When you enter perimenopause, you might start to notice changes in your body. The advice you’ve always heard is to eat less and move more, but despite doing exactly that, your results don’t seem to match your effort. It’s frustrating!

Perimenopause isn’t simply a calorie problem. It’s a metabolic transition driven by changing hormones, muscle biology, and insulin sensitivity. Understanding what’s happening can help you make nutrition and training decisions that actually work with your physiology rather than against it.

Oestrogen is driving change.

I often get clients are struggling with stubborn “meno-belly.” Meno-belly starts to appear due to [the frustrating] redistribution of fat to the abdomen that so many women experience as they enter into menopause. Whilst fat accumulation can only occur in an energy surplus, the redistribution of body fat is a bit more than a consequence of eating more or moving less.

Oestrogen plays a direct role in regulating where your body stores fat. When oestrogen levels are high and stable, fat tends to be stored peripherally - the hips, thighs, bum. As oestrogen declines during perimenopause, that pattern shifts. Fat begins to migrate viscerally - deep abdominal fat that surrounds your organs.

Visceral fat behaves differently from subcutaneous fat - it’s more inflammatory and more strongly associated with insulin resistance, cardiovascular risk, and metabolic disease than fat stored elsewhere.

This is also why the strategies that ‘worked’ in your 30s - a bit less food, a bit more output - can feel less effective now. Calorie balance still matters, but visceral fat is more resistant to calorie restriction alone than subcutaneous fat, and cardio without resistance training doesn't address the muscle loss that can compound the problem. Results may be slower, less visible, or require a slightly different approach.

An important note on HRT: The relationship between oestrogen and body fat is part of the reason why research into HRT continues to grow. A meta-analysis of 17 randomised controlled trials, with over 29,000 total participants, found that HRT significantly improved insulin sensitivity in postmenopausal women without diabetes or cardiovascular disease. HRT isn’t the right choice for everyone, but I do recommend having a conversation with your GP or a hormone specialist to look at options. The evidence base for HRTs metabolic benefits are becoming considerably stronger.

Muscle is an underrated metabolic organ.

Skeletal muscle is the primary driver of whole-body insulin sensitivity. Around 75-90% of insulin-stimulated glucose uptake happens in muscle tissue. When you have more muscle, your body handles blood sugar more efficiently. When you have less, insulin resistance becomes more likely.

Here’s the problem: muscle loss gradually speeds up as you transition to menopause. Oestrogen has a direct anabolic effect, so as it declines, it gets harder to build and preserve muscle mass. This doesn’t mean you can’t - it just requires a bit more patience! The combination of declining oestrogen, rising insulin resistance, and the shift in fat distribution can create a compounding effect. Consequently, it can feel like your body starts to work against you.

The good news is that muscle is highly responsive to the right inputs. You are not at the mercy of your hormones.

How much protein do you actually need?

This is where nutrition becomes so important, and relatively easy to action. Current research is starting to push beyond the standard dietary guidelines - from ‘what you need to survive’ towards ‘it’s time to thrive.’

The UK Reference Nutrient Intake (RNI) sits at 0.75g of protein per kilogram of bodyweight per day. For a 70kg woman, that’s around 52g which is barely enough to maintain basic function, let alone preserve muscle during a hormonally driven period of slightly accelerated loss.

The emerging research consensus suggests that women in midlife need considerably more. A minimum of 1.0–1.2g/kg/day is now widely recommended simply to protect existing muscle mass and bone density during the menopause transition.

But if the goal is to actively build strength and muscle - which has significant implications for long-term health - the research points to a higher range of 1.2–2.2g/kg/day, depending on your training intensity, body composition, and individual goals.

For most women who lift weights (and you should if you don’t), I tend to recommend a practical target somewhere in the middle of this range, aiming for ~1.6g/kg/day.

And why am I so pro eating protein and lifting weights? Because strength and muscle mass are now recognised as powerful predictors of longevity. Grip strength, lean mass, and physical function all correlate strongly with all-cause mortality risk in long-term studies. This means that building and maintaining muscle in midlife is a genuine long-term health investment.

Strength training.

There is overwhelming evidence for the benefits of resistance training during and after perimenopause. It consistently shows up as one of the most powerful interventions available, not just for body composition, but also for insulin resistance and bone density.

Strength training improves insulin sensitivity through several mechanisms: it increases muscle mass (your primary glucose disposal tissue), upregulates GLUT-4 transporters that allow cells to take up glucose more efficiently, and reduces visceral fat over time. These effects are independent of weight loss, so you don’t have to be in a calorie deficit to benefit metabolically from lifting weights.

For bone density, the evidence is also strong. Weight-bearing resistance exercise creates mechanical load on bone, which stimulates bone remodelling and helps offset the accelerated bone loss that occurs as oestrogen declines.

If you can, try at least two resistance training sessions per week. Three can be your “even-better-if”. By ‘progressive’ I mean ‘aim to increase the load over time for adaptation to continue.’

Targeted input.

Perimenopause doesn’t have to be a passive decline that you just have to manage. It’s a phase that can strongly respond to targeted inputs - so when you understand what you can do, you can feel quite empowered.

These are the core points:

• Fat redistribution and insulin resistance during perimenopause are driven by oestrogen decline - the problem is hormonal and metabolic, not a personal failing.

• Prioritise protein. Aim for at least 1.2g/kg/day, and consider going higher (up to 1.6–2.0g/kg) if you’re training consistently and building strength is a goal (it should be).

• Lift weights. Resistance training is one of the most evidence-backed interventions available for insulin sensitivity, bone density, and body composition during this life stage.

• Think long-term. Muscle mass and strength are directly linked to longevity. What you build now has health implications well into your 60s, 70s, and beyond.

If you’re considering whether HRT might be right for you, the metabolic evidence is at least worth discussing with your doctor. It isn’t the whole picture, but I certainly notice a difference with my clients who have found the right HRT for them.