Insulin, the hormone that’s supposed to open the storage containers for energy in the fat and muscle, just didn’t work as well, so more fat and sugar stayed circulating in the blood.’

This is because when we have less oestrogen circulating, our tissues become less sensitive to insulin. So it’s not only easier to gain weight, but it also ups your risk of insulin resistance – an inflammatory condition that can be the first step on the road to type 2 diabetes and cardiovascular disease.

There’s another big change going on in your body, too. The estrobolome is a group of beneficial microbes that helps process oestrogen in the gut. But when oestrogen levels go down, they do too. ‘The void left by the estrobolome will be filled by whatever microbe is the strongest – often by those that lead to more inflammation and more fat accumulation,’ says Dr Amati.

A different microbial mix can change your appetite, too. ‘It is our microbiome that controls our food behaviour, our cravings,’ says holistic health expert Dr Mindy Pelz. ‘The hormone shift creates a microbe shift that creates a hunger shift.’

What are the signs of perimenopause weight gain?

Some women notice their waist widening. As the ovaries wind down their production of oestrogen, the body continues to make a smaller amount of oestrogen in the adrenal glands and in fat tissue. This is why, when oestrogen levels decline, ‘the body in its wisdom is inclined to lay down extra fat stores,’ says nutritionist Petronella Ravenshear.

There are a whole host of other potential weight gain effects due to hormonal changes. The lack of sleep caused by low progesterone impacts hunger hormones, so you are more likely to crave carbs. Low progesterone can also trigger an underactive thyroid in some women, which can lead to a lower metabolism and weight gain (as well as leaving you feeling cold and exhausted).

‘During early perimenopause, some women get high testosterone levels relative to other sex hormones,’ says Campbell. ‘If you have PCOS (polycystic ovary syndrome), you already tend towards this.’ High testosterone can lead to more insulin resistance and fat around the middle. Plus stress – which can peak in midlife when parents need support, careers go stellar and kids take exams – raises cortisol levels, which can lead to insulin resistance, too.

By the time of the menopause, most women tend to have lower testosterone levels. This is age-related rather than perimenopausal, but it’s key, because testosterone supports muscle growth and so a drop adds to general age-related muscle loss. When you have less muscle, you burn less energy, so store more fat. Exercise – in particular strength training – fights this decline, and it makes tissues more insulin sensitive, too: a double win.

Will HRT help me lose weight?

If low oestrogen is the major factor in perimenopausal weight gain, in theory, women should lose weight or stay the same when they start HRT. HRT doesn’t cause weight gain in itself, but it can make some women feel bloated. It can also change fat distribution so weight accumulates less around the middle and more around the bottom and thighs.

However, both too much oestrogen and too little can tip the balance towards weight gain. If you put on weight on HRT, it could be that your dosage isn’t right, and/or other factors, so talk to your GP.

What to do about perimenopause weight gain

Know that you’re not going crazy and your body may well change during this period. If you have just a few of these potential hormone changes, it will shift you towards weight gain. Isn’t that a reason not to be hard on yourself if you gain a few pounds?

‘You’d never expect a woman postnatally to be back to her prenatal self in a year. It’s the same with perimenopause,’ says Dr Amati. Indeed, if you look after yourself, she says, ‘You can end up extremely healthy – just with a different chemistry.’

Here are some ideas on how to do this...

What is the best diet for perimenopause?

We’ve chosen these four experts because they specialise in midlife nutrition. They do have common ground – they all say it’s important to focus on eating whole, fresh foods and that reducing stress and keeping active are both key. Yet their advice can conflict, too. Hopefully this short taste of each approach will guide you to the one that’s right for you.

The science-based perimenopause diet

Famous for its groundbreaking research into the microbiome and using blood glucose monitors to reveal people’s personal reactions to food, Zoe is at the cutting edge of science. Here, Dr Federica Amati, head nutritionist at Zoe who also teaches nutrition to doctors at Imperial College London, shares her top perimenopause diet tips.

1. Eat more plants, especially colourful ones. ‘The biggest finding in our Zoe study is that a diet that’s very high in plant intake helps to mitigate against weight gain, even for women who are already overweight,’ she says. The microbiome thrives on polyphenols, the bright colours in plants. For example, a study showed that eating blueberries in perimenopause has a positive impact on symptoms and overall metabolic health. Other high polyphenol plants include cocoa, coffee, spices, olive oil, nuts and seeds.
2. Avoid UPFs. Most ultra-processed foods (UPFs) are engineered to contain fat and sugar that keep our appetites high. UPFs also provide a high level of metabolic challenge to our bodies.
3. Eat whole fibre. Fibre feeds the good bugs in your microbiome. All natural foods are great, but you’ll help your body even more when you chew foods in their whole form: peanuts rather than peanut butter, an apple rather than apple juice, berries rather than a smoothie, chickpeas rather than hummus.

