Everyone Blames the Hormones. The Truth Is More Complicated.
One of the most common things I hear from patients is: "My hormones are making me gain weight." And while hormonal fluctuations during perimenopause absolutely play a role, they're rarely the whole story.
What I see clinically is a complex interplay of factors — lifestyle changes, sleep disruption, shifting family responsibilities, fatigue, motivation, and yes, hormones — all working together to make weight management harder than it used to be. Blaming it entirely on hormones can actually get in the way of making real progress.
The Eating Pattern I See Over and Over
If I had to describe the most common eating pattern I see in perimenopausal women, it would go something like this: no breakfast, a light lunch if anything, then dinner and snacks from mid-afternoon onwards. Or strict eating during the week, followed by no rules on weekends.
What happens in this pattern is that the woman feels like she's always restricting. She remembers the days she ate well and forgets the evenings or weekends where she went significantly over her calorie needs. So she's working hard, feeling deprived, and not seeing results — and it's genuinely confusing and demoralising.
The issue isn't willpower. It's an inconsistent pattern that creates real metabolic difficulty and makes perimenopause symptoms worse.
Life Gets in the Way — In Very Specific Ways
A lot of my patients are also mothers and partners. They're making dinner for families, not just themselves. They don't always control what's on the table. They're thinking about everyone else first.
Exercise is another area where I see a significant gap between intention and reality. Many women are walking a few times a week or attending Pilates or yoga once or twice. That's a good foundation — but it's often not enough to support the metabolic demands of this life stage. And frequently, it's not a motivation problem. It's energy. It's schedules. It's the fact that perimenopause symptoms make it genuinely harder to push.
Perimenopause Symptoms Are Indirectly Affecting Your Body Composition
This is the part that often surprises patients. The hormonal fluctuations of perimenopause may not be directly causing weight gain — but they are indirectly affecting your ability to manage it.
Poor sleep leaves you exhausted, making it harder to get to the gym or cook well. Brain fog means you don't have the capacity to plan meals. Worsening PMS drives food cravings and can feel completely out of control — especially if you've been under-eating.
Many women also reduce their carbohydrate intake during perimenopause, thinking it will help. But low-carb approaches can actually worsen PMS symptoms, destabilise blood sugar, increase anxiety, disrupt sleep, and trigger headaches — creating a cycle that makes everything harder.
The Bottom Line
Weight changes during perimenopause are real, they're common, and they're not your fault. But understanding what's actually driving them — beyond just hormones — is the first step toward addressing them in a way that actually works. In the final post of this series, I'll walk through what a sustainable, body composition-focused approach looks like in practice.
