If you’ve stepped on a scale recently and been unpleasantly surprised by the numbers, you may be searching for a reason behind your unintentional weight gain. If you’ve recently started taking hormone replacement therapy (HRT) for menopause, you might suspect your new hormone regimen is the culprit. Or is it menopause itself?
Both menopause and HRT can cause weight gain as well as redistribution of your body’s fat deposits. But you may be surprised to learn that neither menopause nor HRT guarantees that you will gain weight—and many women even lose weight during this time. Given these facts, how can you figure out what’s causing you to gain weight and come up with a plan for how to stop it?
While it may not always be possible to isolate the cause of weight gain from confounding factors like aging or lifestyle factors, weight gain doesn’t have to be mysterious or inevitable when you are in menopause or undergoing HRT. Understanding the link between HRT and weight gain as well as the effects of menopause on weight will go a long way toward giving you peace of mind as well as an action plan to take control of your weight. Despite how intimidating unexpected pounds can be, the good news is that you are far from powerless to counteract it even during menopause and HRT.
Why Menopause Promotes Weight Gain
The symptoms of menopause are often difficult to tease apart from the side effects of HRT precisely because both menopause and HRT are unfamiliar processes rooted in profound physiological transformation.
As the result of changing hormone levels, women who are entering menopause or who have already started menopause typically experience:
- Redistribution of existing fat deposits
- Accumulation of new fat deposits in the breasts, abdomen, and hips
- Reduction in muscle density, particularly in the biceps, triceps, and deltoids
- Reduction in bone density
Of these factors, reduced muscle mass is one of the primary triggers for menopause-related weight gain. Because muscles require a lot of energy to maintain, less muscle means your body needs fewer calories to maintain the same weight. Other factors exacerbate this effect. For example, hormonal changes in menopause reduce the body’s use of energy which is stored in fat. At the same time, critical hormones regulating fat breakdown are inhibited, leading to greater difficulty in unlocking the energy contained within fat deposits, but leaving the ability to consolidate energy into fats as strong as ever. This means that if a woman enters menopause and doesn’t increase their level of physical activity or decrease their caloric intake, weight gain is all but assured.
Furthermore, the longer a woman is in menopause, the more pronounced these effects become, as the toll from the normal course of aging starts to add up. That’s because drops in muscle mass, bone density, and a decreasing metabolic rate occur as we age independent of menopause, compounding the risk of weight gain. Indeed, depending on when a woman enters menopause, age-related effects may already be causing weight gain.
However, weight gain is not only rooted in natural biological change but also in the lifestyle factors that may accompany both aging and menopause. Specifically, as people get older, they tend to be less physically active, often due to busy work schedules and family obligations that leave them with less time to exercise. This may be compounded by age-related loss of mobility, which can create significant barriers to physical fitness. Thus, while menopause is a major culprit, it’s only one force out of several that increase the likelihood of unwanted weight gain if you don’t change your habits to cope with their impact.
Does HRT Cause Weight Gain?
While menopause and aging are undoubtedly associated with weight gain, you may wonder if the new numbers on the scale are the result of HRT. This is common; many women assume that HRT and weight gain go hand in hand and that a few extra pounds are nearly inevitable while in treatment. If you’ve experienced menopause so far without weight gain but started to gain weight as soon as you started HRT, you may even be toying with the idea of stopping treatment altogether. But the relationship between HRT and weight gain is far from clear.
Contrary to popular assumptions, most women experience no changes in weight as the result of undergoing HRT. A systematic review of 22 high-quality randomized clinical trials concluded that there was no significant difference in weight between menopausal women who were treated with HRT and those who were not. This suggests that you might gain weight as a result of menopause, but that undergoing HRT will probably not cause additional weight gain.
Interestingly, some women undergoing HRT experience changes in appetite that are accompanied by a shift in metabolism. But the direction of these shifts are far from clear, and researchers have found HRT can sometimes cause women in menopause to lose weight. In one study, for example, women who were recently menopausal and obese lost between 1.9 and 2.3 kilograms (approximately 4 to 5 pounds) when taking HRT, while no weight change was observed in participants who did not undergo HRT. These results provide no clear answers about the impact of HRT on each individual woman, but they do demonstrate that HRT is unlikely to be the cause of unexplained weight gain for most women.
Taking the Next Steps Toward Health
If HRT doesn’t cause weight gain, where does that leave women undergoing HRT who are having a hard time maintaining a healthy weight? The short answer is that you’re probably better off taking the hormones than you would be without it. In fact, researchers have found strong evidence that HRT can prevent the shift in body fat proportions that typically accompanies menopause and mitigate some of the metabolic downregulation that occurs as a result of menopause, especially in energy-intensive places like the heart.
Nonetheless, there’s a good chance that you’ll gain weight as a result of menopause, aging, and the associated lifestyle factors if you don’t increase your level of physical activity and decrease your caloric intake. Working with a practitioner who combines an in-depth understanding of menopause and hormone replacement therapy with an integrative approach to treatment can help you create a comprehensive plan to optimize both your physical and emotional well-being. With the right tools and support, you can take charge of your health and enhance your confidence as you enter this new phase of life.
BodyLogicMD can help you transform your life with expert care from a highly-trained practitioner who specializes in bioidentical hormone replacement therapy and integrative medicine. The practitioners within the BodyLogicMD network are among the top medical professionals in the nation and specially certified to help you address the symptoms of menopause. By taking a comprehensive approach to treatment, practitioners within the BodyLogicMD network will work with you to achieve your health goals and give you the resources you need to thrive. Get started on a customized treatment plan designed to fit your lifestyle and allow you to reach optimal wellness. Begin your journey, contact a local practitioner in the BodyLogicMD network to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz today.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure, or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.