Body Changes in Pre- vs. Peri- vs. Post-menopause
Body Changes in Pre- vs. Peri- vs. Post-menopause

Body Changes in Pre- vs. Peri- vs. Post-menopause

Perimenopause brings about so many changes for any body with a vulva. Included in these changes are more shifts in how our bodies look and feel, very similar to what we experienced in puberty. The good news is that now that we are older, we are hopefully more prepared for these changes. And, it’s helpful to know that it’s not our fault if our bodies start to look and feel different in midlife!

By, Stephanie Dillon, PT, DPT, WCS

Content warning: Please be aware that we are talking about many body changes associated with perimenopause, including changes in body composition and fat distribution. Just a reminder that these changes & words are not "good" or "bad," and we want to avoid putting emotional attachment onto them as much as we can. But of course, learning how this time of life can affect your body is critically important to your health and sense of well-being! So please know this article contains some discussion of adipose tissue and calories, but not in a good or bad way, just as a way of discussing body changes.

There was a small, but excellent, study published in 2022 that investigated changes in body composition during midlife. This study divided 72 people with vulvas into 3 groups based on their ages and menstrual status:

  • Pre-menopausal (PRE): at least 35 y/o with regular periods

  • Peri-menopausal (PERI): at least 38 y/o with irregular periods (but no more than 12 months in-between cycles. REMEMBER - if you go 12 months without a cycle, then you are officially in menopause!)

  • Post-menopausal (POST): no periods for at least 12 months, none in the study were over age 60

The authors then looked at many differences between these groups, including:

  • body composition

  • adipose tissue distribution (basically, where our bodies store fat)

  • resting energy expenditure (how many calories your body burns at rest)

  • oxidation of adipose tissue during moderate-intensity exercise (how much we “burn” fat during moderate-intensity exercise)

  • menopause symptoms 

  • lifestyle factors

The results?

The authors found significant variances in the perimenopause time specifically that stabilized after menopause. Specifically, the perimenopause time was found to have the following as compared to both PRE and POST groups:

  • changes in body composition DESPITE having similar height, weight, BMI measurements, and even dietary intake (specifically—higher percent body fat)

  • greater adipose tissue deposits in the abdominal region (16% higher than PRE and 5% higher than POST)

After menopause, the following was found as compared to pre-menopause:

  • A significant drop in resting metabolic rate (fewer calories burned at rest)

  • A 31% decrease in oxidation rate of adipose tissue during moderate-intensity exercise (not burning as much fat for the same intensity of exercise)

  • A 7% decrease in estrogen (estradiol) levels.  However, there was a 23% decrease as compared to perimenopause! This is a direct reflection of how much hormonal variance we experience during the PERI time.

So what's a person with a vulva to do??

The authors summarize their findings as such:

Altogether, shifts in body composition and metabolism appear to peak during perimenopause and stabilize in post-menopause. This data highlights perimenopause as a critical window for interventions to prevent detrimental changes in body composition and metabolic health.

My BIG takeaway from this article is that the perimenopause time is a particularly volatile one, that will bring about body composition changes that have little to do with how much someone eats or exercises. So, being kinder to our own bodies during this time is important, as well as knowing that these changes DO level out after menopause. But, that perimenopause is a great time to start or continue a good exercise habit!

P.S. The authors also recommended that post-menopausal women focus on exercises to build lean muscle mass (like resistance exercise), and exercises that would improve their oxidation of adipose tissue (like moderate- and high-intensity exercises). Sound like an exercise program we all know and love??? 😉


Gould, L. M., Gordon, A. N., Cabre, H. E., Hoyle, A. T., Ryan, E. D., Hackney, A. C., & Smith-Ryan, A. E. (2022). Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism. Menopause (New York, N.Y.), 29(4), 377–389. 

Photo by Los Muertos Crew: