Facebook Follow AMS on Linkedin Follow us on Twitter @amsmenopausen AMS on Instagram

Best chance for battling menopausal weight gain may be during perimenopause

Most women going through menopause complain about the added weight. Menopause is often accompanied by accelerated adverse changes in body composition, hot flashes, and an increased risk of such chronic diseases as osteoporosis and heart disease. A new study suggests that lifestyle interventions aimed at managing these problems are most valuable during perimenopause. 

Much focus is on the adverse symptoms of menopause. The reality is that many of the changes associated with a decreased quality of life, productivity, and intimacy take place in the period before menopause, known as perimenopause. Studies have documented that menopause is associated with a gain in fat mass, as well as a redistribution of fat toward the abdomen, with perimenopause being a key transition point for these changes. Some studies have also shown that menopause can additionally cause loss of lean mass, as well as bone mass.

It is well known that energy expenditure during rest and exercise is reduced with age, but few studies have evaluated the menopause transition as an independent factor that may influence metabolism. In this new study, researchers evaluated women at all stages of menopause (premenopause, perimenopause, and postmenopause) to understand changes in resting and exercise metabolism in conjunction with body composition. A secondary aim was to identify relationships between body composition and select lifestyle factors such as dietary habits, physical inactivity, and sleep, which are important contributors to changes in body composition and metabolism.

The researchers concluded that perimenopause may be the most opportune window for lifestyle intervention, because this group experienced elevated percentages of fat, lower lean body mass, and a shift toward central obesity. The greatest changes in the overall percentage of fat were observed between the premenopause and perimenopause periods, indicating that that the menopause transition stimulates the changes that later stabilize in postmenopause. The greatest differences in exercise metabolism were highlighted during moderate-intensity exercise, with postmenopause displaying the poorest metabolic flexibility (defined as resting energy expenditure and substrate utilization during exercise). These differences in exercise metabolism occurred despite greater average physical activity reported in the perimenopause and postmenopause groups.

To prevent unwanted changes in resting metabolism, as well as metabolic flexibility, it is suggested that menopausal women engage in activities that help maintain lean mass, such as resistance exercise, as well as maintain or increase oxidative capacity with moderate- to high-intensity exercise.


Objectives: To evaluate body composition, fat distribution, and metabolism at rest and during exercise in premenopausal, perimenopausal, and postmenopausal women.

Methods: This cross-sectional study in 72 women ages 35 to 60 years evaluated body composition via a four-compartment model, fat distribution using dual-energy x-ray absorptiometry-derived android to gynoid ratio, metabolic measures via indirect calorimetry, and lifestyle factors using surveys. One-way analyses of variance and one-way analyses of covariance covaried for age and hormone levels (estrogen and progesterone) were used to compare groups.

Results: Body fat percent was significantly lower in premenopausal than perimenopausal women (mean difference ± standard error: -10.29 ± 2.73%, P=0.026) despite similarities in fat mass and fat-free mass between groups (P≥0.217). Android to gynoid ratio was significantly lower in premenopausal than perimenopausal women (MD ± SE: -0.16 ± 0.05 a.u., P = 0.031). Resting energy expenditure was similar between groups (P = 0.999). Fat oxidation during moderate intensity cycle ergometer exercise was significantly greater in premenopausal than postmenopausal women (MD±SE: 0.09 ± 0.03 g/min, P = 0.045). The change in respiratory exchange ratio between rest and moderate intensity exercise was significantly lower in premenopausal women than peri- (MD±SE: -0.05 ± 0.03 a.u., P = 0.035) and postmenopausal women (MD±SE: -0.06 ± 0.03 a.u., P = 0.040). Premenopausal women reported significantly fewer menopause symptoms than peri- (MD±SE: -6.58 ± 1.52 symptoms, P = 0.002) and postmenopausal participants (MD±SE: -4.63 ± 1.52 symptoms, P = 0.044), while similarities between groups were observed for lifestyle factors including diet and physical activity (P > 0.999).

Conclusions: Perimenopause may be the most opportune window for lifestyle intervention, as this group experienced the onset of unfavorable body composition and metabolic characteristics.


Lacey M Gould, Amanda N Gordon, Hannah E Cabre, Andrew T Hoyle, Eric D Ryan, Anthony C Hackney, Abbie E Smith-Ryan. Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism. Menopause. 2022 Feb 28. doi: 10.1097/GME.0000000000001932. Online ahead of print. 

Content created 9 March 2022

Print Email


Facebook Follow AMS on Linkedin Follow us on Twitter @amsmenopauseAMS on Instagram