Belly Fat and Bloating in Perimenopause: What Gives?

Perimenopause may be an inevitable fact of a woman’s life, but we shouldn’t ignore its effect on our self-esteem, either. Common symptoms like increased belly fat and bloating during this time can wreak havoc on how we see ourselves, adding to the overall challenges of getting older. 

When I reached out to members of the perimenopause community on social media, the number-one reaction I received on this topic was how belly fat and bloating just kill any modicum of comfort or confidence: 

“It can feel really discouraging, and I often try to avoid going out when I’m dealing with bloating,” Christina Grushkin, 48, of Austin, TX, tells Rescripted. Grushkin says she started experiencing perimenopausal-related bloating about a year and a half ago, with this particular symptom usually showing up right before her period. “On the occasions when I do need to go out, I gravitate toward loose, baggy clothes and bottoms for comfort,” she says. This has become a necessity for Grushkin, who hosts the Hot Flash Talks podcast, because “the bloating can get so severe that my stomach visibly extends, making me appear as though I’m about eight months pregnant—which, given my petite 5'2" frame and size 4-6 build, is quite noticeable! It’s tough and doesn’t do much for my confidence.” 

Micah, 33, from Missoula, MT, had a hysterectomy at 29, and says she “noticed menopausal weight gain creeping up six months after I went into surgical menopause.” As she is also in eating disorder recovery therapy, the body changes associated with early menopause have been, to use Micah’s words, “extremely triggering.” This is because her “eating disorder part wants to ‘fix’ my body using the restrictive methods I once used to whittle away at my body.” Despite this weight gain, Micah focuses on “practical ways to start accepting that this might be my size and shape for the rest of my life.” 

So what’s up with this sudden appearance of belly fat and bloating once we hit perimenopause? Do we need to accept these symptoms for what they are, or can we try to stop them in their tracks? Rescripted spoke with Cordelia Nwankwo, M.D., a board-certified OB/GYN in Washington, DC, to understand why belly fat and bloating are so common in perimenopause – and what we can do to ease our everyday discomfort. 

What causes belly fat and bloating in perimenopause?

Why does anything happen in perimenopause? Ask our hormones. Our bodies are shifting as we move away from our reproductive years, and the decrease in estrogen and progesterone triggers metabolic changes. Therefore, “changes or fluctuations in hormones can affect things like muscle mass, fat distribution, and water retention,” says Dr. Nwankwo. “All of which can lead to an increase in belly fat and bloating.” Unfortunately, it’s not only your self-image that can be affected by these perimenopausal symptoms: Dr. Nwankwo says additional belly fat and bloating can increase your risk of diabetes, high cholesterol, and cardiovascular disease as well. 

Are there treatments available? 

While shiny treatment options like hormone therapy or Ozempic may suggest an easy way to combat perimenopausal belly fat and bloating, lifestyle changes are your best bet. Dr. Nwankwo advises revamping your eating habits and exercise routine by adopting an anti-inflammatory diet, eating fewer ultra-processed foods, and “incorporating strength training to improve muscle mass.” To be fair, hormone therapy is an option, but Dr. Nwankwo reminds readers that it will not reduce belly fat or bloating on its own. She suggests discussing the risks and benefits with your healthcare provider first. As for weight-loss drugs like Ozempic, “they don’t really address the change in muscle mass, water retention, or bloating.” 

Accepting perimenopausal body changes

Although your body may adjust to the hormone changes, the increases in belly fat and bloating may not end with perimenopause, warns Dr. Nwankwo: “Hormone levels stabilize but the drop in estrogen can still affect fat distribution, metabolism, etc.” So rather than searching for a quick-fix cure, our energy is better spent learning to love our beautiful, perimenopausal bodies just as they are. 

“I’ve been working on giving myself grace during these moments,” says Grushkin. “I remind myself that it’s okay to feel uncomfortable and allow those feelings to surface. When I’m ready, I look in the mirror and tell myself, ‘This is part of the journey, and it’s okay.’ It’s not always easy, but it’s a step toward self-acceptance.”

Micah has been working with similar affirmations: “I learned recently that when I am unable to find love, acceptance, or gratitude for my body in its current shape and size, I can tell myself, ‘There is good inside me.’ It’s helpful for self-compassion.” 

She also offers this advice for her fellow bloated women: “Don’t keep the clothes that are no longer realistic for your body, even in times when you’re not bloating. Notice what triggers your anxiety about your shape/appearance. I learned in therapy that I was triggered by tight waistbands. I put my denim aside for a while and donated all my pre-pregnancy pairs. It was very liberating and delivered me from the idea that I could ‘get back to that size.’” 

For Grushkin, it’s about accepting that we can celebrate our bodies during all their different phases: “As frustrating as these changes can be, I try to remind myself how fortunate we are to experience this journey—to witness how our bodies adapt and transform. It’s a chance to nurture ourselves with grace, love, and care, and to focus on what our bodies need during this transition. Staying positive can make a big difference, and while it’s not always easy, I’m learning to embrace this stage of life as part of my unique story.”

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Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.