Beyond hormonal changes, several interconnected factors may contribute to perimenopausal weight gain: Metabolic slowdown : Basal metabolic rate naturally decreases with age, meaning the body burns fewer calories at rest Muscle mass loss : Sarcopenia (age-related muscle loss) accelerates during perimenopause, further reducing metabolic rate Sleep disruption : Night sweats and insomnia, common perimenopausal symptoms, interfere with hormones regulating appetite and glucose metabolism Mood changes : Anxiety, depression, and stress during this transition may lead to emotional eating patterns Reduced physical activity : Fatigue, joint pain, and other symptoms may decrease exercise tolerance Research suggests women may gain weight gradually during perimenopause, though individual experiences vary considerably

Frequently used noninvasive measures (Supplementary Table 1) include biometric markers (body weight, body mass index, and hepatic fat), liver function markers (alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase), lipid markers (plasma cholesterol, triacylglycerol, high-density lipid cholesterol, and low-density lipid cholesterol), glycemic markers (fasting plasma glucose, insulin, homeostatic model assessment for insulin resistance and glycated hemoglobin)
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