Andrea Donsky cried when she realized she couldn’t fit into her favourite RW & Co. tank tops anymore.
“I was in tears,” she recalls. “I would be like, ‘What is going on?’ My chest grew, my waist grew. I was very unhappy.”
Toronto-based Donsky was in her mid-forties when she gained about 20 pounds in a year, with no change to her diet or exercise habits. It was all the more perplexing because she was a registered holistic nutritionist with over a decade of experience. Then, at 47, she had her first hot flash. It turned out she’d been in perimenopause, the transitional phase before menstruation stops entirely, for a decade. Her weight gain, sleep issues and mood swings suddenly made sense. “Is that what all this was?” she remembers thinking.
“Of the many different symptoms that perimenopausal women are experiencing, weight gain is among the most distressing ones,” said Dr. Lori Brotto, a psychologist who specializes in women’s health and a professor in both the obstetrics & gynecology and psychiatry departments at UBC. “It can directly impact sense of self and body image.”
It doesn’t help that it often comes as a shock. Seventy-six per cent of women feel unprepared to recognize the early signs of perimenopause, according to 2025 research commissioned by Women’s Health Collective Canada and the Shoppers Foundation for Women’s Health.
In recent years, Donsky has become passionate about ensuring that other women don’t fumble their way through perimenopause and menopause like previous generations have. In December, she will publish her 10th paper in the Menopause Society’s journal, Menopause, in which women rank the symptoms that most affect their quality of life. Number one is sleep disruption; the second is weight gain, body changes and a perceived slower metabolism.
“One of the things you’ll hear a lot from women in perimenopause and menopause is, ‘I just want to feel like myself again,” Donsky said. “When your clothes don’t fit, it affects you. You want to feel good about yourself.”
Brotto often hears clients express a sense of powerlessness around weight gain. “Women will say they’re doing all the things — eating the protein, lifting the heavy weights, watching their alcohol, paying attention to nutrition way more than they did as a premenopausal person — and yet the distribution of fat around their body is something they feel they have no control over.”
In particular, Brotto said, women complain about weight gain around the midsection. The areas of your body where you hold your weight shift with age; the hourglass might start to find herself an apple, for example. Higher levels of estrogen when you’re younger mean that you have more subcutaneous fat; the layer of padding just underneath the skin. As estrogen decreases, you develop more visceral fat around your organs, leading to that thickening of the waistline many mid-life women experience. This is important because it can significantly increase the risk of cardiovascular disease.
These changes can be hard to accept. “A lot of women expect that their body should remain the way it was at 30,” said Dr. Shafeena Premji, a Calgary-based family physician who specializes in menopause care.
Not everything women experience in mid-life is because of menopause — and that can be true when it comes to changes in body composition. “We’re at our peak muscle mass in our thirties. As we are aging, when we drop that muscle mass, there’s also a change in our resting metabolic rate,” Premji said. “There are multiple different things that are happening simultaneously, and it’s erroneous to say (weight gain is) just because of a change in hormones — and that hormones in and of themselves are going to fix the problem.”
Premji encourages patients to keep in mind that this is a transition phase. “There are many, many women who thrive because they’ve accepted that this is their new normal,” she said. “It’s definitely a difficult transition, but it’s not the end. It’s just a checkpoint in life where we need to re-evaluate our priorities.”
But it’s also true that women live in a society that values a narrow beauty standard, and that doesn’t disappear when you enter your DGAF crone era. In fact, there’s increasing pressure to look eternally youthful. If you’re a woman in mid-life, your social media feeds are probably at least 25 per cent “how to fix menobelly,” posts shilling new cosmetic procedures and products, and photos of celebrities seemingly doing deals with the devil to look 40 at 70.
It’s a far cry from the body positivity movement of the late 2010s, which came when Ann Marie McQueen’s self-confidence was at its lowest: She was in her late forties and in the trenches of perimenopause, undereating, over-exercising and still feeling bloated and puffy. “That was so nice for someone like me who had been a chubby kid,” said the Canadian health journalist. “Maybe I could be healthy at any size.”
