Whichever way you slice it, aging isn’t always a pleasant experience for women. And we’re not even talking about menopause alone: Perimenopause, the period leading up to it (no pun intended), can hit hard as well.
Classic symptoms like hot flashes and night sweats might be infamous (ever seen that viral video of steam rising from a woman’s head at an outdoor event?), but this life stage can also bring other side effects, like appetite changes, Rachel Pessah-Pollack, MD, an endocrinologist at NYU Langone Health and a clinical professor at the NYU Grossman School of Medicine, tells SELF.
So what does that mean? And what can you do about it? Here’s everything you need to know about this lesser-known side effect of perimenopause.
First, a refresher: What exactly is perimenopause?
If you swap the r with the first e and cut out the i, you essentially arrive at the answer: pre-menopause. More precisely, perimenopause is “the period of time leading up to the end of your menstrual cycles,” Melissa Groves Azzaro, RDN (a.k.a. the Hormone Dietitian), a practitioner who specializes in women’s health issues like PCOS and perimenopause, tells SELF. While menopause occurs around age 52 on average, your body really sets the stage around 8 to 10 years before that as your ovaries start to produce less of the sex hormones estrogen and progesterone.
Perimenopause symptoms tend to appear in your mid-to-late 40s but can emerge as early as your mid-30s (even in the midst of postpartum) or as late as your mid-50s. In the beginning, you might see your cycles becoming shorter. “If you were typically a 28-day cycler and regular on the dot, you might notice them coming every 26 days or every 25 days,” Azzaro says, as an example. You could also experience more pain or heavier bleeding—a little like puberty in reverse.
Then, as perimenopause advances, your cycles will become decidedly more erratic. “You’ll notice a 28-day cycle, followed by a 15-day cycle, followed by a 60-day cycle,” Azzaro says. Ultimately, you’ll start skipping cycles entirely—“so that’s when you might go 60 days or 90 days between periods.”
How does perimenopause affect your appetite?
Remember when we said that perimenopause is regulated by fluctuating levels of estrogen and progesterone? Because estrogen naturally acts as an appetite suppressant by inhibiting hunger cues, it’s this specific hormonal shift that’s responsible for appetite changes during perimenopause, according to Dr. Pessah-Pollack.
“Normally, estrogen can help reduce the amount of food that you’re taking in, but as estrogen levels go down, that food-suppressant feeling becomes less strong, resulting in higher hunger, potentially higher food consumption, and an increased desire to eat,” Dr. Pessah-Pollack says. Specifically, you produce more of the “hunger hormone,” ghrelin (which stimulates hunger), and become less sensitive to ghrelin’s counterweight, leptin (which signals to your body that you’re full), Kathleen Jordan, MD, chief medical officer at Midi Health, internal medicine physician, and Menopause Society–certified provider, tells SELF.
Insulin, which helps balance your blood sugar (or blood glucose), is another hormone affected by declining estrogen. During perimenopause, the cells in your body become less responsive to it. (This is known as insulin resistance—which can famously raise your blood sugar and itself increase your appetite.) During this time, you might also experience particular cravings for what Dr. Jordan calls “quick-energy foods”—those high in stuff like sugar and simple carbohydrates, since those compounds are rapidly digested and spike your blood sugar as a result. Unfortunately, these foods can only exacerbate the problem: Blood sugar spikes are often followed by crashes that send you searching for another quick-energy food to offset the impact, creating a vicious cycle.
Unsurprisingly, people going through perimenopause might find “that they’re hungrier and potentially gaining weight,” Dr. Pessah-Pollack says. Despite trying to cut down on their calories, she notes, many of her perimenopausal patients notice they’re putting on pounds—a phenomenon Dr. Jordan has observed in her practice as well. “At Midi, our patients regularly report new or worsening struggles with weight. In fact, it is one of the most commonly reported symptoms of perimenopause and menopause,” she says. Your weight gain itself could look different too: Insulin resistance can alter how your body stores fat, causing it to concentrate around your abdomen rather than your hips and thighs.
In addition to these appetite changes, perimenopause can also cause other side effects, some of which can “add to and amplify” the effect, Dr. Jordan says. Sleep disturbances tend to be another major complaint, Azzaro says: “It’s mainly related to the declining progesterone,” since progesterone is calming. But you might also clock shifts in mood (like increased anxiety and depression), and thermoregulation challenges (a.k.a. hot flashes and night sweats), especially in the week before your period when your estrogen levels are at their lowest. In turn, you could experience “increased ‘reward-driven eating’” as you gravitate toward fatty comfort foods to soothe fatigue or stress, Dr. Jordan says.
What can you do about increased hunger during perimenopause?
If you’re trying to control perimenopause-induced appetite changes (or counter effects like weight gain), making certain tweaks to your diet and lifestyle can help. “These small adjustments can help you maintain your best health,” Dr. Jordan says. Here are a few tried-and-true strategies:
Eat more protein
This is one of Dr. Pessah-Pollack’s go-tos. In contrast to those quick-energy foods, protein makes you feel full, so logic follows that leveling up can help curb your appetite and limit your food intake. “High-protein, fiber-rich meals and healthy fats can help stabilize your blood sugar and keep those ‘insatiable’ signals at bay,” Dr. Jordan explains. (As an added bonus, a protein boost can also bolster your muscles, preventing age-related muscle wasting, Azzaro points out.)
