Does HRT Help with Weight Loss?

Of all the changes that arise during menopause, gaining weight can be one of the most frustrating. That’s because there’s often no obvious cause: You aren’t suddenly eating differently or completely stopping all physical activity. On top of that, the extra weight doesn’t spread out evenly—it tends to build up the most in your belly area (often referred to as meno belly). 

These physical changes are due to multiple factors, including a drop in estrogen that accompanies the end of your reproductive years. For this reason, many women wonder whether hormone replacement therapy (HRT), also referred to as hormone therapy or menopausal hormone therapy, could help them lose the extra weight that suddenly shows up in midlife. Read on to find out, plus learn more about other strategies to help you reach the healthiest weight for you.  

Why Menopause Causes Weight Changes

Gaining weight during menopause can feel a lot like your body is adding insult to injury. You may already be dealing with hot flashes, brain fog, and poor sleep—and now your clothes don’t fit as well, either? Like other menopause symptoms, weight gain during this stage is partially due to changing hormone levels. 

Throughout the menopause transition, your estrogen and progesterone levels go in a bit of a free fall. And a side effect of those lower hormone levels is, you guessed it, weight gain. 

There are a few reasons for this:

• Estrogen helps decrease food intake and increase energy expenditure, so as it drops, you might be eating more and moving less. 
• Lower estrogen levels affect where fat builds up on your body. This redistributes fat from elsewhere to your belly—a type of fat known as visceral fat that’s especially dangerous to your health. (Before menopause, visceral fat makes up 5% to 8% of your total fat. But by the time you’re postmenopausal, it’s 15% to 20% of your total fat, according to one study.)
• Right around the time you’re going through the hormone-induced weight and fat gain, you’re also the age when your metabolism naturally starts slowing down. This is largely due to muscle loss (muscle burns more calories than fat) and a tendency to move less as you age.

Understanding Hormone Replacement Therapy (HRT)

If you aren’t familiar with HRT, it’s a type of prescription medication that helps supplement your hormones and bring levels up, with the goal of reducing menopause symptoms and side effects.

You can take either estrogen, progesterone, or, most commonly, a combination of both hormones. HRT can also come in many different forms, including: 

• pills
• skin patches
• vaginal creams and gels
• Pellets (which Midi doesn’t recommend)

HRT can be a game changer for both women in perimenopause and those who have already reached menopause—especially if you’re having moderate to severe symptoms like hot flashes, night sweats, or vaginal dryness. A healthcare professional, like a Midi clinician, can guide you in determining whether HRT can help and, if so, which kind you should try.

Will HRT Help Me Lose Weight?

With low estrogen levels partially to blame for weight gain during menopause, it would make sense that taking estrogen via HRT would help reverse that. But research hasn’t confirmed that link yet. 

That said, HRT can make a difference in belly fat. For instance, one small study found that after 3 months, participants taking combined estrogen and progesterone lost total fat and decreased their waist-to-hip ratio (a way to show that they lost belly fat), even as their weight held steady. Other research backs this up, showing that after 3 years on HRT, women were able to maintain their lean muscle mass and reduce how much belly fat they gained. 

A ripple effect that can make exercising and eating well feel easier may also happen when you’re taking HRT for other menopause symptoms. For example, HRT:

• improves night sweats so you can sleep better
• helps with mood, so you’re more motivated to work out and eat better
• reduces joint pain, so exercise may feel less out of reach  

Logically, this makes sense. If you start sleeping better, are in better spirits, and have less body pain, you may have more motivation to move your body and prepare healthy food—lifestyle habits that are proven to aid weight loss.  

While many women complain of gaining weight while on HRT, no studies have found a connection between HRT and added pounds. That said, if you’re noticing more weight gain after beginning HRT, it’s important to let your healthcare professional know, so they can help you troubleshoot other strategies that can help. 

Factors Affecting Weight Loss with HRT

While HRT could give weight loss an assist and can help reduce belly fat, it won’t have the same effect on everyone. Here are some things that can impact how much the scale moves:

• Your individual response to hormone therapy: As much as HRT can help some women with their menopause symptoms, including belly fat buildup, it doesn’t have a significant effect on everyone. And some women won’t see much relief at all. On top of that, your personal genetics, metabolism, and lifestyle can affect weight, regardless of how well HRT works for you.
• The type of HRT you’re taking: Under the umbrella of HRT, there are a lot of options. It can be estrogen, progesterone, or a mix and it can come in different doses and forms, like creams, oral medications, patches, and more. Each of these types can have a different effect on your health.
• When you start HRT: Women who begin HRT before age 60 or within 10 years of their first symptoms tend to respond the best. In fact, it’s recommended that you start HRT as soon as you have symptoms. 

Complementary Strategies to Boost HRT’s Effectiveness in Weight Loss

Think of HRT as one ingredient that can help you lose fat, hold on to muscle, and minimize weight gain throughout menopause. It can’t operate alone, though. It needs to be mixed together with other lifestyle habits proven to be effective for weight loss. 

Here are some key areas to focus on:

• Eat a balanced, nutritious diet: For anyone in menopause trying to lose weight, with or without HRT, prioritizing nutrient-dense foods like whole grains, lean proteins, and healthy fats is an important step. Foods with fiber, like vegetables, whole wheat, and legumes, are important to eat since they can help you feel full (fighting the extra hunger brought on by the dip in estrogen). Protein is also important: Research shows that upping your intake during perimenopause can help you lose weight and fat while helping you hold on to more muscle.
• Do both cardio and strength training: Cardio is obviously important for heart health and bone strength—things important for women in menopause. But working your muscles with resistance training is also crucial for holding on to muscle, which, as a reminder, burns more calories than fat. Not only does regular strength training reduce total fat, it can help get rid of abdominal fat in postmenopausal women. 
• Overcome any sleep challenges: If night sweats are messing with your sleep, it doesn’t just impact your mood, energy levels, and desire to exercise. It can also affect your body’s ability to metabolize fat and cause you to store more of it. A small study found that this occurred after just 2 nights of disturbed sleep. 
• Reduce your overall stress: Letting stress get too high can make it harder to lose weight, since stress can lead to a desire to eat foods high in fat and calories. And the higher cortisol levels brought on by stress can lead you to store more abdominal fat.

