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Menopause, HRT and weight: what’s going on?

Menopause, HRT and weight: what’s going on?

One concern some women may have during menopause is about weight gain and many assume that HRT contributes to this. In fact, it’s quite normal for women to put on weight as they go through menopause, but many factors can play a part. Hormonal changes can affect mood, appetite, and metabolism. Age also influences your weight during menopause, as we tend to exercise less and burn less energy.

Menopause is a natural process that women go through as they get older. HRT can help relieve the sometimes distressing and uncomfortable symptoms of menopause. Here we’ll find out how the menopause is linked to weight gain and what part (if any) HRT plays.

Daniel Atkinson
Medically reviewed by
Daniel Atkinson, GP Clinical Lead
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Medically reviewed by
Dr Daniel Atkinson
GP Clinical Lead
on August 02, 2022.
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Does menopause cause weight gain?

Many people wonder ‘can menopause cause weight gain?’ The simple answer is yes, but there are reasons why this occurs. According to one study , sex hormones play an essential role in our energy metabolism, eating behaviours and regulation of appetite. Oestrogen is said to inhibit food intake, whereas progesterone and testosterone stimulate your appetite.

During menopause, oestrogen levels drop. This can lead to all the common symptoms of menopause, such as mood changes, hot flushes, breast tenderness and changes in periods. It can also lead to an increase in body fat around the belly, hips, and thighs. Oestrogen helps to regulate body weight and metabolism, so once it drops, weight changes can happen. Therefore, it’s fair to say that menopause and weight gain can be linked .

Changes in hormonal balance and the fact that menopause normally occurs at middle age means that women tend to have a slower metabolism due to less exercise and less lean muscle. If you don’t adjust your diet or exercise regime accordingly, it’s likely that you’ll more easily gain weight during menopause.

During menopause, many women will naturally experience weight changes around their midsection. Often labelled as ‘belly fat,’ it’s a common and natural occurrence. There can be a number of things that influence how much weight you gain during menopause, however, the hormonal changes your body experiences is the main cause of the ‘menopause belly.’

When women go through menopause, oestrogen decreases which increases the percentage of testosterone within your hormonal balance. In general as women age, weight tends to accumulate around the hip area, whereas for men it tends to be around their stomach. When the concentration of oestrogen in women is lower than it was previously, fat storage can be redirected around the stomach. So, while the menopause is not directly linked to weight gain, changes in fat distribution and body composition are.

The amount of time menopause-related weight gain lasts for will vary between individuals. Some women will experience weight loss once they have gone through menopause and their hormones rebalance. Whereas others may not return to the same weight that they had before menopause, even once it has passed.

As mentioned previously, our metabolic rate decreases as we age. This means that it will be easier to gain weight while eating the same amount and types of food that we are used to. Adjusting your diet and living an active lifestyle can help keep weight gain minimal, but it can take more time as a slower metabolism means that you’ll burn fewer calories when you exercise and rest.

Does HRT cause weight gain?

One of the main concerns for many women when it comes to starting hormone replacement therapy (HRT) is ‘can HRT cause weight gain?’ While weight gain is common during menopause, studies show that weight gain is not a direct side effect of starting HRT.

HRT does come with potential side effects. The hormones oestrogen and progesterone can cause bloating, swelling and tummy ache. Your appetite may even change too. This means that while you take these hormones, you may see temporary changes and fluctuations in your weight from these side effects. These side effects combined with the new weight distribution often noted with menopause, outlined above, can contribute to why HRT and weight gain are mistakenly associated with each other.

It’s important to remember that whether you choose to use HRT or not, weight gain during menopause is extremely common. HRT is unlikely to cause weight gain as a side effect as the hormones should help to balance weight management.

HRT exists in many forms including tablets, patches, pessaries, and gels. It’s easy to feel overwhelmed by the choices available, but finding a suitable dose and delivery method of HRT can help you deal with your menopausal symptoms effectively and comfortably. Discussing the pros and cons of the different types of HRT available with your doctor is a good step. If you’re switching between continuous combined HRT, then you may be offered Femoston, which is a type of combined hormone replacement therapy that can help relieve the symptoms of menopause.

