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Perimenopause Is Not Just About Periods: The Metabolic Changes Women Should Know About

When we think of peri<span>menopause</span>, irregular periods, hot flashes and mood changes usually come to mind. But the transition to menopause is not limited to the menstrual cycle. 

Behind the scenes, changing ovarian hormones—particularly fluctuating and eventually declining estrogen—can influence body composition, insulin sensitivity, cholesterol levels, bone health and cardiovascular risk.

For many women, these metabolic changes begin years before their final menstrual period.

<h2>Why does weight suddenly behave differently?</h2>

A common concern during <span>perimenopause</span> is: “I haven’t changed my diet, so why am I gaining weight around my abdomen?”

Ageing itself contributes to gradual loss of muscle mass and changes in energy expenditure. At the same time, the menopausal transition is associated with a shift in fat distribution, with a greater tendency to accumulate visceral or abdominal fat.

This matters because visceral fat is metabolically active. An increase in abdominal fat can be associated with insulin resistance, abnormal <a href="https://www.healthandme.com/health-wellness/perimenopause-cardiovascular-health-why-neglecting-heart-warning-signs-during-perimenopause-can-lead-to-heart-issues-article-156438352" data-type="tilCustomLink">cholesterol</a> levels and a higher risk of metabolic disease. So, the change in waist circumference may sometimes tell us more about metabolic health than the number on the weighing scale alone.

Estrogen interacts with several pathways involved in glucose and fat metabolism. During midlife, changes in body composition, reduced physical activity, sleep disturbance and hormonal changes can collectively make insulin sensitivity less favourable.

This does not mean every woman going through perimenopause will develop diabetes. However, women who already have risk factors—such as overweight or obesity, prediabetes, a history of gestational diabetes or a strong family history of type 2 diabetes—should be particularly mindful.

Also read: <a href="https://www.healthandme.com/health-wellness/why-women-prepare-for-pregnancy-but-rarely-prepare-for-menopause-article-156485007" data-type="tilCustomLink">Why Women Prepare for Pregnancy but Rarely Prepare for Menopause</a>

<h2>Cholesterol and heart health deserve attention</h2>

The menopausal transition can also be accompanied by unfavourable changes in the lipid profile, including changes in LDL cholesterol. Cardiovascular risk increases with age, and menopause is an important time to reassess risk factors such as blood pressure, glucose, cholesterol, smoking, physical activity and body composition.

Women often spend years focusing on reproductive health while overlooking these equally important metabolic markers.

<h2>Muscles and bones need attention as well</h2>

Midlife is also an important period for protecting muscle and bone. Declining estrogen after menopause accelerates bone loss, while ageing contributes to loss of muscle mass.

Resistance training therefore becomes especially valuable. Adequate protein intake, regular weight-bearing exercise, sufficient calcium and vitamin D, good sleep and avoiding smoking can support healthier ageing.

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Perimenopause should not be viewed as a disease, nor should every symptom or kilogram gained in midlife automatically be blamed on hormones. Instead, it is an opportunity for a metabolic health check.

Women should discuss appropriate screening for blood pressure, blood glucose or HbA1c, lipid profile, weight and waist circumference monitoring , DEXA scan for bone health, depending on their individual risk factors.

Most importantly, don’t wait for menopause to start thinking about metabolic health. The perimenopausal years can be an important window to build muscle, improve fitness, optimise nutrition and identify metabolic risk early.

Perimenopause is more than a change in periods—it is a transition in whole-body health. Understanding these changes early can help women enter the next phase of life stronger, healthier and better prepared.

<strong><em>By Dr. Seema Daksh, MBBS, MD (Internal Medicine), DM (Endocrinology), Consultant Endocrinologist, Kailash Hospital, Greater Noida</em></strong>

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When we think of perimenopause, irregular periods, hot flashes and mood changes usually come to mind. But the transition to menopause is not limited to the menstrual cycle. Behind the scenes, changing ovarian hormones—particularly fluctuating and eventually declining estrogen—can influence body composition, insulin sensitivity, cholesterol levels, bone health and cardiovascular risk.For many women, these metabolic changes begin years before their final menstrual period.Why does weight suddenly behave differently?A common concern during perimenopause is: “I haven’t changed my diet, so why am I gaining weight around my abdomen?”Ageing itself contributes to gradual loss of muscle mass and changes in energy expenditure. At the same time, the menopausal transition is associated with a shift in fat distribution, with a greater tendency to accumulate visceral or abdominal fat.This matters because visceral fat is metabolically active. An increase in abdominal fat can be associated with insulin resistance, abnormal cholesterol levels and a higher risk of metabolic disease. So, the change in waist circumference may sometimes tell us more about metabolic health than the number on the weighing scale alone.Blood sugars may raise up tooEstrogen interacts with several pathways involved in glucose and fat metabolism. During midlife, changes in body composition, reduced physical activity, sleep disturbance and hormonal changes can collectively make insulin sensitivity less favourable.This does not mean every woman going through perimenopause will develop diabetes. However, women who already have risk factors—such as overweight or obesity, prediabetes, a history of gestational diabetes or a strong family history of type 2 diabetes—should be particularly mindful.Also read: Why Women Prepare for Pregnancy but Rarely Prepare for MenopauseCholesterol and heart health deserve attentionThe menopausal transition can also be accompanied by unfavourable changes in the lipid profile, including changes in LDL cholesterol. Cardiovascular risk increases with age, and menopause is an important time to reassess risk factors such as blood pressure, glucose, cholesterol, smoking, physical activity and body composition.Women often spend years focusing on reproductive health while overlooking these equally important metabolic markers.Muscles and bones need attention as wellMidlife is also an important period for protecting muscle and bone. Declining estrogen after menopause accelerates bone loss, while ageing contributes to loss of muscle mass.Resistance training therefore becomes especially valuable. Adequate protein intake, regular weight-bearing exercise, sufficient calcium and vitamin D, good sleep and avoiding smoking can support healthier ageing.What should women do?      Perimenopause should not be viewed as a disease, nor should every symptom or kilogram gained in midlife automatically be blamed on hormones. Instead, it is an opportunity for a metabolic health check.Women should discuss appropriate screening for blood pressure, blood glucose or HbA1c, lipid profile, weight and waist circumference monitoring , DEXA scan for bone health, depending on their individual risk factors. Most importantly, don’t wait for menopause to start thinking about metabolic health. The perimenopausal years can be an important window to build muscle, improve fitness, optimise nutrition and identify metabolic risk early.Perimenopause is more than a change in periods—it is a transition in whole-body health. Understanding these changes early can help women enter the next phase of life stronger, healthier and better prepared.By Dr. Seema Daksh, MBBS, MD (Internal Medicine), DM (Endocrinology), Consultant Endocrinologist, Kailash Hospital, Greater Noida

perimenopause is not just about periods: the metabolic changes women should know about

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Perimenopause Is Not Just About Periods: The Metabolic Changes Women Should Know About

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Perimenopause Is Not Just About Periods: The Metabolic Changes Women Should Know About

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