During perimenopause—the years leading up to and just after a woman’s final period—the body goes through changes that can increase heart disease risk. This research describes how a woman in her mid-40s experienced unusual weight gain when starting a psychiatric medication during perimenopause. Even after stopping the medication and exercising more, she couldn’t lose the weight. The case suggests that perimenopause may make women’s bodies extra sensitive to medications that cause weight gain, and that this weight tends to settle around the belly—which is particularly risky for heart health. Doctors should be careful about prescribing weight-gain-prone medications to women going through this life stage.

The Quick Take

  • What they studied: How perimenopause (the transition to menopause) combined with a psychiatric medication affected one woman’s weight gain and body fat distribution, and why the weight didn’t come off even after stopping the medication and improving lifestyle habits.
  • Who participated: One 46-year-old woman with schizoaffective disorder (a mental health condition) and an underactive thyroid gland who started taking a long-acting psychiatric injection during perimenopause.
  • Key finding: The woman gained about 20 pounds in a short time—roughly 10 times more than the medication’s typical side effect would suggest—and the weight settled primarily around her belly. Even after stopping the medication and increasing exercise and healthy eating for over two years, she didn’t lose the excess weight.
  • What it means for you: If you’re a woman in your 40s-50s approaching or going through menopause, be aware that this is a time when your body may be extra sensitive to medications that cause weight gain. Talk with your doctor about the risks and benefits of any new medications, especially those known to affect weight. This doesn’t mean you shouldn’t take necessary medications, but rather that you and your doctor should monitor your weight and heart health closely during this period.

The Research Details

This research presents a detailed case report of one patient’s medical journey. A case report is when doctors carefully document what happened to one specific person to highlight an unusual or important pattern. In this case, researchers tracked a 46-year-old woman’s health changes over several years, including her weight gain, where the weight settled on her body, blood test results, and how her body responded after stopping the medication. The doctors performed physical exams, blood tests (including hormone levels), and ruled out other conditions that might explain the weight gain, such as thyroid problems or Cushing’s syndrome (a hormone disorder). They followed her progress for more than two years after she stopped taking the psychiatric medication.

Case reports are valuable because they can identify patterns that might not show up in larger studies. By carefully documenting this one woman’s experience, the researchers highlight an important interaction: perimenopause (a natural life stage) combined with a medication side effect (weight gain) may create a ‘perfect storm’ for significant weight problems. This type of detailed observation can alert doctors to watch for similar patterns in their other patients and can guide future research.

This is a single case report, which means it describes what happened to one person rather than comparing many people. While case reports are useful for spotting patterns, they cannot prove that something will happen to everyone. The strength of this case is that the doctors were thorough—they did multiple tests to rule out other causes of weight gain and followed the patient for years. However, because it’s just one person, we can’t know how common this pattern is or whether it would happen the same way in other women. The findings suggest a possibility worth investigating further, not a proven cause-and-effect relationship.

What the Results Show

The patient gained 9.2 kilograms (about 20 pounds) over a relatively short period after starting the psychiatric medication. This weight gain was roughly 10 times larger than what the medication’s package insert typically reports. Importantly, the weight didn’t distribute evenly across her body—instead, it accumulated primarily around her belly and internal organs (called visceral fat), which is the most dangerous type of fat for heart health. Blood tests showed elevated follicle-stimulating hormone and undetectable antimullerian hormone, confirming she was in perimenopause. Other tests ruled out thyroid problems, pregnancy, prolactin imbalance, and Cushing’s syndrome as causes of the weight gain. When her psychiatrist stopped the medication, the patient increased her physical activity and made dietary improvements. However, more than two years later, she had not lost a significant amount of weight despite these lifestyle changes.

The patient reported vasomotor symptoms (hot flashes and night sweats) and irregular periods, which are typical signs of perimenopause. Her thyroid function remained normal throughout, indicating her thyroid wasn’t contributing to the weight problem. The fact that the weight remained stubbornly resistant to exercise and diet changes even after medication discontinuation suggests that the body’s fat cells may have ‘remembered’ the weight gain and resisted losing it—a phenomenon researchers call ‘metabolic memory.’ This is particularly important because belly fat is linked to higher risks of heart disease, diabetes, and other health problems.

