Many women over 40 experience hormonal barriers to weight loss, but the right treatment can help.

HRT Can Make Weight Loss Over 40 a Reality for Women

by Charlotte

It can happen rather insidiously. Your youthful figure gives way to a pooch here and a bulge there. The metabolism that has once allowed you to enjoy your favorite foods without regret seems to have forsaken you. Suddenly you no longer look — or feel — like yourself.

Many women over 40 are seeking to lose weight — some for the first time in their lives. As perimenopause takes hold, the body and shape with which you are familiar are replaced by a foreign silhouette, one that is heavily influenced by shifting hormones and a slowing metabolism. 

Muscle mass declines and stubborn belly fat appears, and the effects can be more than aesthetic. Some studies have even shown that having a higher body mass index can exacerbate some symptoms of menopause, including hot flashes and night sweats. 

Plus, weight gain can put you at risk of a whole range of diseases, such as diabetes and heart disease, that can create life-threatening health problems and seriously affect your quality of life.

You are not doomed to live with those extra pounds. Today, there is more support available than ever before to help you look and feel your best as you age. And, with the right strategies, you can make weight loss over 40 a reality for you.

Understanding the Challenges of Weight Loss Over 40

The causes of weight gain are varied and complex. They can occur at any time during a person’s life cycle, but women face an uphill battle as they age. More specifically, changing hormone levels make weight loss over 40 a significant challenge. Research has demonstrated that aging and the menopause transition each contribute substantially to altered metabolism that increases the accumulation of body fat and the risk of metabolic syndrome and insulin resistance. 

This may not only deeply affect your confidence and comfort in your own skin, but also make you more vulnerable to a cluster of dangerous and potentially deadly conditions, including: 

  • Obesity
  • Hypertension
  • Type 2 diabetes 
  • Heart disease and stroke

Excess weight is also associated with an increased incidence of depression, loss of self-esteem and social functioning and a decrease in health-related quality of life. In other words, weight loss over 40 is no trivial matter — it’s a significant concern with very real implications for your physical and emotional well-being. 

In the simplest terms, weight gain occurs when the energy consumed from food exceeds energy expended through physical activity and the maintenance of basal metabolism and body heat. Many factors affect energy balance in the body, including a variety of hormones that play key roles in balancing metabolism and energy homeostasis. In fact, hormonal imbalances and fluctuations lie at the heart of many women’s struggles with weight, particularly as they age:

  • Falling estrogen levels. As women approach menopause, they begin to lose the protective effect estrogen has against abdominal weight gain, often causing a perceptible change in body composition. But the mechanisms for this weight gain are complex; while the location of fat changes, metabolism also slows — sometimes drastically. Additionally, studies suggest that estrogen deficiency is linked to decreased energy expenditure due to reduced physical activity. In other words, you don’t burn as many calories as you used to and it may take more effort to increase physical activity to compensate for the difference.
  • Thyroid disease. Hypothyroidism is a common cause of sudden weight gain and brings many symptoms associated with slowing metabolism, including constipation, dry skin, memory problems and fatigue, menstrual irregularities and miscarriage. Hypothyroidism is much more prevalent in women than in men, with women over 50 experiencing the greatest risk. For this reason, some experts recommend thyroid screening for women before their first pregnancy, at age 35 and every five years thereafter, then every one or two years after age 50. Finding the appropriate thyroid hormone replacement regimen can have a profound effect on a woman’s health and may assist with weight loss over 40. 
  • Cortisol. The influence of cortisol on body weight is complex. As our main stress hormone, cortisol is secreted by the adrenal glands located above the kidneys. Along with the sympathetic nervous system, it manages our critical “fight or flight” instinct — our physiological response to danger and stress. This critical hormone regulates our energy stores by increasing blood sugar when needed, controls inflammation, regulates blood pressure, and influences our sleep/wake cycle. When stress levels are chronically high, as they are for many women in mid-life, excess cortisol may contribute to the over-consumption of comfort foods with consequent abdominal weight gain.

A variety of other factors may also contribute to weight gain and challenge weight-loss efforts in women over 40. These include drugs like steroids and antidepressants, high calorie consumption, chronic lack of sleep, and mobility issues or medical conditions that force a sedentary lifestyle. It’s important to talk to a doctor about your lifestyle and medical history to determine why you might be having trouble losing weight.

Why Does It Matter? Why Now?

Working to prevent weight gain and striving to lose excess weight are particularly important after 40, as it can impact the risk of several dangerous health conditions that often arise with age. A large-scale study conducted in Finland found that peri- and postmenopausal weight gain was associated with the onset of hypertension regardless of initial weight, physical activity level or hormone replacement status. 

They further determined that blood pressure rose relatively quickly after the weight was gained and that even a modest weight gain resulted in hypertension. Likewise, the risk of cardiovascular disease — a leading cause of death among women — increases with age and the decline of estrogen levels as the menopause transition is approached. The risks of metabolic syndrome also increase with natural menopause and are even higher with surgical menopause. In other words, now is a critical time to take action to preserve your immediate and long-term health.

Putting the Pieces Together

The obvious answer to weight loss is reducing calorie intake and exercising more. But if you have maxed out your capacity to diet and exercise without seeing the desired results or have hormone-related symptoms that interfere with your ability to make healthy lifestyle changes, it’s time to do more. For many, the answer could be hormone replacement therapy (HRT). 

For women experiencing menopause or perimenopause, HRT under the guidance of a hormone health specialist can be life-changing. Researchers have found strong evidence that estrogen or combined estrogen-progesterone replacement therapy may help to prevent menopause-related changes in body composition and the associated metabolic consequences. Additionally, many women find that HRT alleviates symptoms that interfere with weight loss — such as fatigue, sleep disturbances and mood symptoms — and allows them to make the choices necessary to shed unwanted pounds. 

If a thyroid condition is thwarting your efforts for weight loss over 40, getting a specific and accurate diagnosis is critical. If your lab results and symptoms point to hypothyroidism, hormone therapy is the gold standard in treatment and can help you restore balance and take control of your health. 

A hormone specialist can devise a treatment plan tailored to your unique needs and provide nutrition and lifestyle recommendations to support greater ongoing health. Hormone therapy practitioners can also provide invaluable advice about the latest treatment options, including bioidentical hormone replacement therapy (BHRT) that uses hormones identical to the natural ones your body creates. Increasing numbers of perimenopausal and postmenopausal women seeking menopausal hormone therapy are choosing biodentical hormones because they can help mitigate common side effects.

Meanwhile, if chronic stress is impeding your weight-loss efforts, a hormone health specialist will start by analyzing your cortisol levels. If a cortisol imbalance is indicated, a personalized treatment plan will be developed. This may involve customized prescriptions for hormone replacement, but will also offer supportive diet and supplement recommendations, as well as lifestyle guidelines. Balancing this key homeostatic system is vital not only to weight-loss success, but to the maintenance of life itself. 

It is clear that hormone changes and imbalances can critically challenge weight-loss efforts in women over 40. With so many pieces comprising this complex puzzle, a hormone health professional can be your best ally in finding a lasting solution — one that can reshape your body and your outlook. When lifestyle changes prove insufficient to correct midlife weight gain, personalized hormone replacement therapy can help you overcome this potentially dangerous development and help you feel like yourself again.

Ready to make an appointment with a bioidentical hormone therapy specialist? Find a qualified hormone therapy practitioner in your state now.

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 to diagnose, treat, cure or prevent diseases.


  • Charlotte

    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.