A Guide to Managing Weight During Perimenopause and Menopause

The hormonal changes that happen during menopause can affect many areas of your life, and your weight is no exception. This is our guide to help you understand how menopause and weight management are linked, and how you can stay healthy during this period.

Article Summary:

• Menopause happens when your body stops producing estrogen and progesterone, causing your periods to stop.
• Many menopausal symptoms are linked to weight gain, including hormone changes and poor sleep.
• Lifestyle changes including eating a balanced diet, exercising regularly, and getting plenty of sleep can help you manage your weight throughout menopause.

What is menopause?

Menopause is the stage in life when periods change and stop due to hormonal changes. As you get older, your ovarian function decreases, affecting the production of reproductive hormones. Your progesterone and estrogen levels fluctuate and reduce, and since these hormones dictate your menstrual cycle, eventually your periods stop entirely. [1]

This process occurs over three stages:

Perimenopause is the transition phase, where your periods begin changing from what you usually experience during your cycle. You may notice your periods becoming more unpredictable, having a heavier or lighter flow, or lasting for more or fewer days than before. For most, perimenopause starts between the ages of 45 and 55. [2]

Menopause is reached when you haven't had a period for 12 consecutive months. The average age of menopause in Canada is 51 years old. [3]

Postmenopause refers to the years of your life after you notice your periods have stopped.

As with any hormone change, menopause doesn't just affect your reproductive system. Menopausal symptoms can occur throughout all stages of menopause, and may include: [3]

• Hot flashes (also known as hot flushes), or a sudden feeling of heat in your upper chest and face
• Night sweats and sleep trouble, including disrupted sleep or insomnia
• Loss of muscle mass and weight gain, especially around the waist
• Vaginal dryness and decreased sexual desire
• Memory issues and brain fog
• Anxiety and depression

How does menopause cause weight gain?

Before menopause, estrogens in your body are responsible for distributing fat to your thighs and bum. However, during and after menopause, when your estrogen levels have depleted, different sex hormones called androgens accumulate fat around the abdominal region instead. [4] Low estrogen also reduces your body's insulin sensitivity, or how easily your cells use blood glucose. [5] This insulin resistance causes high blood sugar, which in turn triggers your pancreas to release more insulin into your blood to rebalance your levels.

However, high insulin levels are a fat storage signal in your body, and also lead to the accumulation of fat around your stomach and waist, rather than your hips. [6] Ultimately, the result of these hormonal shifts within your body is a higher concentration of belly fat, commonly referred to as 'menopause belly'.

Hormone changes during menopause may also affect your appetite, research shows. A 2019 review found a link between reduced estrogen and your body's ability to regulate hunger. [7] Without your usual satiety signals, you may not feel as full after meals, which could lead to overeating.

Poor sleep is also associated with changes to appetite. Many factors contribute to disrupted sleep during menopause, from hormone changes interrupting your usual sleep cycle to vasomotor symptoms, which you may know as hot flashes or night sweats. [8] [9] When you have trouble sleeping, it doesn't just make you feel tired. It can cause changes to your mood and, crucially, affect hunger and impulse control. In clinical studies, sleep restriction has been found to increase levels of ghrelin, your body's hunger hormone, and cause you to eat more as a result. [8] [10]

Is menopause weight gain permanent?

It's important to remember that it's natural for your body to change as you get older. You're experiencing many different hormonal changes, many of which influence fat distribution, appetite, and your sleeping patterns. However, that doesn't mean you can't make lifestyle modifications to help you manage your weight and feel your best while you're going through this stage of your life.

How to manage menopausal weight gain

Making manageable lifestyle changes could help you feel more in control of your weight during menopause.

Diet and nutrition

Adopting healthy eating patterns is key when it comes to weight management. To lose weight, your body needs to be in a caloric deficit. That simply means you're burning more calories than you're consuming. Research shows that following diets low in red and processed meats, and rich in fruits, vegetables, legumes and whole grains (such as the Mediterranean diet) may help reduce weight gain during menopause. [11]

It's also recommended that you reduce your alcohol intake, as alcoholic drinks can be high in calories. You can find more tips on following a balanced diet in Canada's Food Guide.

Physical activity

Staying active during menopause can help you manage your weight in several ways. The first, and most obvious, is by burning through your body's fat stores. Movement requires energy, which increases your caloric deficit, and means your body will start to use stored fat as fuel. Resistance training, and other weight-bearing exercises, also build muscle mass. Muscle burns more calories at rest than fat, so maintaining it can help you burn energy even when you're relaxing.

