Why Is It So Hard to Lose Weight During Perimenopause? Understanding Insulin Resistance and ADHD

You are eating the way you always have. You are moving just as much, maybe more. And still the scales will not budge, your waistband feels tighter, and the cravings feel impossible to outrun.

If you are dealing with ADHD and perimenopause weight gain, you are not imagining any of this, and you are certainly not the only one asking why you cannot lose weight in perimenopause when nothing else in your life has changed. There is usually a piece of biology working against you that has nothing to do with effort. It is called insulin resistance, and once you understand what it is, the last few years might start to make a lot more sense.

What is insulin resistance?

Picture your body as a busy delivery network. Every cell is a depot waiting on its next parcel of glucose, the fuel your body makes from the food you eat. A delivery van cannot just pull up and unload, though. It needs a pass to get through the gate, and that pass is insulin, a hormone made by your pancreas.

When the system is working well, you eat, your pancreas releases insulin, the gate opens, and glucose gets where it needs to go.

Insulin resistance is what happens when the gate scanners stop reading the pass properly. The insulin is still there, but your cells respond to it less and less. Your pancreas notices the parcels are not getting through and does the only thing it knows how to do, which is send out more passes. Instead of one dose of insulin doing the job, it now takes considerably more, and this can carry on for years before it shows up clearly on a standard blood test (Petersen and Shulman, 2018). Common signs include weight gain around the abdomen, sugar cravings, energy crashes after meals, and a sense that your body will not respond to changes the way it once did, regardless of how hard you try.

How does insulin resistance affect weight loss?

Insulin does not only move glucose into cells. It is also your body's main storage instruction. When insulin stays high, it tells your body to hold on to fuel rather than release it, and the easiest place to hold that fuel is as fat.

This is where a bath makes a useful picture. Trying to lose weight while insulin stays high is a bit like pulling the plug while someone keeps the tap running. You are doing the right things, but the water level barely moves, because your body keeps being told to top up its stores rather than draw them down. This is a large part of why weight loss can feel so much harder than it did ten or twenty years ago, even when your habits have barely changed.

Does perimenopause cause insulin resistance?

Oestrogen does far more than regulate your cycle. It also helps your cells stay responsive to insulin (Brinton et al., 2015). During perimenopause, oestrogen does not decline in a smooth line. It rises and falls unpredictably for years before eventually settling much lower.

As oestrogen drops, your cells become less responsive to insulin, your pancreas compensates by producing more of it, and fat becomes easier to store, particularly around the middle (Harvard Health Publishing, 2026). This is the biology behind a sentence I hear often: nothing about my life has changed, except my body has. Most of the time, that woman is right. Her hormones have changed how her body processes food, not her discipline.

Why do women gain weight around the middle during perimenopause?

Before perimenopause, women tend to store fat around the hips and thighs. As oestrogen falls, more fat is stored around the abdomen instead, which is where a lot of perimenopause belly fat conversations start.

This is not only about appearance. Abdominal fat is more metabolically active than fat stored elsewhere, and it is linked to greater insulin resistance, which can then encourage even more fat to be stored in the same place (Harvard Health Publishing, 2026). It is a cycle your body has fallen into, not a personal failing.

Can ADHD make insulin resistance worse?

ADHD does not cause insulin resistance directly. But several things that come with an ADHD brain make it more likely, and this is where menopause insulin resistance and ADHD start to overlap.

ADHD brains typically run on lower dopamine activity, and sugar delivers a fast, reliable dopamine hit. Reaching for something sweet is not a failure of willpower. It is your brain searching for stimulation it is not getting elsewhere, and it is one of the most common forms ADHD cravings for sugar take.

Many women with ADHD also miss meals without meaning to, absorbed in something until hunger arrives all at once. By then, whatever is fastest usually wins, and that pattern of skipping and then overeating puts extra strain on insulin over time.

Sleep and stress add to the load. Poor sleep on its own can make you temporarily more insulin resistant, and both ADHD and perimenopause are well known for disrupting sleep. Add the ongoing stress that tends to come with an ADHD brain trying to keep on top of everything, and cortisol stays raised for longer than it should, which can make insulin resistance worse still (Wasserstein, Stefanatos and Solanto, 2023).

Put those pieces together, falling oestrogen, worse sleep, more stress, less dopamine, stronger cravings, and it is easy to see why losing weight with ADHD in perimenopause can feel like trying to hit a moving target. This is not about eating too much. It is about biology stacking the odds.

How can I improve insulin sensitivity during perimenopause?

The encouraging part is that insulin resistance behaves more like a dimmer switch than an on or off light. It can move in the other direction.

Building muscle through resistance training is one of the most effective changes you can make, because muscle is remarkably good at using glucose for fuel (Ryan, 2023). Eating enough protein at each meal, alongside fibre from vegetables, beans and wholegrains, helps steady blood sugar rather than sending it sharply up and down. Avoiding long stretches without eating matters too, particularly if it tends to end in a rushed, sugar heavy meal later on. Even a short walk after eating can measurably improve how your body handles glucose. Protecting sleep and finding ways to lower stress both help as well, and for some women, appropriately prescribed hormone therapy also improves insulin sensitivity, which is worth raising with your doctor if it feels relevant to you.

None of this requires cutting out entire food groups or following a rigid plan. It is about giving your body fewer reasons to hold on so tightly.

What this means for you

If you have spent months, or years, blaming yourself for a body that will not respond the way it used to, I would like to offer a different question.

Not what is wrong with me, but what does my body actually need right now.

That question will not make weight loss instant. But it tends to replace shame with something far more useful: understanding you can actually work with, rather than criticism that leaves you stuck.

What would change if you stopped asking what is wrong with you, and started asking what your body needs right now?

Frequently asked questions

Can ADHD cause insulin resistance?

Not directly. But ADHD traits such as dopamine seeking, irregular eating, poor sleep and chronic stress all raise the risk, and several of these tend to intensify during perimenopause.

Why am I gaining weight around my stomach during perimenopause?

Falling oestrogen changes where your body prefers to store fat, moving it from the hips and thighs towards the abdomen, partly because abdominal fat and insulin resistance feed into one another.

Does HRT improve insulin resistance?

For some women, appropriately prescribed hormone therapy can improve insulin sensitivity, though this varies by individual and should be discussed with your doctor rather than assumed.

Can insulin resistance be reversed?

It can often be improved significantly, even if it is not fully reversed. Building muscle, eating regularly, protecting sleep and lowering stress all move things in the right direction.

What foods help improve insulin sensitivity?

Meals built around protein, fibre and slower releasing carbohydrates tend to help most, particularly when they replace long gaps without eating rather than adding to an already busy day of grazing.

References

Brinton, R.D., Yao, J., Yin, F., Mack, W.J. and Cadenas, E. (2015) 'Perimenopause as a neurological transition state', Nature Reviews Endocrinology, 11(7), pp. 393-405.

Harvard Health Publishing (2026) Insulin resistance in women and why it rises after 50. Harvard Medical School.

Petersen, M.C. and Shulman, G.I. (2018) 'Mechanisms of insulin action and insulin resistance', Physiological Reviews, 98(4), pp. 2133-2223.

Ryan, A.S. (2023) 'Detrimental changes in health during menopause: the role of physical activity', Journal of Clinical Medicine, 12(17), 5517.

Wasserstein, J., Stefanatos, G. and Solanto, M.V. (2023) 'Perimenopause, menopause and ADHD', Journal of the International Neuropsychological Society, 29(S1).