Older adults should aim for between 1 and 1.2 grams of protein per kilogram of body weight (around 0.5 grams per pound) per day. Ideally, prioritize Mediterranean-style lean proteins like eggs, dairy products, and lean meats.
Limit carbs
In addition to eating more protein, “minimizing simple carbohydrates and sugary foods helps too,” Dr. Jordan says. While carbs aren’t inherently bad, eating them in the absence of protein, fats, and fiber can leave you hungry again before long, as we covered above, so they won’t do much to offer relief from an increase in appetite. “Hormone changes in midlife don’t mean we have to give up the foods we love—but it does mean that it might be healthier now to moderate the amounts of sugary treats,” Dr. Jordan says. (Or at least time them so they “come after a protein- or fiber-rich meal that slows down the sugar load.”)
Get enough sleep
Poor sleep can drive cravings that will exacerbate a perimenopausal increase in appetite, so adequate rest is key. Research shows that even a single night of tossing and turning “will make you crave and eat more sugar and carbs and calories the next day,” Azzaro says. (Of course, sleep disturbances are also a symptom of perimenopause, as we’ve covered, so this situation can rapidly turn into a vicious cycle if not controlled. “It all becomes very conjoined,” Dr. Pessah-Pollack says.)
Manage stress
Like poor sleep, stress is a well-known trigger for cravings and increased food intake. Not only can perimenopause symptoms themselves send your stress levels through the roof, but this window often also “aligns with the most difficult time in most women’s lives, because they become that sandwich generation,” Azzaro says. “They’ve maybe got young kids at home, they’ve got aging parents, they’re at the peak of their career—so it can be a lot.”
Exercise more
While exercising more could actually increase your appetite, it can also help you “avoid some of the swings in glucose levels” that can prompt cravings, Dr. Jordan says. Just walking for 15 or so minutes after a meal can “help level off blood sugars and avoid both the highs and lows of blood sugar fluctuation” (not to mention the dreaded food coma!).
The US Department of Health and Human Services’ Physical Activity Guidelines for Americans recommends at least 150 minutes (two and a half hours) of moderate-intensity aerobic exercise per week. “That roughly translates to 30 minutes five days per week, but you can also do it in 75 minutes of vigorous-intensity exercise” instead, Dr. Pessah-Pollack says.
Incorporate strength training
While all physical activity is beneficial, strength training has particular perks. Maintaining and building muscle mass can help support your metabolism, Dr. Jordan says. What’s more, focusing on strength can also help channel any increase in appetite or weight gain in a positive direction psychologically, according to Dr. Pessah-Pollack. “You’re no longer fixated on a number on the scale, but you’re actually seeing that your clothes look different,” she says. “Remember, too, that weight alone is not what matters—it’s body composition that helps your health the most. This means supporting more lean muscle mass and less body fat, which is why building muscle is so important,” Dr. Jordan adds.
Strength training can also help address some of the other side effects of perimenopause, like a low mood (endorphins FTW!) and a loss of bone density. “Strength training has significant benefits at your hip and at your spine,” Dr. Pessah-Pollack says—and research also suggests it can “potentially help reduce hot flashes.”
Per the Physical Activity Guidelines, adults need two days of moderate-to-greater-intensity muscle-strengthening exercises per week. “You want to do two to three sets of 8 to 12 reps at minimum,” Dr. Pessah-Pollack says.
Talk to your doctor about more significant interventions
Hormone therapy (HRT), which primarily works by replacing lost estrogen and progesterone, is an increasingly popular treatment for menopause symptoms—and for good reason. “These treatments have been linked to improved insulin sensitivity and lipid levels, positively impacting metabolism and health risks in many women,” Dr. Jordan says. Other medications may also be beneficial here, including the ones that have probably been all over your social feeds for the last few years: GLP-1s. Popular options like Ozempic and Zepbound “are incredibly effective in managing our appetite and metabolism while helping with weight management and minimizing risks of cardiovascular disease—the most common killer of women,” Dr. Jordan says. If you’re leery of GLP-1s, “there are other medications that can help, too, like Contrave, metformin, or even phentermine.”
Last but not least, stop treating the scale as your judge and jury
If you experience weight gain during perimenopause, no matter how hard you try to keep it at bay, try not to beat yourself up for it. If the body-positive movement taught us anything, it’s that your body size doesn’t determine your worth, despite what diet culture preaches (and like Dr. Jordan mentioned, body composition can be a better metric anyway). “In medicine, we talk about the things we can modify, like activity levels and food choices, but it’s important to note that some women just genetically have different metabolisms,” Dr. Jordan says. “So stop blaming yourself for what you have or have not done to support your best metabolic health—and stop judging it based on your weight alone. We share this information so that women understand the many tools and tricks that they can do to support their best health—not so they can chastise themselves for where they are now.”
Related:
- 5 Women on What It’s Really Like to Be in Menopause Before 40
- How 4 Real Women Manage Menopause Symptoms at Work
- This Nutrition Trick Might Delay Menopause
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