Exercise can help you manage other menopausal symptoms, too. Low estrogen levels can affect your bone health, but adding regular movement to your daily routine can help maintain bone density and strength. Changes to your mood and sleep can also be managed by increasing physical activity. [12]

Health Canada recommends that adults should incorporate 2.5 hours of moderate to vigorous aerobic exercise each week. [13]

Hormone replacement therapy (HRT)

Hormone therapy is a treatment used to alleviate menopause symptoms by replacing estrogen and progesterone in your body. One study found that HRT may support weight loss by influencing insulin response and energy expenditure. [14] Another found that HRT didn't directly affect weight loss or gain, but it did help redistribute fat to the thighs and hips, rather than the stomach. [15]

Although this evidence is mixed, HRT is considered to be the most effective treatment for symptoms such as hot flashes and sleep disturbances which, as discussed above, can have an impact on appetite and diet. [16]

Sleep

Not getting enough sleep can affect energy levels and contribute to weight gain, so it's important to stick to a regular schedule. Keeping your bedroom cool or using a fan can help reduce discomfort if you experience night sweats, and limiting your caffeine and alcohol intake can make it easier to fall asleep. Health Canada recommends aiming to get between 7 and 9 hours of sleep every night. [17]

Medicated weight loss

Medications like Zepbound (tirzepatide) or Wegovy (semaglutide) mimic a natural hormone in your body, GLP-1 (glucagon-like peptide-1), which helps control blood sugar and appetite. [18] They support weight loss by slowing digestion, reducing hunger, and regulating blood glucose levels. [19, 20]

Only Wegovy, Zepbound and generic semaglutide are approved by Health Canada for chronic weight management, subject to eligibility and assessment by a licensed healthcare provider. [21]

Looking for weight loss support? Our Clinical team can help you find the right treatment at MedExpress.

References

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3. National Defence. The Women and Diversity Health Guide to: Menopause - Canada.ca [Internet]. Canada.ca. 2021 [cited 2026 Aug 12]. Available from: https://www.canada.ca/en/department-national-defence/services/benefits-military/health-support/women-diversity-health/health-guide/wdh-menopause-guide.html

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13. Public Health Agency of Canada. Physical Activity Tips for Adults (18-64 years) [Internet]. Canada.ca. 2018 [cited 2026 Aug 12]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/physical-activity-tips-adults-18-64-years.html

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15. Reubinoff BE, Wurtman J, Rojansky N, Adler D, Stein P, Schenker JG, et al. Effects of hormone replacement therapy on weight, body composition, fat distribution, and food intake in early postmenopausal women: a prospective study. Fertility and sterility [Internet]. 1995 Nov [cited 2026 Aug 13];64(5):963–8. Available from: https://pubmed.ncbi.nlm.nih.gov/7589642/

16. Yanachkova V, Vasileva-Slaveva M, Kostov S, Yordanov A. Reconsidering Hormone Replacement Therapy: Current Insights on Utilisation in Premenopausal and Menopausal Women: An Overview. Journal of Clinical Medicine [Internet]. 2025 Oct 10 [cited 2026 Aug 13];14(20):7156. Available from: https://www.mdpi.com/2077-0383/14/20/7156

17. Public Health Agency of Canada. Key findings: Physical Activity, Sedentary Behaviour and Sleep (PASS) Indicators — Canada.ca [Internet]. Canada.ca. 2026 [cited 2026 Aug 13]. Available from: https://health-infobase.canada.ca/pass/key-findings.html#sleep

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19. Blundell J, Finlayson G, Axelsen M, Flint A, Gibbons C, Kvist T, et al. Effects of once‐weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity. Diabetes, Obesity and Metabolism [Internet]. 2017 May 5 [cited 2026 Aug 13];19(9):1242–51. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573908/

20. MacIsaac RJ. Semaglutide: a key medication for managing cardiovascular-kidney-metabolic syndrome. Future cardiology [Internet]. 2025 Mar [cited 2026 Aug 13];1–21. Available from: https://pubmed.ncbi.nlm.nih.gov/40458885/

21. Regulatory Decision Summary for Wegovy - Drug and Health Products Portal [Internet]. Hpfb-dgpsa.ca. 2021 [cited 2026 Aug 13]. Available from: https://dhpp.hpfb-dgpsa.ca/review-documents/resource/RDS00896