Menopause weight gain and belly fat
Weight gain in perimenopause and menopause is common, often at the waist. Menopause and HRT have not been shown to be the main cause of the extra pounds.
Perimenopause
The years before your last period, when cycles change and symptoms start while periods still come.
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Guides on this topic
Menopause symptom checklist for your GP
A printable list of perimenopause and menopause symptoms, with how often each occurs and how much it bothers you, for a GP visit about hormone therapy.
Perimenopause: the overview
Perimenopause is the run-up to menopause: symptoms have started, and periods are still happening. Menopause is the point after 12 months with no period. A change in the cycle is usually one of the first signs, and hormone replacement therapy (HRT) can be started at this stage if the symptoms bother you.
For most women that last period falls between 45 and 55 (nidirect: menopause). The average age in the UK is 51 (NHS: menopause).
Perimenopause symptoms and first signs
Periods may come more often or less often, and bleeding may get heavier or lighter, before they stop altogether (NHS: symptoms of menopause and perimenopause). NICE recommends diagnosing perimenopause when vasomotor symptoms have recently started and the menstrual cycle has changed in any way (NICE guideline NG23).
A hot flash (a hot flush in the UK) is a sudden feeling of heat, or of cold, in the face, neck and chest, with sweating. It can last several minutes, during the day or at night, and it can come with palpitations, anxiety or dizziness. A hot flash at night, with sweating, is called a night sweat.
Sleep problems and low mood are common in the same years (NHS: what are menopause and perimenopause). Broken sleep can make memory and concentration feel worse (sleep). Hot flashes may ease later, and low mood or anxiety can become what you notice most (symptoms).
A printed sheet is easier to use in a GP appointment. The symptom checklist records cycle changes, how often each symptom occurs, and how much it affects you.
How long does perimenopause last?
There is no set duration. Periods usually become less frequent over a few months or years before they stop, and they can also stop suddenly. Symptoms can begin months or years before periods stop. After the last period, symptoms can last around four years, and some women have them for much longer (nidirect: menopause).
Perimenopause finishes at menopause, after 12 months with no period. NICE counts those months only if you are not using hormonal contraception. Measured across the whole transition, symptoms usually last 7 to 9 years, sometimes longer, and they can change as that time goes on (NHS: symptoms of menopause and perimenopause). The four-year figure is counted from the last period, while 7 to 9 years is how long the NHS says symptoms usually last from start to finish.
Hormone replacement therapy for perimenopause
You can take HRT during perimenopause. If symptoms are bothering you, the NHS suggests talking to a GP about starting HRT. Whether to take it, and when, is your choice. You do not need to wait until symptoms are severe, or until periods have stopped completely. A GP should explain the benefits and risks (NHS: when to take HRT). The extra cases of breast cancer, blood clots and stroke per 1,000 women are set out in the article HRT risks in plain numbers. Hormone therapy covers the main kinds of HRT.
While periods continue, the usual recommendation is sequential combined HRT, also called cyclical HRT. Oestrogen is taken every day, and a progestogen is added for the last 10 to 14 days of each monthly cycle. Continuous combined HRT, both hormones every day with no break, is the common choice after menopause (NHS: types of HRT). NICE says to offer HRT for hot flashes and night sweats, to offer combined HRT if you have a uterus, and to discuss sequential versus continuous combined regimens.
If menopause happens before 45, the same NHS guidance says HRT or the combined contraceptive pill is particularly important. You are usually advised to take HRT until at least the age of 51.
You can still get pregnant during perimenopause. Contraception is still needed for 2 years after the final period if you are 40 to 49, and for 1 year after the final period if you are 50 or over (NHS: symptoms of menopause and perimenopause). Continuous combined HRT is not a contraceptive, and it is still possible to get pregnant while taking HRT (NHS: common questions about continuous combined HRT). NICE asks clinicians to share contraception information with anyone who has menopause symptoms.
How is perimenopause diagnosed?
From the age of 45, with a typical pattern, NICE advises diagnosing perimenopause based on symptoms alone. Hormone levels swing from one day to the next, so a blood test on a single day is a poor way to confirm it. Under the age of 45, tests are more likely to be needed, because menopause at that age is managed differently.
For the first GP appointment, bring two or three months of period dates and a note of what disrupts sleep, work or mood.
Questions readers ask
What are the symptoms and signs of perimenopause?
Timing and flow of periods tend to shift before anything else. Heat, sweating at night, poor sleep and mood changes commonly join them, and they do not line up in one sequence for everyone.
How long does perimenopause last?
It varies. Some people have a few unsettled months, others several years of cycles spacing out. Once a year has passed with no period, this stage is over. Symptoms can keep going after that, and they often feel different from one year to the next.
Can hormone replacement therapy be started during perimenopause?
Yes. You can raise it with a GP as soon as symptoms bother you, with cycles still underway. Prescribers usually choose a cyclical combined prescription at that point. The decision is yours, after benefits and risks have been explained.
Can I still get pregnant during perimenopause?
Yes. Ovulation does not stop on a timetable. Hormone therapy will not prevent a pregnancy, so keep contraception going through this stage and for a time after the final period. How long that tail lasts depends on your age.
Do I need a blood test to confirm perimenopause?
After 45, a recognisable pattern of symptoms is enough for a doctor to name perimenopause. Levels jump about, so one sample can look unremarkable. Below 45, blood tests come into the conversation more often, because an earlier menopause is its own situation.
Other topics
- Symptoms: Brain fog, anxiety, aches and other changes, and what each symptom usually means.
- Hormone therapy (HRT): What HRT is, the forms it comes in, who it suits and how the risks really stack up.
- Hot flashes: Why the heat comes on, and which treatments have trial evidence, with and without hormones.
- Sleep: Why sleep breaks down in perimenopause and menopause, from sweating at night to 3am waking, and what helps you stay asleep.
- Weight and diet: Why weight changes in midlife, and how to eat for energy, bone strength and heart health.