From the Guidelines
Estrogen plus medroxyprogesterone (Medroxyprogesterone) is not recommended or effective for weight loss in perimenopausal women. While hormone therapy may be prescribed for managing menopausal symptoms like hot flashes, night sweats, and vaginal dryness, it is not an appropriate treatment for weight management. In fact, some women may experience weight gain as a side effect of hormone therapy, particularly with medroxyprogesterone 1. Weight changes during perimenopause are complex and typically result from a combination of aging, decreased metabolic rate, reduced muscle mass, hormonal fluctuations, and lifestyle factors rather than simply estrogen deficiency. For perimenopausal women concerned about weight gain, more effective approaches include:
- Regular physical activity (both aerobic exercise and strength training)
- A balanced diet rich in whole foods and adequate protein
- Stress management
- Ensuring sufficient sleep These lifestyle modifications address the underlying metabolic changes occurring during this life transition and provide sustainable weight management without the risks associated with using hormone therapy for non-approved purposes. The USPSTF found convincing evidence that estrogen and progestin therapy is associated with moderate harms, including an increase in the risk for stroke, dementia, gallbladder disease, and urinary incontinence, as well as a small increase in the incidence of invasive breast cancer and adequate evidence of a small increase in breast cancer deaths 1. Therefore, hormone therapy should not be used for weight loss in perimenopausal women, and instead, lifestyle modifications should be prioritized to promote sustainable weight management and overall health.
From the Research
Estrogen and Medroxyprogesterone for Weight Loss in Perimenopausal Women
- The available evidence does not directly address the effectiveness of estrogen plus medroxyprogesterone for weight loss in perimenopausal women 2, 3, 4, 5, 6.
- However, a study published in 2001 found that low-dose continuous combined conjugated estrogens and medroxyprogesterone acetate did not result in significant weight gain in postmenopausal women, and the body mass index did not change after 24 months of treatment 5.
- Another study published in 1998 found that treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of coronary heart disease events in postmenopausal women with established coronary disease, but it did increase the rate of thromboembolic events and gallbladder disease 3.
- A review published in 2023 discussed the management of menopausal symptoms, including the use of hormonal and nonhormonal options, but did not specifically address the effectiveness of estrogen plus medroxyprogesterone for weight loss in perimenopausal women 4.
- Current recommendations for hormone replacement therapy (HRT) use in menopausal women are summarized in a review published in 2022, but the review does not provide information on the effectiveness of estrogen plus medroxyprogesterone for weight loss in perimenopausal women 6.
- A study published in 2015 discussed the use of conjugated estrogens combined with bazedoxifene for estrogen-deficiency symptoms of menopause, but did not address the effectiveness of estrogen plus medroxyprogesterone for weight loss in perimenopausal women 2.