Does HRT cause weight gain? Separating fact from fiction

Menopause: an inevitable and sometimes unwelcome annoying change. It signals the end of our reproductive years, bringing with it a myriad of physical and emotional adjustments, including shifts in hormones, particularly the decline of oestrogen.

One of the most common complaints during menopause is weight gain — those pesky extra pounds that seem to creep up without warning, leaving us feeling perplexed and frustrated. The battle with the scale becomes an all-too-familiar struggle, making us wonder if there's a way to manage this aspect of menopause effectively.

For those embarking on the menopausal journey and contemplating the idea of starting HRT (Hormone Replacement Therapy), a common question is "how will HRT affect your weight management during this time?".

That's why we've put together everything you need to know about the connection between HRT and weight gain, plus some hand tips on how to get back control of your weight during this phase of your life.

What is HRT?

Hormone Replacement Therapy (HRT) is a treatment designed to address the challenging symptoms experienced during menopause by replenishing the diminished levels of female hormones. The 2 key hormones involved in HRT are oestrogen and progesterone [1].

Throughout menopause, hormonal fluctuations can lead to a range of symptoms, ranging from hot flushes, mood swings, vaginal dryness, and weight gain [2]. HRT can help women going through this transitional phase by providing relief from these discomforts.

HRT works by restoring hormone levels, aiding the management of the intensity and frequency of menopause symptoms, and helping to bring a sense of calm and comfort during this transitional phase.

HRT can be administered in different forms, including pills, skin patches, vaginal creams, gels, and rings, with the specific type and dosage of HRT being determined based on individual needs and preferences [3].

Does HRT cause weight gain?

One common concern among menopausal women considering Hormone Replacement Therapy (HRT) is whether it will make them gain weight. Let's delve into the research to understand this better.

There isn't much scientific evidence to suggest that taking HRT is a direct cause of weight gain [4]. While there isn't a lot of research that shows a substantial link between HRT use and weight gain, many women still report weight gain while taking Hormone Replacement Therapy.

During menopause, there is often a decrease in the resting metabolic rate, which can lead to reduced calorie utilisation and subsequently drive weight gain [5]. While some weight gain during menopause should be expected, you should gain weight gradually.

If you notice a significant increase in your weight after starting HRT, it's important to discuss this with your trusted healthcare professional to get to the bottom of the cause.

Why am I gaining so much weight on HRT?

While we can't say for sure that taking HRT is or is not related to weight gain, if you've recently started HRT and have noticed a spike in your weight, this might be due to water retention [6].

Many women experience initial water retention during the first months of treatments. The good news is that it's generally temporary and not indicative of long-term weight gain.

While HRT may not directly cause weight gain, it is still essential to adopt a proactive approach to managing weight during menopause. Maintaining a healthy diet and engaging in regular exercise play significant roles in weight management.

Why is weight gain common in midlife?

Weight gain during midlife is a common concern among women. During this time, many women notice changes in their body shape and overall weight. A particular concern for many women is increased body fat around their mid-sections.

While menopause doesn't necessarily mean you will gain weight, the International Menopause Society does note that increased belly fat, in particular, is increasingly experienced by women going through menopause.

Let's take a look at some of the reasons that most women will gain weight during this time.

Ageing and metabolism

As women age, they experience a natural decline in muscle mass [7], which slows down their metabolism. A sluggish metabolism makes it easier for the body to accumulate excess weight.

Decreasing oestrogen levels

Oestrogen, a hormone crucial in regulating body weight, plays a significant role in a woman's life. However, during menopause, oestrogen levels decrease.

This hormonal shift affects body fat distribution, often leading to increased tummy fat [8], which is associated with various metabolic complications. While this change is a natural aspect of the menopausal process, there are ways to manage its impact on weight.

Lifestyle factors

Unhealthy lifestyle habits, such as a sedentary lifestyle and poor dietary choices, can contribute to weight gain during midlife. Lack of exercise and consuming a diet high in processed and sugary foods can exacerbate the challenges of managing weight during this phase.

Can HRT help some women lose weight?

HRT has shown promise in aiding weight loss for certain women during and after menopause, with some studies suggesting that HRT may have a positive on weight management and body fat distribution during menopause [9].

Let's explore how HRT can potentially assist with weight loss and the important factors to consider.

Hormonal balance

One of the key ways HRT may facilitate weight loss is by restoring hormonal balance. This can have a positive effect on metabolism, making it easier for some women to manage their weight.

