Perimenopause and Weight Stigma: Why Your Doctor's Advice May Be Missing the Point
Weight gain during perimenopause is driven by hormones, not willpower. Here is how to navigate weight stigma in healthcare and in your own thinking.
Weight Gain in Perimenopause Is Hormonal, Not a Lifestyle Failure
Many women gain weight during perimenopause, particularly around the abdomen, even when nothing in their diet or exercise habits has changed. Declining oestrogen alters how the body stores fat. Insulin sensitivity shifts. Cortisol levels rise. Muscle mass naturally decreases, which reduces metabolic rate. This is not laziness or a lack of willpower. It is biology. Yet a significant number of women report being told to simply eat less and move more, as if the hormonal reality does not exist.
What Weight Stigma Looks Like in Healthcare
Weight stigma in medical settings means symptoms get attributed to weight rather than investigated properly. A woman presents with fatigue and joint pain. She is told to lose weight. The actual culprit, low oestrogen, goes unaddressed for months or years. This happens regularly. If you have been dismissed or had multiple symptoms attributed to your weight without further investigation, you are not imagining it. Asking for a full hormone panel is a reasonable and legitimate request.
The Emotional Cost of Feeling Like Your Body Is the Problem
Internalised weight stigma, believing that your body's size is your fault and your moral responsibility to fix, has real mental health consequences. It increases anxiety and depression, reduces the likelihood of seeking medical care, and fuels disordered eating. During perimenopause, when mood is already more volatile for many women, this additional layer of self-blame can be genuinely damaging. You deserve care that does not hinge on your weight.
Separating Health Behaviours From Weight Outcomes
Health and weight are not the same thing. You can eat well, exercise consistently, sleep as much as perimenopause allows, and still gain weight during this transition. Focusing on health behaviours rather than the number on the scale is both more sustainable and more accurate. Strength training, protein intake, sleep hygiene, and stress management all have measurable benefits regardless of what they do to your weight.
Advocating for Yourself With Medical Professionals
You are allowed to redirect a medical conversation. If a consultation heads towards weight and away from your actual symptoms, you can say: I would like to focus on the symptoms I came in with and explore whether there is a hormonal explanation. Bringing a written list of symptoms, including when they started and how they have changed, gives a conversation structure. If you feel consistently dismissed, seeking a menopause specialist or a GP with a specific interest in women's health is a reasonable next step.
Tracking Patterns Rather Than Weight
One way to shift focus away from weight is to track what your body is actually experiencing. PeriPlan lets you log symptoms and track how they change over time, which can give you useful data to bring to appointments. Seeing that your bloating spikes mid-cycle, or that your energy is consistently low in the mornings, tells a more useful story than a scale reading. It also gives you something concrete to discuss with a doctor that sits outside the weight conversation.
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