During perimenopause and menopause, many women notice weight creeping on, often around the middle, and wonder whether HRT is to blame. In truth, the relationship between hormone replacement therapy (HRT) and weight is more complex than it first appears.
In this article, we unpack the real drivers of weight gain in midlife, clarify the role of HRT, and share how hormone therapy may actually support your metabolism and wellbeing.
Menopause and weight gain
A major review by the International Menopause Society found that menopause doesn’t directly cause weight gain, but it does change how and where fat is stored. Menopause is associated with an increase in total body fat, and women tend to experience an increase in abdominal fat [1].
Large cohort data suggest women on average gain ~0.5–0.7 kg per year through midlife, with no sharp acceleration due to menopause itself, while fat mass shifts toward the abdomen.[2]
Does HRT cause weight gain?
The NHS states that there is little evidence that HRT makes you put on weight [3]. Instead, any weight changes are more likely to be due to ageing, hormonal changes and lifestyle factors that coincide with the timing of menopause.
That said, some women do report gaining weight on HRT, especially in the early stages, and this can be down to a multitude of factors. However, this usually stabilises with time.
Why am I gaining weight on HRT?
Even if HRT doesn’t cause weight gain directly during menopause, there are still several reasons why weight gain may happen during this phase of life:
- Loss of muscle mass reduces resting metabolic rate, meaning fewer calories are burned at rest [2].
- Poor sleep, hot flushes and fatigue reduce motivation to exercise and make healthier food choices. In one study of over 68,000 women, women who slept less than 5 hours a night gained more weight than those sleeping 6 hours or more [4].
- Cravings for sugar and carbs may increase, especially when combined with emotional eating. A 5-year study found that the desire to eat, hunger and food consumption all increased during the menopausal transition and remained elevated postmenopause [5].
So, if you’re gaining weight on HRT, it may be related more to what your body is already going through, rather than the HRT itself.
Can HRT help with weight loss?
A growing body of research suggests that HRT may actually help with weight management for some women.
One study found that oestrogen therapy increased resting energy expenditure by 222 kcal/day, suggesting a potential for weight stabilisation or loss [6]. Other research found combined HRT may limit age-related gains in abdominal/visceral fat and modestly improve insulin sensitivity; consistent weight-loss effects aren’t demonstrated. [7].
HRT may also lead to better fat distribution. Rather than accumulating around the middle, fat may be redistributed more evenly, which is better for long-term health [8].
Crucially, by relieving symptoms like poor sleep, low energy and mood swings, HRT can give women back the motivation to move more, eat better, and feel in control again.
So, while HRT is certainly not a weight loss medication, it can contribute to maintaining or reaching a healthy weight through balancing hormones and the impact of this on overall quality of life.
The best HRT for weight loss
There isn’t one-size-fits-all guidance when it comes to HRT and weight loss. That said, some elements may help:
- Oestrogen: Some evidence suggests that oestrogen hormone therapy increases a woman's resting metabolic rate (how much energy she expends). This might help limit weight gain during menopause [6].
- Micronised progesterone: may be better tolerated than some synthetic progestins, so fluid retention may be less of an issue for some [9] and, therefore, reduce the likelihood of temporary weight gain.
- Testosterone: may help with energy levels and mood. However, its only evidence-based use in women is for treating hypoactive sexual desire disorder, and only after other possible causes have been explored and addressed.[10]
What works best for you will depend on your symptoms, lifestyle, and medical history.
Will I lose weight if I stop HRT?
Any weight changes during menopause are usually due to hormonal changes and lifestyle factors, not HRT itself. If you do lose weight after stopping HRT, it’s more likely due to a change in habits or underlying health rather than the withdrawal of hormones.
Stopping HRT can worsen menopausal symptoms, leading to fatigue, disrupted sleep, and anxiety, all of which can make weight management harder.
HRT and metabolic health
Weight gain with HRT isn’t always about the number on the scale. It’s also about how your body stores fat and how your metabolism is functioning.
The menopause transition is linked to increased insulin resistance and metabolic syndrome, which includes:
- High blood pressure
- Abdominal weight gain
- Blood lipid abnormalities
- Increased risk of type 2 diabetes and cardiovascular disease [11].
HRT has been shown to reduce some of these risks by:
- Improving insulin sensitivity [7]
- Reducing central fat accumulation [8]
- Improving blood lipid profiles [12]
So, when considering HRT, it can be beneficial to look at how it can protect long-term metabolic health as well as impact your current weight.
