The Goal Isn't Weight Loss. It's Body Composition.
When a patient tells me she wants to lose weight, what she almost always means is that she wants to lose fat. She wants to feel better in her body, have more energy, and reduce her health risks. The number on the scale is a proxy for that — and often not a very accurate one.
This is especially true in perimenopause, where the goal isn't just to reduce body weight, but to preserve and ideally increase muscle mass and bone density while reducing fat. That's a fundamentally different objective than simply "eating less" — and it requires a fundamentally different approach.
Why We Can't Rely on the Scale Alone
The scale doesn't tell you what you're losing. If you're dropping weight through calorie restriction alone, a significant portion of that loss may be muscle — particularly in perimenopause, when estrogen decline affects how the body processes protein and maintains muscle tissue.
That's why I use other metrics alongside weight. Waist-to-hip ratio is an important marker of metabolic risk. DEXA scans, where accessible, give us a real picture of body composition — how much fat, how much muscle, what's happening at the bone level. These tools give us information we can actually act on.
What Sustainable Looks Like in Practice
Sustainable fat loss during perimenopause is slow and steady. It supports overall health rather than compromising it. And crucially, it has to be something a woman can actually maintain long-term — not just for eight weeks.
That means consistent eating patterns rather than restriction. It means adequate protein to support muscle. It means not cutting carbohydrates so aggressively that sleep, mood, and energy suffer. It means understanding that food cravings during PMS are often a signal of under-eating, not a lack of willpower.
It also means moving more — but in a way that's realistic. Building on what's already there, increasing frequency or intensity gradually, and working with energy levels rather than against them.
Trying to Do Too Much Too Quickly Doesn't Work
One of the most common mistakes I see is patients trying to overhaul everything at once and expecting fast results. If they don't see those results quickly, they lose motivation. If they do see them quickly, the rapid loss is often coming at the expense of muscle and nutrients.
Nutrient deficiencies are a real concern with restrictive approaches — calcium, fibre, B vitamins are commonly depleted. These aren't minor inconveniences. They affect bone health, gut health, energy, and mood. They make perimenopause harder, not easier.
The One Thing I Want You to Remember
If there's one thing I want patients to take away from this series, it's this: weight management in perimenopause is not about working harder or restricting more. It's about working smarter — understanding what your body actually needs during this transition, and making changes you can sustain.
The women who see the best results are the ones who stop chasing quick fixes and start building habits that support their health for the long term. That's what I work toward with every patient — and it's what this series has been about.
