So you’re in your late 40s or your early 50s and you’ve noticed your weight increasing, just a little but it’s not going away. You’re noticing a few hot flushes, becoming daily. You’re having trouble sleeping and the difficulty concentrating and the lack of energy is really affecting your work. You’re busy. You haven’t got time for this. Your eating habits are pretty good (or so you believe) and you do a little exercise when you can fit it in but you need a solution, a quick fix, something that will help with the symptoms and will help halt the weight gain…. It’s the weight gain that bothers you the most. You hate looking in the mirror at yourself. You struggle to feel comfortable in your clothes and, oh my goodness, it’s summertime and the family want to visit the beach again!
Is there anything that will help?
You’ve googled. You’ve joined a ‘menopause’ facebook group. You’ve talked to your colleague who is just that little bit older. And they all have suggested going on HRT.
Is this the answer? Will HRT help you to lose weight (as well as fix all those other symptoms)?
Hormone Replacement Therapy (HRT) or Menopause Hormone Therapy (MHT), as it is now known, is a medication that contains female hormones. It is commonly prescribed by a doctor to treat symptoms like hot flushes. The main hormone is oestrogen but the exact form or combination of hormones will be determined by the prescribing doctor but it may come as oral tablets, gels or patches that go on the skin, creams or tablets that are placed within the vagina or an intrauterine device (IUD). Many women do find that MHT is beneficial for hot flushes and can also help with mood, sleep and libido concerns, but there are also some risks associated with the taking of it, including increasing the risk of breast cancer or blood clots as well as possible side effects of nausea, fluid retention, bloating, breast tenderness and irregular bleeding.
But what about weight - can it help at all with managing weight?
Let’s take a step back for a moment and consider the hormone, oestrogen. Oestrogen is one of the main hormones involved in the female reproduction system. It’s needed for puberty, the menstrual cycle, pregnancy, and helps with maintaining bone strength. You may not know that oestrogen also plays a role in our metabolism by helping to regulate our food intake, insulin sensitivity, body fat distribution, weight and energy expenditure.
During the menopausal transition, oestrogen will wildly fluctuate initially before eventually stabilising at a much lower level than during the reproductive years. This is actually what is meant to happen! In our postmenopausal years we are meant to have lower levels of oestrogen, just as we did during childhood, before puberty. However, many of the ‘symptoms’ that women experience around the menopausal transition may be related to the fluctuating oestrogen, the high highs of oestrogen and then the adjustment to the low levels of oestrogen. It’s whilst these changes are occurring that the typical symptoms such as hot flushes and mood swings are often at their worst.
Now if we consider that oestrogen plays a role in regulating our weight and metabolism, it would make theoretical sense then that if oestrogen levels are low then this influence on weight and metabolism will be reduced. And so, theoretically, by taking MHT, it makes some sense that by ‘artificially’ adding in oestrogen, to help with the hot flushes, you may also experience regulation with your weight.
But what does the research say?
Well, it seems there’s no real clear evidence that taking MHT does help with weight loss, but then it doesn’t really say that it does not either. It’s all a bit inconclusive! There is suggestion that MHT/HRT prevents an increase in fat mass and visceral adipose tissue (the ‘hidden fat’ stored deep inside the belly wrapped around the liver, intestines and other organs) especially for those women who have reached menopause within the last 2 years and/or those that have a waist circumference greater than 88cm but there is little conclusive evidence that it does actually make a difference to weight, BMI (Body Mass Index), nor insulin sensitivity and blood glucose levels which are also linked with chronic disease risk and weight gain. In fact, there is some evidence that going on HRT significantly increased weight for women with a larger waist circumference - now that’s not what you need!
So what should you do?
If weight loss is your main or only concern, or you are in the earlier stages of the menopausal transition then, MHT may not be the best option for you.
As a nutritionist, however, it is out of my scope of practice to determine whether you should contemplate MHT further. There are lots of factors (risks, benefits, age, symptoms, stage of menopausal transition etc) to consider so it’s best to talk to a knowledgeable doctor (not all doctors are well-informed about menopause nor MHT so do your homework first!).
Regardless of whether you choose the MHT route or not, your dietary, exercise and lifestyle habits will influence your weight management. Finding the right foods, the best exercise and knowing how to reduce stress are just a few things that will help you to lose weight as well as reduce your risk of chronic health problems now and in the future. There is plenty of evidence clinically and in the research that supports this but it does often need to be a long term change. It’s not a quick or immediate fix. Your body metabolises differently now and reacts differently to stress; the oestrogen no longer has the same effect on managing your weight as it did during your reproductive years, and so, you can’t expect to continue the same eating habits, the same exercise routine (or lack of) nor the same busy, stressful schedule that you got away with before.
HRT/MHT or not, your habits probably need to change!
Finding what works best for you will be a whole lot easier and quicker if you seek the help of a nutritionist, who uses a precision health approach (like me!) rather than googling a whole lot more!
And, finally, let me just throw this into your bag to consider……there are many reasons why women in their 40s and 50s gain weight or struggle to lose it; it may not just be related to falling oestrogen levels. And so, if you are on MHT already and have seen no change, or want to consider these other reasons further, then the best place to start is by reading my ‘Why Losing Weight is Even More of a Struggle in your 40s and What You Can Do About It’ ebook - it’s free to download here.
References
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HealthDirect, (2021), Hormone Replacement Therapy (HRT), https://www.healthdirect.gov.au/hormone-replacement-therapy
Jensen LB, Vestergaard P, Hermann AP, Gram J, Eiken P, Abrahamsen B, Brot C, Kolthoff N, Sørensen OH, Beck-Nielsen H, Nielsen SP, Charles P, Mosekilde L. Hormone replacement therapy dissociates fat mass and bone mass, and tends to reduce weight gain in early postmenopausal women: a randomized controlled 5-year clinical trial of the Danish Osteoporosis Prevention Study. J Bone Miner Res. 2003 Feb;18(2):333-42. doi: 10.1359/jbmr.2003.18.2.333. PMID: 12568411 (abstract only)
Papadakis GE, Hans D, Gonzalez Rodriguez E, Vollenweider P, Waeber G, Marques-Vidal P, Lamy O. The Metabolic Benefits of Menopausal Hormone Therapy Are Not Mediated by Improved Nutritional Habits. The OsteoLaus Cohort. Nutrients. 2019 Aug 16;11(8):1930. doi: 10.3390/nu11081930. PMID: 31426347; PMCID: PMC6722637.
Paschou SA, Goulis DG, Lambrinoudaki I, Papanas N. Menopausal hormone therapy for women with obesity in the era of COVID-19. Case Rep Womens Health. 2020 Jun 25;27:e00233. doi: 10.1016/j.crwh.2020.e00233. PMID: 32637325; PMCID: PMC7316057.
World Health Organisation (2022), Menopause https://www.who.int/news-room/fact-sheets/detail/menopause
Yüksel H, Odabasi AR, Demircan S, Köseoğlu K, Kizilkaya K, Onur E. Effects of postmenopausal hormone replacement therapy on body fat composition. Gynecol Endocrinol. 2007 Feb;23(2):99-104. doi: 10.1080/09513590601152177. PMID: 17454160.