From the Guidelines
Hormone replacement therapy (HRT) for women does not directly cause significant weight gain for most patients. While some women may experience temporary fluid retention or bloating when starting estrogen therapy, research shows that HRT is not associated with significant weight gain 1. In fact, HRT may help prevent the redistribution of fat to the abdomen that commonly occurs during menopause. Some key points to consider include:
- Common HRT medications include estradiol and progesterone (for women with an intact uterus)
- Weight fluctuations during menopause are more likely due to aging, decreased metabolism, reduced muscle mass, lifestyle changes, and other hormonal shifts rather than HRT itself
- Maintaining a healthy diet, regular exercise, adequate sleep, and stress management remain important factors in weight management during menopause, whether you're using HRT or not. If you notice weight changes after starting HRT, discuss this with your healthcare provider, as your dosage or delivery method might need adjustment.
From the Research
Female HRT and Weight Gain
- The relationship between female Hormone Replacement Therapy (HRT) and weight gain is complex, with various studies yielding different results 2, 3, 4, 5, 6.
- Some studies suggest that HRT may not cause significant weight gain, and in some cases, may even help prevent an increase in body fat mass and fat redistribution 2, 3.
- A study published in the Journal of Clinical Endocrinology and Metabolism found that women assigned to estrogen therapy averaged 1.0 kg less weight gain at the end of 3 years compared to those assigned to placebo 4.
- Another study published in Maturitas found that combined hormone replacement therapy resulted in a fat loss of 2.1 kg and a decrease in the waist-to-hip ratio in obese menopausal women 5.
- However, a large prospective study published in Cancer Epidemiology, Biomarkers & Prevention found that adult weight gain was strongly associated with postmenopausal breast cancer risk among non-HRT users, but not among current HRT users 6.
Factors Influencing Weight Gain and HRT
- Age, physical activity level, and lifestyle factors may influence the relationship between HRT and weight gain 4.
- A study found that older age and higher physical activity level at baseline were independently predictive of less weight gain 4.
- Another study found that factors such as work activity, alcohol consumption, and Hispanic ethnicity were associated with smaller increases in girths 4.
HRT Regimens and Weight Gain
- Different HRT regimens may have varying effects on weight gain and body composition 2, 3, 4, 5.
- A study found that continuous daily estrogen and progestin replacement therapy did not prevent or increase early postmenopausal weight gain and fat accumulation, but minimized the shift from gynoid to android fat distribution 3.
- Another study found that combined hormone replacement therapy using 17beta-oestradiol transdermic and oral medroxyprogesterone acetate resulted in a significant increase in lipid oxidation and a decrease in the waist-to-hip ratio 5.