Perimenopause: what happens to your body and how to adapt

The NHS describes the most common ones: hot flushes (a sudden feeling of heat in the face, neck and chest), night sweats, mood changes, poorer concentration and memory, disturbed sleep, vaginal dryness and discomfort, more frequent urinary infections. And one that affects almost everyone: weight gain, most often around the stomach and upper body.

The SWAN study followed 1,246 women with repeated body-composition scans. The result is surprising: during the menopause transition weight does not rise faster than before, but fat mass does. The yearly gain in fat doubles (from about 1.0% to 1.7%), while lean mass moves from a slight gain to a slight loss (about 0.2% per year).

That is why “I have not gained much” and “my clothes fit differently” are both true at the same time. The change is in the composition, not the number. And that is exactly why simply eating less does not solve it — you have to protect your muscle.

The PROT-AGE expert group recommends that healthy adults over 65 eat at least 1.0–1.2 g of protein per kilogram of body weight per day, and more when they train regularly. The reason is “anabolic resistance”: with age, muscle responds less to protein, so it needs more of it and spread across the day. For a 65 kg woman that is 65–78 g per day, split into 3–4 meals of 25–30 g each.

Fibre (at least 25 g a day according to EFSA) helps with fullness and blood sugar — the two things that become more capricious in perimenopause.

The WHO recommends 150–300 minutes of moderate activity a week and muscle-strengthening exercise on at least two days. In the LIFTMOR trial, postmenopausal women with low bone mass trained for 8 months, twice a week for 30 minutes, supervised and with gradually increased loading — and improved the bone density of their spine and hip, with a good safety record thanks to correct technique.

You do not need to start heavy. You need to start and to progress. Walking stays valuable, but on its own it does not stop muscle loss.

Disturbed sleep is both a symptom and an accelerator of the other problems: more hunger, less energy to move. Protect 7 or more hours (the recommendation of the American Academy of Sleep Medicine), a cool bedroom, a light dinner without alcohol and screens off early. For very strong hot flushes and night sweats there are medical options — see below.

Hormone therapy is the most effective treatment for hot flushes and for the genitourinary symptoms of menopause, and it prevents bone loss — that is the 2022 position of The Menopause Society. For women under 60 or within 10 years of the start of menopause, without contraindications, the benefit–risk ratio is favourable; starting later carries higher risks. The decision is individual and is made with a doctor who knows your history.

I am not a doctor and this article is not medical advice. My role is nutrition, movement and habits — and they work best together with good medical follow-up.