Potential Side Effects and Risks of HRT

There are a lot of misconceptions surrounding the risks of using HRT, so what’s the truth? For the majority of women, the most common side effects are:

• headaches
• cramping, diarrhea, upset stomach, and vomiting
• mood changes
• tenderness or pain in the breasts
• trouble sleeping
• vaginal bleeding
• swollen hands, feet, or calves
• pelvic pain 

You may have heard that HRT raises your risk of breast cancer, but the 2002 study that claim was based on has since been debunked. While there were more cases of breast cancer in women who used HRT, the total number of new cases was still small. And other studies have shown that breast cancer risk may actually go down in women taking certain forms of HRT. Make sure to talk about your personal risk for breast cancer with your clinician before starting HRT.

Not everyone on HRT experiences side effects, and not every form of HRT carries the same risk. For example, if you’re using a local form of HRT, like a vaginal cream, you may have fewer side effects compared with taking an oral form that affects your entire body. 

Alternatives and Additional Support for Weight Loss

While HRT may be an attractive option for some menopausal women hoping to manage weight gain and lose belly fat, it’s not for everyone. Some women experience severe side effects on HRT or have a health condition that makes HRT an unsafe choice.

Luckily, there are other options if you’re looking to lose weight. Strategies that can help:

• Personalized weight-loss medications like GLP-1s, even in microdoses, can help, and some women are finding benefits from combining GLP-1s with HRT. In fact, a recent study found that combining HRT with the GLP-1 medication tirzepatide may enhance results even further. In the study, postmenopausal women who were overweight or had obesity and used both treatments lost an average of 17% of their body weight—compared with 14% for participants using tirzepatide alone.
• Tried-and-true lifestyle habits that can reduce belly fat and help you maintain your weight throughout menopause. These are the same habits recommended for people taking HRT: eating a healthy diet that prioritizes protein and fiber, doing a mix of cardio and strength training every week, taking steps to improve your sleep, and keeping your stress levels down.
• Supplements, like fiber and berberine have been shown to help aid in weight loss. Research suggests that making the single change of eating more fiber helps you lose weight, according to a study in The Journal of Nutrition. Berberine, now dubbed “nature’s Ozempic,” may also help aid in weight loss by improving overall health, and it has been shown in several studies to help lower blood sugar levels and improve cholesterol levels—two health markers exacerbated in menopause.

Whatever path you choose, your best first move is talking with a healthcare professional and getting personalized guidance on whether HRT is right for you, what to expect, and how to build a holistic care plan that matches your own unique health needs.

Key Takeaways

• In addition to common menopause symptoms like hot flashes and night sweats, many women experience weight gain and an increase in belly fat brought on by the drop in estrogen and lifestyle changes at midlife.
• HRT has been shown to reduce belly fat buildup during menopause, but it does not directly lead to weight loss.
• That said, HRT improves sleep (by helping with night sweats), mood, and joint pain, which may help you feel more motivated to eat well and lose weight.
• Whether you are taking HRT or not, you can manage your weight by eating a healthy diet full of lean protein and fiber, doing strength training and cardio workouts, sleeping better, and managing stress.

Frequently Asked Questions (FAQs)

Can HRT help you lose weight? 

HRT is not a weight loss drug, and taking it does not directly result in weight loss, say Midi Health experts. Instead, HRT can help you feel better by improving your sleep, mood, and joint pain, which can, in turn, help you stick with healthy habits like exercising and eating well. That said, HRT has been shown to help reduce belly fat buildup brought on by the hormonal changes that happen during menopause.

How long does it take to start losing weight with HRT? 

While HRT does not lead to weight loss directly, you may start to notice improved symptoms like better sleep within a few weeks of starting it.

How to lose 20 pounds during menopause? 

There is no simple formula that everyone should follow to lose weight during menopause. Talk with a healthcare professional about what might be best for you, whether it’s a medication like GLP-1s or HRT, lifestyle changes, or a combination of both.

Why am I gaining weight on HRT? 

HRT does not make you gain weight. If you’re gaining weight while on HRT, other factors related to menopause are most likely to blame. The drop in estrogen brought on by menopause can make you hungrier and cause your body to store more fat. And at the same time, many women in midlife find themselves moving less than they did when they were younger, adding to the potential for weight gain.

Can HRT cause weight gain? 

Research hasn’t found a link between hormone replacement therapy (HRT) and weight gain. In fact, the opposite can happen—many women actually lose belly fat once they start HRT, says Kathleen Jordan, MD, Midi’s Chief Medical Officer. One study in the journal Maturitas showed that after just three months, women not only dropped overall body fat but also slimmed down their waist-to-hip ratio. "And the benefits don’t stop there. Better sleep, a brighter mood, less joint pain—HRT can make it easier to move your body, eat well, and feel like yourself again, all of which support weight loss," says Dr. Jordan. If the scale does creep up while you’re on HRT, it’s not a dead end. Adjusting your HRT dose or adding more fiber could get you back on track with your weight goals and keep your symptoms under control.

Does low estrogen cause weight gain? 

Yes. Estrogen is involved in your brain’s appetite center, so when it drops, you end up feeling hungrier, which can naturally lead to eating more and gaining weight. Another side effect of low estrogen is that it switches fat buildup from lower in your body to your belly.