What to do if you’re gaining weight on HRT
Whether you’re on HRT or not, managing weight during menopause involves a multi-faceted approach:
1. Review your diet
Eating a balanced, Mediterranean-style diet that includes whole grains, plenty of vegetables, lean protein, and healthy fats is one of the most effective strategies for supporting weight management during menopause and postmenopause. Mediterranean-style diets are linked with improvements in BP, lipids and weight in trials [13].
Try to reduce your intake of refined sugars, processed foods, and alcohol, which can contribute to energy crashes and cravings. Increasing fibre and protein also helps support a healthy metabolism and can keep you feeling fuller for longer.
2. Move more
Regular movement is crucial. Aim for a mix of cardiovascular exercise and strength training to help preserve muscle mass and encourage fat burning. Government guidelines recommend at least 150 minutes of moderate activity per week alongside two sessions of strength-based exercise [14]. Activities like brisk walking, swimming, yoga, cycling, and resistance training can all make a meaningful difference.
3. Sleep well
Sleep disruption during menopause is common and can influence eating behaviours and timing, making maintaining a healthy weight more challenging [15]. Improving sleep with the support of HRT, bedtime routines, and good sleep hygiene practices can reduce cravings and restore energy, helping you feel more in control of your food and activity choices.
4. Manage stress
Chronic stress and higher cortisol are associated with greater fat storage around the abdomen [16]. Techniques such as yoga, mindfulness, deep breathing, or simply making time for joy and connection can all help lower stress levels. Lower cortisol not only supports weight control but also boosts mood and motivation.
5. Get support
Speak to a menopause specialist to review your HRT regime and ensure it’s tailored to your individual needs. If you're still struggling, consider asking for thyroid blood tests, as thyroid disorders become more common as you age, are ten times more common in women than in men [17], and can significantly impact metabolism [18]. Professional guidance can help pinpoint what’s going on and offer solutions that work for you.
¹Understanding weight gain at menopause (June 2012) https://www.tandfonline.com/doi/full/10.3109/13697137.2012.707385
²Menopause: Nutrition and Weight Gain - BMS (June 2023)
https://thebms.org.uk/wp-content/uploads/2023/06/19-BMS-TfC-Menopause-Nutrition-and-Weight-Gain-JUNE2023-A.pdf
³Side effects of hormone replacement therapy (HRT) - NHS (January 2023) https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/side-effects-of-hormone-replacement-therapy-hrt/
⁴Association between Reduced Sleep and Weight Gain in Women - PMC (November 2012) https://pmc.ncbi.nlm.nih.gov/articles/PMC3496783/
⁵Effects of the menopausal transition on dietary intake and appetite: a MONET Group Study - PubMed (February 2014) https://pubmed.ncbi.nlm.nih.gov/24065065/
⁶Impact of estrogens on resting energy expenditure: A systematic review (October 2022) https://onlinelibrary.wiley.com/doi/pdf/10.1111/obr.13605
⁷Beneficial effect of hormone replacement therapy on weight loss in obese menopausal women - PubMed (August 1999) https://pubmed.ncbi.nlm.nih.gov/10515671/
⁸Influence of Menopausal Hormone Therapy on Body Composition and Metabolic Parameters - PMC (March 2020) https://pmc.ncbi.nlm.nih.gov/articles/PMC7097676/
⁹Natural Micronized Progesterone Sustained Release (SR) and Luteal Phase: Role Redefined!! - PMC (February 2016) https://pmc.ncbi.nlm.nih.gov/articles/PMC4800604/
¹⁰Testosterone replacement in menopause - BMS (December 2022) https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf
¹¹Metabolic Disorders in Menopause - PMC (October 2022) https://pmc.ncbi.nlm.nih.gov/articles/PMC9606939/
¹²Effect of hormone replacement therapy on atherogenic lipid profile in postmenopausal women - PubMed (December 2019) https://pubmed.ncbi.nlm.nih.gov/31677448/
¹³Systematic review of mediterranean diet interventions in menopausal women - PMC (January 2024) https://pmc.ncbi.nlm.nih.gov/articles/PMC11007410/
¹⁴Physical activity guidelines for adults aged 19 to 64 - NHS (May 2024) https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-for-adults-aged-19-to-64/
¹⁵Sleep, Health, and Metabolism in Midlife Women and Menopause: Food for Thought - PMC (December 2019)
¹⁶Stress-induced cortisol response and fat distribution in women - PubMed (May 1994) https://pmc.ncbi.nlm.nih.gov/articles/PMC6338227/
¹⁷Thyroid & Menopause - British Thyroid Foundation https://www.btf-thyroid.org/thyroid-menopause
¹⁸Thyroid and menopause article (May 2023) https://www.btf-thyroid.org/thyroid-and-menopause-article
