In recent years perimenopausal obesity has attracted much attention, because it affects as many as 60% of women of menopausal age. The severe clinical implications of obesity directed our efforts to establish etiological factors and possible ways of treatment. It is clear that there are numerous conditions that underly perimenopausal obesity. Among these, genetic factors, neuropeptides, adrenergic nervous system activity and hormones play a role. Reproductive hormones are also an important factor, but their influence on adipose tissue is only indirect because there are no receptors for sex steroids in fatty tissue. Reports of hormone replacement therapy in women of postmenopausal age have come to different conclusions, so its influence on the etiology of perimenopausal obesity cannot be completely excluded. However, the potential benefit of this kind of treatment in female patients at menopausal age must always be considered.