Previous research shows that perimenopause itself typically causes only modest weight gain (if any) in most women. However, this case suggests that when a medication with weight-gain side effects is introduced during perimenopause, the effects may be magnified. The research also aligns with existing knowledge that perimenopause involves shifts in where body fat is stored—women tend to lose fat from their hips and thighs while gaining it around their belly. This shift toward belly fat is concerning because belly fat is more strongly linked to heart disease than fat stored elsewhere.

This is a single case report, so we cannot conclude that all women in perimenopause will experience the same dramatic weight gain from this medication. Individual responses to medications vary greatly based on genetics, metabolism, and other factors. We don’t know if this woman had other factors (like family history or previous metabolic issues) that made her particularly susceptible. The case also doesn’t include a comparison group of women who took the same medication at different life stages, so we can’t definitively prove that perimenopause was the key factor. Additionally, the patient’s adherence to lifestyle changes after medication discontinuation wasn’t measured objectively, so we can’t know exactly how much exercise she did or how strictly she followed dietary recommendations.

The Bottom Line

For women in perimenopause: (1) Have a conversation with your doctor before starting any new medication, especially those known to affect weight or metabolism. (2) If you must take a medication with weight-gain side effects, ask about monitoring plans—regular weight checks and heart health assessments. (3) Discuss preventive strategies like structured exercise programs and nutritional counseling before starting the medication. For healthcare providers: Exercise caution when prescribing medications with obesity-related side effects to perimenopausal women. Consider alternative medications when possible, and if the medication is necessary, implement close monitoring of weight and cardiometabolic risk factors (blood pressure, cholesterol, blood sugar). These recommendations are based on clinical observation rather than large-scale studies, so they represent a ‘moderate’ level of confidence.

Women in their 40s and 50s who are approaching or going through menopause should pay special attention to this information, particularly if they’re considering starting medications known to affect weight (including some psychiatric medications, certain diabetes medications, and some others). Healthcare providers treating perimenopausal women should also be aware of this heightened sensitivity. This is less relevant for women who are past menopause or for men, as the hormonal changes of perimenopause appear to be the key factor.

Weight gain from medications can happen relatively quickly—in this case, it occurred within the first year of starting the medication. However, weight loss after stopping the medication may take much longer. In this patient’s case, significant weight loss didn’t occur even after two years of increased exercise and dietary changes. This suggests that if weight gain does occur during perimenopause, it may be particularly stubborn to lose. The takeaway: prevention (avoiding the weight gain in the first place) may be easier than treatment after the fact.

Want to Apply This Research?

  • If you’re a woman in perimenopause starting a new medication, track your weight weekly (same day, same time) and record any changes in where you notice weight gain (belly, hips, thighs, etc.). Also track your exercise minutes per week and take photos monthly to visually monitor fat distribution changes. This data helps you and your doctor spot concerning patterns early.
  • Before starting a new medication during perimenopause, use the app to establish a baseline exercise routine (aim for 150 minutes of moderate activity per week) and log your typical eating patterns. Then, when you start the medication, maintain or increase these healthy habits as a preventive measure. Set reminders for regular check-ins with your doctor to review weight and metabolic health markers.
  • Create a long-term tracking dashboard that monitors: (1) monthly weight trends, (2) waist circumference (belly fat is the key concern), (3) exercise consistency, (4) dietary quality, and (5) any new symptoms like hot flashes or irregular periods. Share this data with your healthcare provider at regular intervals (every 3-6 months) to catch any concerning changes early. If weight gain does occur, this data will help your doctor determine whether medication adjustment is needed.

This case report describes one woman’s experience and should not be interpreted as medical advice or a prediction of what will happen to you. Individual responses to medications vary greatly. If you are taking any psychiatric medications or other medications with potential weight-gain side effects, do not stop taking them without consulting your doctor—the benefits of the medication may outweigh the risks. Always discuss concerns about medication side effects with your healthcare provider before making any changes. This information is for educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Women in perimenopause with concerns about weight gain, heart health, or medication side effects should consult with their primary care doctor or a cardiologist.