Favourite tuna salad recipe (serves 4): Mix together 3 diced celery sticks, 1 chopped red onion, 250g cannellini beans, 120g canned tuna, 2 crushed garlic cloves ,1tbsp red wine vinegar, 3tbs olive oil, 3tbsp chopped parsley, 1tbsp chopped chives, 2tbsp capers, 4 sliced radishes, salt and pepper.
Most surprising piece of advice: Eat kimchi and other fermented foods. ‘A recent trial from Korea showed that a high intake of kimchi reduced the risk of obesity.’
The flipside: Dr Amati’s advice isn’t specifically about losing weight; it’s a for-life way of eating (but that’s no bad thing).

The cult perimenopause diet

The Human Being Diet (HBD) is an online phenomenon by nutritionist Petronella Ravenshear, with a passionate community of midlife followers on Instagram. ‘Although many people are drawn to HBD to lose weight, the weight loss occurs as a side effect of returning the body to balance," says Ravenshear. Her top three mid-life musts include:

1. Eat a breakfast of protein and plants, ideally within an hour of waking. This signals to the brain via the fullness hormone leptin that we have enough energy, so it can reduce hunger.
2. Zero snacking. This gives your gut microbes time to regenerate. Eat three times a day, with five hours between meals. ‘If you are always snacking, you are always producing insulin. Not only is insulin pro-inflammatory, but it’s also a very effective fat storage hormone,’ Ravenshear says.
3. Start the day with 500ml water, and drink another 5 litres before lunch, as water may help to reduce the signal from the hunger hormone ghrelin.

Ravenshear’s favourite breakfast: Grind 35g sunflower and pumpkin seeds and mix with a grated apple, 1⁄2 teaspoon of cinnamon and salt and pepper.
Most surprising piece of advice: Once a week, feast on what you want to stop your body going into energy preservation mode.
The flipside: The breakfast is not very substantial and the first 16 days are brutal! And you stay on an easier form of the programme for ever, except for a weekly treat meal.

The easy perimenopause diet

Nutritionist Pippa Campbell boils down all the confusing hormone advice into easy-to-follow tips. She’s big on supporting your body to process used-up oestrogen via your liver and gut, making way for new, fresh oestrogen to do its work.

1. Start each meal with a few bites of protein and eat protein at every meal around the size of one chicken breast (or two to three eggs). 'Women at midlife need more protein in order to build muscle, but also to make hormones and help them feel full for longer,' she says.
2. Pause and breathe before you eat. 'It's good for digestion and nutrient absorption, plus when your adrenal glands are making stress hormones, it's harder for them to make sex hormones,' says Campbell. Try doing a minute of deep breathing before meals and chewing food slowly and well, up to 30 times.
3. Support the liver with cruciferous vegetables (broccoli family) and sulphur-rich veg (onions, garlic). Help the gut clear old hormones by eating fermented foods (sauerkraut, olives in brine, apple cider vinegar) and fibre-filled prebiotic foods (root vegetables, pulses, chia seeds). Support oestrogen balance by eating phytoestrogens (flax seeds, tofu).

Hormone balance smoothie: Mix 100-200ml of non-dairy milk (more if you like it thinner) with 1 scoop of pea or whey protein powder, 1 small handful blueberries, 1 small handful rocket (or any greens), 1tbsp ground flax seeds (for hormone-balancing phytoestrogens) and 1tbsp nut butter.
Most surprising advice: Eat a raw carrot a day. The fibre in carrot skins binds to used-up oestrogen in the gut and carries it out of the body.
The flipside: You are supposed to follow the food framework 80% of the time; it takes time to work out how to do this.

The hardcore perimenopause diet

Holistic health expert Dr Mindy Pelz has a totally different approach to midlife weight gain: fasting. This, she says, helps to reboot the microbiome and repair the gut, reducing insulin resistance and helping hormonal symptoms, too.

1. The intermittent fast (IF) of 13 hours without food is the entry level. ‘Push breakfast back an hour, then by two hours, until you feel comfortable going 15 hours,’ says Dr Pelz. Work towards fasting from dinner to dinner (Dr Pelz also has a three- to five-day water-only fast). If you get stuck, you can have a ‘fasted snack’ – such as a spoonful of nut butter or a cup of bone broth.
2. If you have a cycle, the week before your period is a time for 'hormone feasting'; you need carbs in order to make progesterone to support your cycle. NB, those carbs need to be natural carbs.
3. If you are on HRT or postmenopause, fast in a 5:1:1 pattern. Five days a week, do the 13 to 15 hour IF. One day a week, do a longer fast, perhaps dinner-to dinner. Then one day a week, eat as you like.

The 3 Ps: The meal at the end of your fast should contain polyphenols (berries), probiotics (yogurt) and prebiotic fibre (nuts and seeds).
Most surprising advice: Eat ‘good’ oils (olive, avocado, coconut, grass-fed butter, raw nuts, ghee). Avoid ‘bad’ ones, such as vegetable oil and sunflower oil. ‘Good fats give you long-lasting energy. Bad oils block hormone receptor sites,’ says Dr Pelz.
The flipside: If your cycle isn’t regular, it’s hard to work out when you should fast. Then obviously: not eating!

Always consult your GP about any specific concerns and before following the medical advice on our pages.

This feature originally appeared in the May 2024 issue of Red Magazine.