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What to do about belly fat in perimenopause

weight gain; belly fat

You might be familiar with the rollercoaster ride that is perimenopause or maybe you’re just starting to get to know the hormone chaos that perimenopause can bring. As if sleep issues and mood swings weren't enough, many of us are also gaining weight, especially around the belly. Let's dive into the science behind why most of us put on weight in perimenopause and what we can do about it.

Perimenopause symptoms are influenced by various hormones, including high or low estrogens, low progesterone, imbalanced cortisol levels, and fluctuating blood sugar levels.

As you may remember, progesterone is your first hormone to decline from 35 years on, followed by estrogen, which starts to decline a bit later in perimenopause (usually around mid 40s but that’s different for everyone). Go back to my article on the stages of hormone transition to read more.

You could say that low estrogen is one of the main culprits of weight gain in peri and that’s because the natural production and storage of estrogen will happen in your fat cells once your ovaries stop producing it. So the lower your estrogen, the more fat your body wants to accumulate in order to compensate and keep levels up.

But there’s another aspect to this: your blood sugar balance! Healthy estrogen levels also protect you from high blood sugar levels, so if your estrogen drops, your blood sugar is more sensitive (you may notice that in your luteal or second phase of your cycle that you have to eat more frequently throughout the day or you feel tired after meals, hangry or crave sugar or carbs).

Many women in perimenopause experience high blood sugar levels and even develop pre-diabetes or diabetes. With age, your insulin receptors aren’t as responsive anymore to insulin, which means that the glucose that’s circulating in your blood actually can’t get into your cells. That’s how you feel chronically fatigued as well because your body can’t access the energy that’s provided and on top of that the chronic high glucose levels result in high inflammation. And inflammation will cause brain fog, muscle pain, stiffness, hot flashes, and weight gain around the belly.

What are the symptoms of low estrogen?

  • Depression

  • Insomnia

  • Brain fog and memory issues

  • Vaginal dryness & frequent UTIs

  • Migraines

  • Increased cholesterol

  • Snoring or sleep apnea

  • Joint pain, plantar fasciitis

  • Increased risk of heart attack

  • Osteoporosis

  • Increased wrinkles on skin and loss of elasticity

What are the symptoms of high blood sugar?

  • Hot flashes and night sweats

  • Mood swings and irritability, especially when hungry

  • Anxiety and lack of grounding, especially when hungry

  • Feeling hungry although you just ate

  • Frequent urination

  • Blurred vision

  • Fatigue and energy fluctuations

  • Weight gain and difficulty losing weight

  • Brain fog and cognitive issues

  • Numbness or tingling in the feet or hands

  • Frequent infections & slow-healing

  • Fasting glucose levels above 88 mg/dL

  • HbA1C levels above 5.4%

But there’s other culprits that cause weight gain in perimenopause and menopause:

  • Loss of muscle mass

  • Slower metabolism

  • Increased stress

Metabolism Matters As we age, our metabolism tends to slow down, which means we burn fewer calories. This can make it easier for the pounds to creep up, especially around the midsection and also to lose them again once they’re there...

Stress, Cortisol & Inflammation Connection: As your hormone levels drop, they leave more room for your stress hormone cortisol to rise. Elevated cortisol means increased inflammation which means accumulation of belly fat. So you really have to pay extra attention to managing your stress levels.

Now that we've uncovered the why, let's talk about the how. Here are some practical steps to help you get rid of that stubborn belly fat during perimenopause:

  1. Exercise regularly, especially weight lifting or body weight exercise to stimulate bone renewal and muscle growth/tone

  2. Eat enough protein to support muscle mass

  3. Focus on nutrient-dense foods, incorporating plenty of fiber, lean proteins, and healthy fats into your meals.

  4. Keep moving to keep your metabolism up by stretching regularly or taking a short walk around the office when you’re sitting all day

  5. Stress management: Find your stress-relief strategies, whether it's meditation, deep breathing, or a hobby you love. Your body and mind will thank you.

  6. Prioritize restorative sleep – it's not only important for your mood and energy levels but also for keeping those hormones (especially cortisol) in check.

  7. Now countering declining levels of estrogen is a bit more tricky:

    • Bring in estrogenic foods (go back to the end of my previous article for more details here)

    • Try adaptogens or herbs to boost estrogen: Maca being my favorite

    • Use bioidentical estrogen: Supplementing with bioidentical estrogen is defintely the best way to counter that effect and also to keep your brain, blood sugar, heart and cholesterol levels healthy. Not even to mention the vaginal dryness and accelerated skin aging that can come with low estrogen.

Want more guidance with these steps? Consider joining our program “Perimenopause like a Boss” where we’ll go through all these steps and provide you with ready protocols for using these supplements and bioidentical hormones. The program also includes a copy of my blood sugar & hormone balancing cookbook.


Ladies, perimenopause might throw a few curveballs our way, but we're armed with knowledge and strategies to take control. Embrace this transitional phase as an opportunity to prioritize your health, happiness, and well-being.

Remember, you're not alone in this journey, and that belly fat? Well, with a dash of exercise, a sprinkle of stress management, and a dollop of bio-identical hormones, you've got this!


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