Will HRT make me gain weight?

The science behind menopausal weight gain – and why HRT isn’t the culprit

• Weight gain, particularly around your mid-section, is common during perimenopause and menopause
• The reasons why you may put on weight at this time…
• And the strategies to help maintain a healthy weight

Weight gain in midlife is common, but how can menopause affect the scales?

If you are perimenopausal or menopausal and have noticed you’ve gained a few pounds, you aren’t alone: almost one in four (23%) of 5,800 women who responded to a Newson Health survey said they had gained weight since the start of perimenopause [1].

As one survey respondent put it: Weight gain (so quick! Nearly two stone in three months).

‘I am active and go to the gym and eat well. The weight gain made me lose a lot of confidence, I’m struggling to shift it.’

The weight gain can amount to a few extra pounds, and for some it may be more, but many women aren’t able to pinpoint the reasons for weight gain at this time, particularly around the waist.

You may be searching for answers about weight gain, particularly if your eating or exercise habits haven’t changed – and if you’re currently taking hormone replacement therapy (HRT), you may be wondering if there’s a link.

However, there’s little evidence that taking HRT can lead to weight gain [2]. You may gain some weight during the menopause and as you get older, but this often happens whether you take HRT or not.

Now you know that HRT doesn’t lead to weight gain, let’s look at some of the other factors that can come into play at this time.

RELATED: Nutrition, mindset and maintaining a healthy weight in menopause

Changing oestrogen levels

During your reproductive years, the most potent form of the hormone oestrogen produced in your body is oestradiol.

When levels of oestrogen fluctuate and fall during perimenopause and menopause, your body tries to combat falling levels by trying to obtain it elsewhere, including oestrone, another type of oestrogen produced in the body, which is less potent than oestradiol, and more inflammatory.

Oestrone is produced in fat cells, and your body may increase fat storage in an attempt to maintain oestrogen levels when oestradiol levels drop. This can lead to an increase in body fat, especially around the abdomen.

Women can develop a ‘spare tyre’ in response to this and might also have strong cravings for foods high in sugar or unhealthy fats, which the body will, in turn, lay down as oestrone-producing abdominal fat.

Comfort eating

Fluctuating and falling oestrogen and testosterone levels can have a knock-on effect on levels of dopamine and serotonin – chemicals that impact mood and the reward centres in your brain.

Dopamine is often released when thinking about a ‘reward’ or pleasurable experience and can be linked to repeated patterns of behaviour, such as comfort eating at the end of a stressful day. Serotonin is responsible for improving your mood, influences appetite regulation and can be affected by fluctuating hormones.

RELATED: The importance of testosterone for women

Your exercise routines on the wane

Oestrogen, progesterone and testosterone work as anti-inflammatory agents in your muscles, and also help to lubricate your joints [3]. So, during the menopause, when hormone levels dip, it can cause muscle and joint pains. This is usually most common in the mornings, as this is when hormone levels tend to be lowest.

RELATED: Perimenopause, menopause, aches and pains

As a result, you may have scaled back on day-to-day activities or are exercising less: 42% of women who responded to Newson Health’s survey cited the psychological and/or physical impact of menopause symptoms as a barrier to exercise [1].

‘I work in the health industry, so my regime hasn’t necessarily changed too much,’ one woman told the survey.

‘What I have noticed is my motivation to exercise, shop and food prep has massively dipped. I have changed what exercise I do and added in more rest and more gentle sessions than usual. My diet is balanced but I am craving more sugar and carbs than I ever have.’

RELATED: Exercising during the perimenopause and menopause

Poor sleep… and hunger hormones

Falling oestrogen can disturb your sleep patterns for several reasons: hot flushes and night sweats, as well as disruption to the sleep hormone melatonin and raised levels of the stress hormone cortisol.

Leptin and ghrelin are two other hormones that are closely linked to weight. Leptin acts as an appetite suppressant and ghrelin is an appetite stimulant. Increased fat in the body can cause leptin resistance, which means that the normal signals to let you know you are full become disrupted.

Sleep also has an important part to play in the regulation of these two hormones; poor sleep can increase ghrelin, making you feel hungry, and decrease leptin, which stops you from feeling full.

RELATED: Sleep and hormones

Changes to metabolism

A 2022 study of which balance founder Dr Louise Newson was a co-author, found menopausal women are more likely to weigh more, eat more sugary foods, have higher levels of glucose and insulin, and have difficulty sleeping. Menopausal women were also more likely to have higher levels of raised glucose levels after eating, the study found [4].

Can HRT help me lose weight?

While HRT alone will not help you lose weight, you may find that replacing your missing hormones may ease symptoms – such as joint and muscle pains, poor sleep and low mood – that can affect your ability to exercise and eat a balanced diet.

As one woman told the Newson Health survey: ‘Since getting my HRT right and particularly since starting testosterone, I have loads more focus and have purposefully made an effort to eat well and exercise more.

‘I am now in the normal BMI range for the first time in years. Prior to this it was all too easy to eat junk food and be lazy.’

In addition, a small study of 35 women found HRT can positively affect body fat distribution, particularly in fat accumulation around the midsection [5].

What can I do to maintain a healthy weight in menopause?

If you’re concerned about weight gain or any other menopause-related symptoms, your first step should be speaking to a healthcare professional to talk about any treatments or lifestyle changes that could benefit you. It’s useful to build up a picture of your symptoms ahead of your appointment – the free balance app has a symptom tracker where you can record the type, severity and frequency of symptoms to create a health report to take along to your appointment.

If you do need to lose weight, it’s best to concentrate on sensible but meaningful modifications rather than relying on a fad diet or diving headfirst into an unsustainable fitness drive.

The Mediterranean diet is a great starting point: despite the name, it isn’t a ‘diet’ per se but is inspired by the way people traditionally eat in coastal Mediterranean countries. It contains plenty of fruits, vegetables, beans, nuts, seeds, whole grains and unsaturated fats such as olive oil. It also includes moderate amounts of dairy foods, eggs, fish, and poultry, and a limited amount of red meat and saturated fat, such as butter.

RELATED: How the Mediterranean diet can help menopausal symptoms

Exercise is also key, but if you haven’t exercised much for a while, it can feel daunting. It’s worth thinking less about ‘exercise’ and more about ‘activity’ or ‘movement’ instead. Make space in your diary for some activity every day – whether a lunchtime or weekend walk or setting your alarm a little earlier to fit in an online class. Every little helps.

RELATED: Lost motivation? How to regain your fitness mojo in menopause

References

1. Newson Health (2024) ‘Women’s Experiences of Perimenopause and Menopause’
2. NHS.uk (2023) ‘Side effects of hormone replacement therapy (HRT)’
3. Hussain, S. M., Cicuttini, F. M., Alyousef, B., Wang, Y. (2018), ‘Female hormonal factors and osteoarthritis of the knee, hip and hand: a narrative review’, Climacteric, 21(2), pp. 132–9. doi: 10.1080/13697137.2017.1421926
4. Bermingham, K.M. et al. (2022), ‘Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study’, EBioMedicine, vol. 85: 104303. doi:10.1016/j.ebiom.2022.104303
5. Sumino, H. et al. (2003), ‘Effects of hormone replacement therapy on weight, abdominal fat distribution, and lipid levels in Japanese postmenopausal women’, International Journal of Obesity and Related Metabolic Disorders, 27,9 (2003): 1044-51. doi:10.1038/sj.ijo.0802371

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