Navigating Weight Shifts in Perimenopause and Menopause

Alloy Community Manager Rachel Hughes and Dr. Taylor Hahn break down why weight changes in midlife aren’t your fault — and what you can do about them

Weight gain in perimenopause and menopause can feel sudden, confusing, and frustrating. Many women are doing everything “right”—eating well, staying active—yet still notice changes in their body. The truth? It’s not laziness or a personal failing. It’s biology.

Alloy Health Community Manager Rachel Hughes recently spoke with Dr. Taylor Hahn, OB-GYN, menopause specialist, and obesity medicine expert, to unpack what’s happening in midlife and how women can approach weight, health, and self-compassion.

Here we’ve broken down a highlight from their conversation:

Weight Gain in Midlife Is Biological

Many women in midlife feel like their bodies have shifted overnight. And too often, the advice they hear is simply: “Eat less and move more.” But the reality is far more complex. Hormonal shifts in estrogen, progesterone, and testosterone affect metabolism, fat storage, and insulin sensitivity—it’s not your fault. Understanding biology helps reduce guilt and self-blame.

Visceral Fat Is the Real Challenge

Visceral fat, the type around your organs, increases in midlife, is harder to lose, and affects metabolic health.

Dr. Hahn suggests focusing on preserving lean muscle and improving overall metabolic health, not just scale numbers.

Build Sustainable Habits

Strength training, plant-forward nutrition, and manageable lifestyle changes are more effective than drastic diets or workouts.

As Dr. Hahn states, “Aim for consistency, not perfection. Small, sustainable habits add up.” 

Estrogen and Insulin Resistance

Declining estrogen reduces insulin sensitivity, which can contribute to weight gain and inflammation.

It’s important to determine whether hormone therapy or other interventions could support metabolic health.

Loose Skin After Weight Loss

Weight loss can feel like a victory, but for many women, loose skin creates unexpected frustration. It’s important to acknowledge that these feelings are valid. Rapid fat loss often leaves behind loose skin under the arms, belly, or face, and your body doesn’t get to choose where fat comes from. Strength training and collagen-supporting approaches can help, but self-compassion matters most.

BMI and Body Composition: No One-Size-Fits-All

BMI alone doesn’t reflect muscle mass, fat distribution, or overall health, especially in midlife. “I kind of despise BMI as a marker,” says Dr. Hahn. “It doesn’t tell you anything about muscle, fat distribution, or health.” Instead she suggests focusing on body composition and strength, rather than the number on the scale. Try to combine sustainable movement, nutrition, and personalized care to support metabolic health and preserve lean muscle.

No Shame in Seeking Help

Midlife is complex, and every woman’s path is her own. Seeking guidance is a strength, not a failure. Connect with a provider, like Alloy, for personalized care, because your health journey deserves guidance, tools, and compassion.

Watch the full webinar replay on Alloy Health’s YouTube channel here.

And to learn more about MHT, GLP-1s, and metabolic health, visit myalloy.com to connect with a provider like Dr. Taylor Hahn.