From the Research
During perimenopause, weight loss becomes more challenging due to hormonal fluctuations, particularly declining estrogen levels, which can slow metabolism, increase fat storage, and reduce muscle mass. For a patient consuming exactly their basal metabolic rate of 1445 calories daily, weight loss will be difficult because this amount only covers basic bodily functions at rest, not additional energy expenditure from daily activities. I recommend creating a modest caloric deficit of 250-500 calories per day through a combination of slightly reduced caloric intake (around 1200-1300 calories) and increased physical activity, particularly strength training to preserve muscle mass. Adding 2-3 sessions of resistance training weekly can help counteract the natural muscle loss that occurs during perimenopause, as suggested by the general principles of menopause management 1. Focus on nutrient-dense foods with adequate protein (0.8-1g per kg of body weight) to support muscle maintenance. Managing stress is also important as elevated cortisol levels during perimenopause can promote abdominal fat storage. Be patient with the process, as weight loss typically becomes slower during this hormonal transition, often requiring 3-6 months to see significant results. Regular sleep of 7-8 hours nightly will help regulate hunger hormones that can be disrupted during perimenopause. While hormone replacement therapy (HRT) may be considered for managing menopausal symptoms, its role in weight loss is not directly addressed in the provided studies 2, 3. Selective estrogen receptor modulators (SERMs) have been explored for their potential benefits in menopause management, including effects on bone and lipid metabolism, but their direct impact on weight loss during perimenopause is not clearly defined in the given evidence 4, 5. Therefore, the approach to weight loss during perimenopause should prioritize lifestyle modifications, including diet and exercise, with consideration of individual factors that may influence the effectiveness of these interventions.