Can hormone replacement therapy (HRT) be prescribed for weight gain associated with perimenopause?

From the Guidelines

Hormone replacement therapy (HRT) should not be prescribed solely for weight gain associated with perimenopause due to its potential risks and the availability of more effective lifestyle interventions for weight management. The use of HRT for the primary prevention of chronic conditions, such as weight gain, is not recommended by the U.S. Preventive Services Task Force, as stated in their 2013 guideline 1. This recommendation is based on the lack of convincing evidence that HRT provides a substantial benefit in preventing chronic diseases, including those related to weight gain, while also considering its potential harms.

Key Considerations for HRT

• HRT is primarily used to alleviate symptoms of menopause, such as hot flashes and vaginal atrophy, rather than for weight management.
• The decision to use HRT should be based on a thorough evaluation of the individual's risk factors, medical history, and the potential benefits and harms of therapy 1.
• Lifestyle modifications, including regular physical activity, a balanced diet, adequate sleep, and stress management, are more effective and recommended as the first-line approach for managing weight during perimenopause.

Risks Associated with HRT

• The use of HRT, particularly with combined estrogen and progesterone, has been associated with an increased risk of blood clots, stroke, and breast cancer in some women 1.
• These risks must be carefully weighed against the potential benefits of HRT for each individual patient.

Alternative Approaches for Weight Management

• Regular physical activity, such as 150 minutes of moderate exercise weekly, can help manage weight and improve overall health during perimenopause.
• A diet rich in whole foods, along with adequate sleep and stress management techniques, is also crucial for effective weight management during this transition.

From the FDA Drug Label

The Women’s Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) during 5 years of treatment with oral conjugated estrogens (CE 0.625 mg) combined with medroxyprogesterone acetate (MPA 2. 5 mg) relative to placebo. Because of these risks, estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.

Hormone Replacement Therapy (HRT) for Weight Gain Associated with Perimenopause:

• There is no direct information in the provided drug labels that supports the use of HRT for weight gain associated with perimenopause.
• The labels discuss the risks associated with HRT, including increased risks of endometrial cancer, cardiovascular disease, breast cancer, and other conditions.
• The labels recommend that estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.
• However, they do not provide information on the use of HRT for weight gain associated with perimenopause. 2 2 3

From the Research

Hormone Replacement Therapy for Weight Gain Associated with Perimenopause

• There is evidence to suggest that hormone replacement therapy (HRT) may not necessarily cause weight gain, and some regimens may even help prevent an increase in body fat mass and fat redistribution 4.
• The menopause is associated with a decrease in the resting metabolic rate, which can lead to weight gain, and HRT may help alleviate this symptom 4.
• HRT is indicated for managing menopausal symptoms, including those experienced during perimenopause, and can be individualized to maximize efficacy and minimize risks 5.
• Some studies suggest that HRT can provide effective relief for a wide range of health conditions, including weight gain associated with perimenopause, and may avoid the need for multiple treatments for separate problems 6.
• However, it is essential to consider the potential risks associated with HRT, including stroke, cardiovascular disease, breast cancer, and venous thromboembolism, and to weigh these against the benefits of treatment 7, 8.

Considerations for Prescribing HRT

• HRT should be individualized to maximize efficacy and minimize risks, taking into account factors such as the woman's age, medical history, and symptoms 5.
• Different HRT regimens, including cyclic and continuous administration, and various dosage forms, such as injections and transdermal formulations, may be considered 7.
• For women with an intact uterus, estrogen should be combined with progestin or a selective estrogen receptor modulator (SERM) to minimize malignancy risk 7.