Hormonal fluctuations during menopause can impact appetite, energy expenditure, and fat storage [10]. By stabilising hormone levels, HRT may support efforts to consume fewer calories through a reduced appetite, as well as overall better weight management.

Fat distribution

HRT has been associated with a potential redistribution of body fat, favouring a shift away from the midsection to peripheral sites like the thighs and gluteal region.

Increased energy levels

HRT has been linked to increased energy levels, which may lead to improved physical activity and calorie expenditure [11]. This boost in energy can make it easier for women to exercise regularly and maintain an active lifestyle.

Quality of life improvement

Many women find that restoring hormones to healthy levels with HRT may aid in reducing belly fat, which is associated with various health risks. This improvement in overall well-being can motivate women to adopt healthier habits and support weight loss efforts.

Because the changes in body fat distribution during menopause can lead to health problems, for example, breast cancer and cardiovascular disease, it is important to find ways to help manage your weight during this time.

However, it's essential to understand that HRT is not a magical 'quick fix' solution for weight loss. Plus, because everybody will react differently to it, this treatment shouldn't necessarily be used as your only way of losing weight.

Is it harder to lose weight on HRT?

One common misconception surrounding Hormone Replacement Therapy (HRT) is whether it makes weight loss more challenging for menopausal and postmenopausal women.

However, there is little evidence to support this claim. In fact, some studies suggest that HRT can aid in weight loss and positively affect body fat distribution, particularly in fat accumulation around the midsection [12].

Because HRT helps shift your body back into a 'pre-menopausal' state, HRT can actually often help you restore metabolic function. However, it's important to remember that while HRT can be a valuable component in weight management, it is essential to maintain a healthy lifestyle for maximum benefits. Regular exercise and a balanced diet are integral to achieving weight loss goals.

A healthcare provider's guidance is crucial to understanding the potential benefits and risks of HRT for weight management, as individual responses to treatment may vary.

How do you avoid weight gain on HRT?

To ensure weight management success while on HRT, it's important to incorporate some strategies and lifestyle changes. Let's look at some of the key ways you can avoid weight gain while on HRT.

The first tip is to maintain a healthy diet by focusing on consuming a well-balanced diet rich in a variety of nutrient-dense foods. This might look like eating more fruit, vegetables, whole grains, lean proteins, and healthy fats. Minimising your intake of processed foods, sugary snacks, and high-calorie beverages can also help as these certain types of food can contribute to weight gain.

It's also important to review your portion control. You may want to practice mindful eating and be more attentive to your portion sizes. Paying attention to hunger and fullness cues can help prevent overeating and unnecessary calorie intake, supporting your weight management goals while on HRT.

Establish a regular exercise routine as the perfect complement to your HRT regimen. Aim for a well-rounded fitness routine that includes cardiovascular exercises, strength training, and flexibility exercises. Consulting with a healthcare provider or a fitness professional can help create an exercise plan tailored to your specific needs and abilities.

Drinking an adequate amount of water throughout the day is vital for overall health and maintaining proper hydration. Staying hydrated can also help manage appetite and support weight management efforts while on HRT.

High-stress levels can contribute to weight gain. Implement stress management techniques, such as meditation, deep breathing exercises, or engaging in activities that help you relax and unwind. Reducing stress can positively impact your well-being and weight management.

Ways to approach weight loss

While some women find success with managing their weight on HRT, it's not uncommon to find it to be particularly challenging. If you're finding that managing your weight through menopause and lifestyle changes just isn't quite enough, there are other approaches you can take.

Juniper’s Weight Reset Programme takes a holistic approach to helping women lose weight and keep it off, during any phase of their lives. With Juniper, you'll be connected with lifestyle coaches and dietitians, as well as have access to weight loss medication that is scientifically backed.

You can kickstart your weight loss journey with Wegovy or Mounjaro, two groundbreaking weight loss injections that mimic the GLP-1 and GIP hormone respectively to help control cravings, delay stomach emptying, and keep you feeling fuller for longer.

Plus, we have a team of expert dietitians and health coaches you can consult with, to help you work through any challenges you're experiencing during your weight management journey. This holistic approach sets you up for sustained weight loss, rather than a quick-fix solution.

HRT and weight FAQs

Will I lose belly fat on HRT?

HRT may help you lose stomach fat by helping to restore hormonal balance and potentially redistribute body fat, particularly around the midsection.

Does HRT change your body shape?

At first, you may feel more bloated than usual — this is a common side effect of HRT and should subside with time. As for more long-term changes, you may notice certain body changes once you start HRT, particularly when it comes to fat distribution.