One of the most common reasons given by women for not starting Hormone Replacement Therapy (HRT) is concern that it will make them gain weight. However, evidence and scientific studies says that this isn’t true.

What does happen to weight in midlife?

During midlife the majority of women find that they gain weight gradually over time. The statistics say half a kilogram a year as an average increase, though it can feel like much more than this for many women. In fact, for some women, it can literally feel like body weight increases overnight.

Why does weight gain happen?

Midlife weight gain is related to many factors, including physiology changes, lifestyle and environmental factors.

For many reasons the way we live can become more sedate at this time of life, and tastes for higher calorie foods including sugars and carbohydrates, alongside a glass of wine or gin and tonic, aren’t uncommon.

The other big and very annoying change that women notice during menopause is the feeling of losing a waist and gaining a belly that they just can’t get rid of. This change happens because oestrogen is responsible for fat being held around the hips and thighs, and its general decline during menopause changes body shape. A major review by the International Menopause Society stated that menopause does not cause weight gain but does increase ‘belly fat’.

Does HRT make things worse?

The results of very many accurate scientific studies show that HRT does not increase weight gain. What we do know is that HRT can reverse menopausal changes meaning that weight is held around the hips and thighs again.

Why do some women report this side effect?

For some women, the side effects of HRT can include water retention, bloating and breast tenderness and swelling, which can all feel much the same as weight gain. If these side effects don’t settle, and make you feel uncomfortable, it is worth discussing changes to your HRT prescription with your GP or menopause specialist doctor.

Another reason why some women may appear to gain weight occurs when background anxiety, with reduced appetite, keeps weight a little lower than it would be naturally. This anxiety is often reversed by the positive impact of HRT, which in turn can increase appetite and weight over time. This generally plateaus as HRT settles in the body, rather than numbers continually rising on the scales.

Can HRT help women to lose weight?

There aren’t any studies or evidence to support the fact that HRT causes weight loss directly, but for many women HRT makes them they feel much better in themselves. This may mean they tend to eat better, cook from scratch with more fruit and vegetables, reduce processed foods and also reduce alcohol. HRT often improves energy levels and therefore the motivation to be active, getting in more steps everyday or restarting exercise.

Another menopausal symptom that often improves with HRT is sleep, and the science says that lack of sleep can drive weight gain through the stress hormone, cortisol.

All of these improvements can make it easier to control and reduce weight. Furthermore holding weight around the hips rather than the middle tends to feel better for most women which is an added positive to HRT, making clothes feel more comfortable and regaining a physique often associated with youthfulness and femininity.

Summary

HRT does not cause weight gain. Side effects of HRT may feel like it but the reality is that bodies change in midlife. In fact, many women lose weight and feel considerably fitter on HRT.

Dr Liz Andrew has worked as a GP for over 12 years and developed a passion for offering women menopause care. She is an advocate for giving women the knowledge and support they need to make choices about their own bodies during a time in their lives that can feel fraught. She understands the unique and often misunderstood pressures on women which can become particularly difficult during the hormonal changes of peri menopause and thereon. She prescribes body identical HRT and encourages the use of lifestyle adjustments to actively improve wellbeing.