Understanding Perimenopause and How Hormonal Shifts Affect Weight Management

Perimenopause is the transitional phase leading up to menopause, typically starting in a woman’s 40s but sometimes earlier. During this time, oestrogen and progesterone levels fluctuate before eventually declining, leading to common symptoms like irregular periods, mood changes, hot flushes, and increased abdominal weight gain.

For women with PCOS, perimenopause can present additional challenges, particularly when it comes to insulin resistance and metabolic health. Since women with PCOS are already prone to insulin resistance, the natural hormonal shifts of perimenopause can further exacerbate blood sugar dysregulation, making weight management and symptom control even more difficult.

How Perimenopause Affects Insulin Sensitivity

1. The Decline in Oestrogen and Its Impact on Insulin

Oestrogen plays a crucial role in maintaining insulin sensitivity. As oestrogen levels decline during perimenopause, insulin function becomes less efficient, increasing the risk of insulin resistance, weight gain, and metabolic disorders.

2. Increased Fat Storage, Especially in the Abdomen

A study published in Diabetes found that perimenopausal women experience a shift in fat distribution, with increased abdominal fat accumulation due to declining oestrogen levels. For women with PCOS, who already have a predisposition to storing fat in this region, this change can be even more pronounced.

3. Higher Risk of Type 2 Diabetes

As insulin resistance worsens, the risk of developing type 2 diabetes increases. Research shows that women with PCOS have a higher lifetime risk of diabetes, and this risk becomes more significant during perimenopause.

Signs of Worsening Insulin Resistance in Perimenopause

If you are entering perimenopause and already have PCOS, it’s essential to watch for these signs of worsening insulin resistance:

• Unexplained Weight Gain: Especially around the midsection, despite no major changes in diet or exercise.
• Increased Cravings: Particularly for sugary or high-carb foods, as insulin resistance disrupts blood sugar regulation.
• Fatigue & Energy Crashes: Low energy levels, especially after meals, can be a sign that your body is struggling to regulate blood sugar effectively.
• More Irregular Periods: While cycle changes are expected during perimenopause, insulin resistance can make them more erratic.

How to Improve Insulin Sensitivity in Perimenopause

• Prioritise Protein & Healthy Fats: Ensuring each meal is rich in protein and healthy fats can stabilise blood sugar and reduce insulin spikes.
• Strength Training & Movement: Resistance training has been shown to significantly improve insulin sensitivity and maintain muscle mass and bone density, which naturally declines with age.
• Manage Stress & Sleep: Chronic stress increases cortisol, which can worsen insulin resistance. Implementing stress-management techniques and prioritising 7-9 hours of quality sleep can make a big difference.
• Consider Supplements: Myo-inositol, omega-3 fatty acids, and magnesium have been shown to support insulin sensitivity and metabolic function in both PCOS and perimenopause. In addition having your hormones test can allow you to add in more personalised herbal support to help reduce drastic fluctuations in oestrogen during the transition period.

Final Thoughts

Perimenopause can be an extra challenging time for women with PCOS, but by proactively managing insulin resistance through diet, movement, and lifestyle changes, you can reduce weight gain, improve energy levels, and feel more in control of your health. Small, consistent changes can make a significant impact in supporting your body through this transition and beyond.

References
1. Carr, M. C. (2003). The emergence of the metabolic syndrome with menopause. The Journal of Clinical Endocrinology & Metabolism, 88(6), 2404–2411. https://doi.org/10.1210/jc.2002-021480

2. Toth, M. J., Tchernof, A., Sites, C. K., & Poehlman, E. T. (2000). Menopause-related changes in body fat distribution. Diabetes, 49(5), 774–781. https://doi.org/10.2337/diabetes.49.5.774

3. Moran, L. J., Misso, M. L., Wild, R. A., & Norman, R. J. (2010). Impaired glucose tolerance, type 2 diabetes and metabolic risk in polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction Update, 16(4), 347–363. https://doi.org/10.1093/humupd/dmq001

4. Hansen, R. D., Raja, C., Aslani, A., Smith, R. C., & Allen, B. J. (2012). A review of the assessment of muscle mass and nutritional status in elderly patients. Clinical Nutrition, 31(3), 337–347. https://doi.org/10.1016/j.clnu.2011.11.020