The Real Reason You Can't Lose Weight in Perimenopause
You're eating the same way you always have. Maybe even less, because you’re being mindful of your calories. You're exercising—maybe even more than you used to. But no matter what you try, the weight keeps creeping up, especially around your stomach.
Here's what I want you to know: weight gain in perimenopause is a whole-body metabolic shift.
What's Actually Happening
When estrogen declines during perimenopause, your body has a system designed for that. Putting on belly fat helps actually create a small amount of estrogen, to accommodate for the falling production! Everything is working exactly as it’s meant to. But on top of that, your body's relationship with insulin changes. Estrogen helps your cells respond to insulin and use glucose efficiently. When estrogen drops, insulin resistance increases.
That leads to:
More fat storage (especially around the abdomen)
Increased sugar and carb cravings
Blood sugar swings
Energy crashes
Difficulty losing weight even with calorie restriction
More stress on your system
Your body starts processing carbohydrates differently than it used to, and it starts to work against your weight loss goals.
The Cortisol Connection
Stress hormones also play a major role. Most women in their 40s are dealing with significant life stress—career, aging parents, kids, relationship changes—while going through a major hormonal transition. It all seems to hit at once, right?
Chronic stress keeps cortisol elevated, which:
Increases belly fat storage
Disrupts sleep (worsening metabolism)
Increases insulin resistance
Makes weight loss nearly impossible!
Why "Eat Less, Exercise More" Backfires
When you drastically cut calories or over-exercise during perimenopause, you're putting additional stress on an already stressed system. Your body interprets this as a threat. It slows your metabolism and holds onto fat even more tightly, because it thinks it might need the energy later.
This is why women tell me: "I'm eating 1200 calories and still gaining weight," or "I'm working out 6 days a week and nothing's changing." (it’s not like you aren’t trying!)
This is where it can feel like your hormones are working against you.
What Actually Works
Balance blood sugar: focus on protein and fiber at every meal. This stabilizes insulin and reduces cravings. For bonus blood sugar control, I always recommend a CGM (continuous glucose monitor) to really fine-tune your sugar balance. Specific supplements like berberine can be REALLY helpful too and can be a great intermediate before reaching for prescription medications. (See more about this on my blog here!)
Manage stress and cortisol: if cortisol is chronically elevated, weight loss is nearly impossible. Prioritize sleep and nervous system regulation. Even if it feels impossible, find more ways to focus on yourself so you can unwind amongst ongoing stress.
Strength training over excessive cardio: Building muscle improves insulin sensitivity and boosts metabolism. Even though it feels easier to burn calories with high cardio, excessive cardio can actually raise cortisol and worsen the problem.
Don't under-eat: chronic calorie restriction slows metabolism and makes everything worse. Nourish your body with filling, high-quality nutrition (think Mediterranean diet!)
Address hormone imbalances: weight loss becomes much easier when estrogen, progesterone, thyroid, and cortisol are balanced. This may mean using HRT (Hormone Replacement Therapy), or alternatives like herbals that restore order to the chaos.
Consider GLP support: Some people do great with using GLP peptides/medications to help support their weight loss goals. But it’s important to note that there are “right ways” and “wrong ways” to utilize this tool (Check out my Vibrant Metabolism Program for more info about my approach).
It’s not you.
If you're struggling with weight gain in perimenopause, it's not because you're not trying hard enough. We have to dive deeper!
The approach that worked in your 30s doesn't work now because you're operating in a different hormonal environment.
Ready to get a plan that actually works for your body? Book a free call here. We specialize in optimizing your metabolism and hormones and create an individualized treatment plan that supports sustainable weight management that works for YOU.
Meet Your Doctor
Hi, I’m Dr. Caitlin Fanning, ND (Naturopathic Doctor),
I help women who are struggling with hormone changes, fatigue, and infertility optimize their hormones and get their life back so they can feel like their best self.
If you're ready to take charge of your health and make real, lasting changes to your energy, your hormones, or your overall well-being, I would love to talk more!