Combined HRT is a medication that contains oestrogen and progesterone. You can also get treatment that only contains one of these hormones. While making your decision, you may be thinking, ‘does progesterone cause weight gain’ and ‘does oestrogen cause weight gain’. The answer is no, increased levels of progesterone or oestrogen are not associated with increased weight gain.

Although your HRT of choice may list weight changes (increases or decreases) as a potential side effect, the likelihood of this happening is slim. You should speak to your doctor about the benefits and risks, as in most cases the type of HRT will not matter if you are worried about your weight.

You’re unlikely to lose weight if you stop hormone replacement therapy, if anything, you’re more likely to gain weight as levels of oestrogen and progesterone will drop. Menopausal women who undergo HRT tend to have less body fat, especially visceral fat (fat that surrounds the internal organs) compared to women who aren’t on a HRT plan. However, studies show that this effect disappears once therapy is discontinued. If you’re thinking about discontinuing your HRT plan, then you should contact a clinician who can advise you on the best way forward.

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HRT

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Can HRT help with weight loss?

If you were wondering ‘will HRT help me lose weight?’, the answer is no. Studies show that people who use HRT are less likely to put on weight than those who don’t, but it shouldn’t be used as a weight loss solution.

HRT works by trying to keep your hormones at a pre-menopausal level. As a result, you might not gain as much weight as someone who isn’t on a HRT plan because you will have the hormones that support your usual metabolism in your system. The only way to aid weight loss on HRT is to adjust your diet and exercise regime. Eating the right balance of food and exercising regularly can benefit you in many other ways too.

HRT and weight loss – choosing what’s best for you

If you’re noticing menopausal symptoms or weight gain, then HRT might be able to help with these symptoms. Unless you suffer from a pre-existing health condition, choosing how to take HRT is normally a matter of personal choice. But if weight gain is your main concern then, as mentioned previously, there is no best HRT for weight loss.

HRT is available in many forms:

  • Tablets
  • Skin patches
  • Gels
  • Pessaries

Some brands are more popular than others. Evorel or Evorel Conti patches tend to be a popular choice for those who suffer from certain health conditions or forget to take medication daily. Patches are easy to use and deliver a constant and low level of hormones. And evidence shows that women without a history of cardiovascular problems are at no increased risk of blood clots, stroke or heart problems when using patches and gels. Women who have experienced cardiovascular health problems in the past are safer to use patches and gels also.

OestroGel is another popular form of HRT that is absorbed through the skin, however, you must apply the gel yourself. Again, Oestrogel and weight loss are not linked.

Tips to help with menopause weight – advice from our clinicians

Maintaining a healthy weight can become harder as you get older and this can become even more difficult during menopause. However, weight gain doesn’t have to be inevitable during the menopause. Menopause weight gain can cause health complications, especially excess fat around your midsection. This includes but is not limited to:

  • Breathing problems
  • Type 2 diabetes
  • Heart disease
  • Blood vessel disease

As mentioned previously, no treatment alone will combat menopausal weight. As you get older, it’s important to look after yourself and to keep fit. Here are some tips to help with menopause weight.

Focusing on healthy eating will benefit your mind and body and includes choosing nutritious food and controlling your portion sizes. Knowing your calorie intake and keeping it around the same level or below can be an easy and effective way to maintain or lose weight.

Regular exercise is a good way of keeping active and healthy. The changes in hormones can affect your metabolic rate during and post-menopause, so you may need to participate in more intense exercise than before if your aim is to lose weight.

Getting a good night’s sleep can be difficult when you are going through the menopause, but research has shown that a poor night’s sleep can impact your metabolism. Think about your sleep routine and how you can make it as effective as possible.

Getting help from your friends and family can be really beneficial. You could find a ‘workout buddy’ for support in keeping up with your new exercise routine.

Losing weight safely and gradually is always better than quick fixes and fad diets. Make your weight loss plan easy to maintain long-term and stick to it. Eating too few calories can actually slow down your metabolism, which will make it harder to lose weight in the future .

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HRT:

Get expert advice

The symptoms that come with menopause can be tough to deal with, and weight gain can be common. As we’ve already mentioned, the right HRT and dosage can reduce the risk of weight gain during treatment. If you're interested in trying HRT to help you with not only your weight, but any other menopause symptoms, talk to your clinician. Based on your health, symptoms, and preferences, they'll be able to recommend a treatment that could work for you.

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When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

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