Weight management

Weight management here means looking after your weight and shape through perimenopause and after, for your health rather than for a number. The British Menopause Society's tool for clinicians makes a useful point: good nutrition and weight management are tackled with the same changes, and bone health and heart disease risk are the areas of nutrition it asks clinicians to watch at this stage.

The same tool asks doctors to check first that a woman wants to work on her diet and lifestyle and feels ready to, and to accept that waiting for the right time is better than pushing at the wrong one. You are allowed to say not yet.

The BMS calls weight gain one of the most common changes in perimenopause and after. It says most of it settles around the abdomen and upper body, because as estrogen falls, fat around the organs increases while lean muscle reduces and metabolic rate slows.

The Pakistan Menopause Society lists central fat, insulin resistance and heart risk among the longer-term changes after menopause (Table 1). The British Menopause Society notes that South Asian women have a higher rate of central obesity, insulin resistance, diabetes and high blood pressure during the menopause transition. Fat around the middle matters for that reason, not for how a dress fits.

Eating

The British Menopause Society suggests starting with a food and activity diary. The common issues it lists are large portions, meals at no set time, grazing and snacking without noticing, long stretches of sitting, and eating fast while doing something else. It suggests making a few changes at a time and adding more once those stick.

It says carbohydrates are essential, especially as you become more active, and names chapati and basmati rice among the lower-glycaemic choices. It also says no food needs cutting out because of menopause, and warns against diets that cut whole food groups or promise that one food speeds weight loss.

The Pakistan Menopause Society's Table 5 is written for Pakistani kitchens. It says sweetened drinks and colas drive central obesity and metabolic risk. It encourages whole grains, dals and legumes, fish and eggs, and dishes such as saag, methi, moong dal, channa and makkai ki roti. Our page on nutrition goes further.

Moving

The BMS says regular resistance exercise builds muscle and raises metabolic rate. See strength training.

Measuring

The BMS suggests measuring bust, waist and hips, and noticing how clothes fit, as well as using the scales. That way a change in shape still counts when the scales barely move.

Diets and fasting

The BMS says the evidence behind popular diets is thin. High-quality studies of keto, time-restricted eating and fasting diets have not been carried out in women in perimenopause or after, and weight lost on popular diets is likely to come back. Women's Health Concern, the BMS's patient arm, says fad diets often bring fast weight loss followed by more weight gain, and does not recommend severe calorie cutting or long periods without eating. It suggests a regular eating pattern instead, noting that long gaps without food tend to lead to bigger portions at meals.

That is about weight-loss diets. Fasting in Ramadan is a separate question, covered on our Ramadan and fasting page.

Weight-loss medicines, including the newer injections, are a question for your doctor, who can weigh them against your health and history. This page does not cover them.

Ask for a check if your weight has moved to your middle, especially with diabetes, heart disease or high blood pressure in the family. The Pakistan Menopause Society asks doctors to record blood pressure, weight and preferably waist size, and to consider a blood sugar test and a cholesterol test according to age, risk and cost (Tables 2 and 4).

In England, the NHS says you may be able to refer yourself to a local NHS weight management service without seeing a GP.

Losing weight without trying is different. The Pakistan Menopause Society lists unexplained weight loss among the red flags that need evaluation or referral (2.3). See a doctor rather than waiting.

Food is how many families show love. A second helping refused can read as rudeness, and the iftar table and the wedding season do not bend around one woman's plan. The Pakistan Menopause Society lists shared healthy habits with your husband and family as part of menopause care (4.2.6). Changing what the household eats, rather than eating separately, is one way to make that real.