5 myths about perimenopause and weight

When my endocrinologist told me my weight was the same as last year and it was perfectly fine, he meant it as reassurance, but I found it frustrating.

My dresses still fit, just differently. The belly fat I had never carried in my life, even after childbirth, was suddenly there, and nothing I tried was shifting it: not the under-desk treadmill I bought so I could keep moving through the working day, not the regular strength training sessions, not the months of being stricter with myself than I had ever been. If anything, the fat kept growing. I was exhausted and hungry and my body was quietly doing its own thing regardless.

Nobody connected this to perimenopause. My endocrinologist pointed to the scale. My GP didn't mention hormones. I was told I was fine, which left me to figure out on my own that the rules I had been following — eat less, move more, be disciplined enough — had stopped applying. Something more fundamental had shifted underneath them, and I was the last to know.

Here are five myths I wish I'd seen through much earlier.

Myth 1: “If my weight hasn't changed, I'm fine”

My endocrinologist was quite certain of this one, and he wasn't being careless so much as working from a framework that simply doesn't account for what actually happens to women's bodies during perimenopause.

Total weight and body composition are not the same thing. During the menopause transition, fat redistributes, often significantly, without the overall number on the scale changing at all. The fat that oestrogen had been directing to the hips, thighs and buttocks for decades starts migrating inward instead, accumulating around the organs rather than under the skin. Visceral fat, the kind that wraps around the liver, pancreas and intestines, increases from around 5–8% of total body fat before the transition to 15–20% after it.

This matters metabolically. Visceral fat isn't the same as the soft subcutaneous fat you can pinch; it's biologically active in ways that drive insulin resistance and low-grade inflammation, and none of that registers on a scale.

If your clothes are fitting differently around the middle while your weight looks fine on paper, you are not imagining it and you are not being irrational about a number. Your body is redistributing, and the scale is simply the wrong tool for measuring it.

Myth 2: “I just need to eat less”

I spent a long time believing this one, and it sent me in completely the wrong direction.

Calories still matter, but reducing them doesn't address where your body chooses to store or release fat, and in perimenopause that's being directed increasingly by hormones rather than by what you ate for dinner. Oestrogen has a direct role in fat distribution through receptor signalling in adipose tissue, and while it's present in meaningful amounts it keeps fat in the subcutaneous compartment: hips, thighs, buttocks. As it declines, that signal weakens and fat begins accumulating abdominally instead, and reducing calories doesn't change that mechanism.

Sleep makes all of this considerably harder. Progesterone, which falls alongside oestrogen during perimenopause, has natural calming effects and supports sleep. When it drops, sleep disruption becomes very common, and poor sleep shifts ghrelin and leptin (the hormones that regulate hunger and fullness) in exactly the wrong directions. You're hungrier than you used to be, you feel full less reliably, and you're trying to sustain restriction through all of it.

There were many nights when I couldn't fall asleep because of intense hunger. I would fight myself until 4am because I didn't want to add blood sugar issues on top of everything with my diabetes, but eventually, to get at least a couple of hours of sleep, I had to go and eat something.

This nighttime hunger softened significantly after I started HRT, which confirmed for me personally that it wasn't something I could simply control through willpower.

Myth 3: “More exercise will fix it”

I have real personal investment in correcting this one, because I made exactly this mistake and it cost me months.

My instinct when nothing was working was to add more: more walking, more time on the treadmill, more cardio and dancing in addition to my strength training. What I didn't understand then is that sustained exercise without adequate recovery raises cortisol, which in a body already managing perimenopausal hormonal shifts and disrupted sleep specifically promotes abdominal fat storage. Your body interprets chronic overexertion as a signal to hold on to energy reserves, and adding more exhausting exercise to an already stressed system doesn't compensate for the hormonal picture; it adds to it.

The shift that made a real difference was moving away from more cardio and towards strength training. Building and preserving muscle improves glucose handling, raises resting metabolic rate and protects bone density, all of which matter considerably more as oestrogen declines. Moving differently and recovering properly makes far more difference than simply moving more.

Myth 4: “It's just ageing — there's nothing to do about it”

Age is part of this picture, but it's not the whole picture, and the distinction matters because hormonal factors are addressable in ways that ageing in isolation isn't.

The specific changes of perimenopause, including visceral fat accumulation, muscle loss and declining insulin sensitivity, are driven meaningfully by falling oestrogen and progesterone, not simply by the passing of years.

That means there are levers, and it's worth knowing what they are. HRT is one of them: research shows it can partially reverse visceral fat accumulation ↗ and improve metabolic markers, and if you're noticing fat redistribution or finding it increasingly difficult to manage your weight despite consistent habits, it's a conversation worth having with a specialist who understands hormonal health properly. This is a decision for you and your doctor, not a recommendation from me, but the option exists and is too often not raised until much later than it could be.

Myth 5: “Being strict enough will eventually work”

This one cost me the most, because the more it didn't work, the harder I pushed, and the harder I pushed, the worse things got, and I had no framework to understand why.

Chronic caloric restriction is a physiological stressor, and so is exhausting exercise without adequate recovery. Research shows both can raise cortisol, and cortisol in a body already navigating perimenopausal hormonal changes specifically promotes abdominal fat storage — visceral fat tissue has a higher density of cortisol receptors than subcutaneous fat, which is part of why chronic stress tends to settle precisely where you least want it. The harder you restrict, the more you train through exhaustion, the more your body interprets this as a threat and holds on to the very fat you're trying to lose. I was doing everything I could, things were getting worse, and at the time I genuinely didn't know that was possible.

What actually moved things was getting enough sleep, managing stress rather than pushing through it, shifting from more cardio to strength training, and eating enough protein at every meal to protect what muscle I had. None of these felt like doing more (the sleep and stress work in particular felt like doing considerably less), but they addressed what was actually driving the changes in my body, rather than fighting against it while the real cause went unaddressed.

Adequate protein, resistance training, sleep quality and stress reduction are all available regardless of HRT, and each targets specific mechanisms rather than functioning as general lifestyle advice. That said, it's worth working through any significant dietary changes with your doctor rather than adopting something restrictive on your own — strict ketogenic diets, for instance, are increasingly popular, but very low carbohydrate intake can affect thyroid function and amplify cortisol responses, both of which are already under pressure during perimenopause, and the evidence for keto specifically outperforming a balanced, protein-forward diet ↗ in this context simply isn't there.

What the research says

Lena Filatova

Lena Filatova has lived with type 1 diabetes for 23 years. She writes about women's health, perimenopause and long-term wellbeing at lenafilatova.co.uk.