After moving into menopause, finding a great doctor and treating some underlying issues with her thyroid and gut, she’s a smaller size than she was then. “But in my own mind, I still think I need to lose weight. It’s so pervasive, and what makes me really angry is that I lived through heroin chic, and now I’m living through skeletal women,” she said, pointing out that extreme thinness is particularly harmful when it comes to osteoporosis, another challenge facing women as we age.
Even within the menopause conversation, there’s a lack of recognition that we all have naturally different bodies, said McQueen, who now runs the online community Hotflash Inc. “All of the biggest menopause doctors are very slim people,” she said.
She points to a feeling among the primarily Gen X women going through this phase of life that they just can’t do anything right. “So many women of my cohort, we’d go to the gym and do 90 minutes of cardio, and you maybe did some weights at the end. And now we’re supposed to be so muscular.” Yet she often hears from fitness experts that women still just want to lose weight, whatever the consequences.
When it comes to managing your weight for health reasons, particularly if you have developed diabetes or cardiovascular disease as a result of increased visceral fat, hormone therapy likely isn’t going to be your saviour. “I wish it would, but our studies show it’s not,” said Dr. Michelle Jacobson, an OB-GYN and the co-founder and chief medical officer at Coven Women’s Health, a virtual clinic in Ontario. “There’s really no evidence that taking estrogen and progestin around menopause will decrease your weight gain or change your weight distribution.”
Jacobson said there is some evidence that a steroid medication called Tibolone, which affects estrogen, progestin and androgen receptors, may help increase lean muscle mass.
While GLP1s such as Ozempic have proven benefits for people who live with chronic obesity or diabetes, Jacobson said it’s an evolving field when it comes to perimenopausal women. There is a conversation to be had if their waist-to-height ratio (not the BMI, an infamously inexact measurement) places them in a danger zone for adverse health outcomes.
Weight loss can help alleviate some of the symptoms of menopause, Jacobson noted. And a 2026 Lancet study showed post-menopausal women taking HRT as well as the GLP-1 tirzepatide (also known as Mounjaro or Zepbound) saw more weight loss than those on the GLP-1 alone. But if you’re happy in the body you’re in, she said, you don’t need to make it smaller to improve hormone therapy efficacy. To anyone who’s heard they should go on Ozempic to lose weight so their HRT will “work better”; Jacobson said that’s nonsense. “Not at all — and arguably, if you have no menopausal symptoms, particularly vasomotor symptoms [like hot flashes or night sweats], there’s also no indication for that person to take hormone therapy at all,” she said.
When Jacobson does prescribe a GLP1, it’s never in isolation, particularly given she notes the drugs’ links to potential muscle mass and bone density loss. Clients will also work with a dietitian, develop a weightlifting routine, and meet with a social worker to address other behaviours that might be contributing to weight gain. The goal is not “quick weight loss but rather targeting dropping inches around your abdomen,” she said.
Informed by her experience with perimenopausal weight gain, Donsky published a book this spring called “Nourishing Menopause.” It identifies 17 different reasons you might put on weight in perimenopause and menopause, which run the gamut from stress to inflammation to sleep challenges. One seems counterintuitive: Not eating enough.
“When you’re not getting enough food, your body might be like, ‘I don’t want to burn through this fat because I don’t know when my next meal is coming,’” said Donsky. “It’s really important that women eat enough calories — to get the nourishment we need, but also for energy and for brain health.” She recommends a whole-food diet filled with protein, fibre and complex carbohydrates, with plenty of veggies, fruit, seeds, nuts and legumes.
As a nutritionist, Donsky said her own journey involved relearning everything she thought she knew about not just food and exercise, but mindfulness and self-esteem. “It’s not willpower. That’s an important thing to really understand, because for a lot of us women, we blame ourselves.”
