HRT and your weight during menopause

What is hormone therapy for menopause?

Hormone therapy, also known as hormone replacement therapy (HRT, in Dutch hormoonsuppletietherapie or HST), tops up the falling oestrogen levels during menopause with medication. You usually receive estradiol in the form of tablets, patches, gel or spray. If you have a womb, the doctor combines this with a progestogen or a hormonal coil (IUD) to protect the lining of the womb.

Modern products often contain estradiol that is identical to the hormone your body produces itself. This is also called bio-identical hormone therapy. The hormone treatment is intended for women with significant menopause symptoms: hot flushes, night sweats, mood swings or poor sleep. Weight loss is not on that list; the treatment is not intended or registered for that purpose.

How long such a course of hormones lasts differs from woman to woman. Many women use the medication for several years, sometimes even after menopause. You always taper off in consultation with your doctor, so that symptoms do not suddenly return.

Why do you gain weight during menopause?

Weight gain during menopause is caused by a combination of a slower metabolism, loss of muscle mass and a changing fat distribution. At rest you burn fewer calories than before menopause, while your eating pattern often stays the same. The result: weight gradually creeps on, without you doing anything differently from before.

Falling oestrogen levels play a leading role in this. In women, oestrogen directs fat storage towards the hips and buttocks. When that hormone falls, storage shifts to the belly, mainly as deeper fat around the organs. Research in the International Journal of Obesity followed 156 women for four years: in the women who reached menopause, belly fat increased significantly and fat burning fell by 32%.

On top of that comes muscle loss. Muscles use energy even at rest; if you lose muscle mass, your calorie burning drops further. And poor sleep caused by hot flushes or night sweats increases your hunger, so you eat more without noticing. Several causes interact in this way; our article on menopause weight gain sets them all out. You can read why the kilos settle around your waist in particular in our article on the menopause belly.

Does hormone therapy make you gain weight?

No, hormone therapy almost never makes you gain weight permanently. A Cochrane analysis of 28 studies involving 28,559 women found no difference in weight or BMI between women with and without hormone therapy. So the kilos that appear at this stage of life also appear without hormones.

Where does the persistent myth come from, then? In the first weeks you may retain fluid, leading to a bloated feeling and tender breasts. That feels like weight gain and explains many experiences of women who blame the therapy. However, it is not fat and it usually disappears within a few months.

Moreover, you start the treatment in exactly the stage of life in which almost every woman gradually gains weight. The scales then go up because of menopause itself, not because of the medication. Incidentally, the same Cochrane review also found no evidence that hormone therapy can prevent weight gain; anyone who promises that is selling a fairy tale.

Side effects and risks of hormone therapy

As well as benefits, hormone therapy also has side effects and risks. That is why you always make the choice together with your GP (huisarts) or gynaecologist. According to Thuisarts.nl (the Dutch GP association's patient website), these are the main points to consider:

• Temporary side effects: tender breasts, headaches, nausea and fluid retention, especially in the first months
• Irregular bleeding: common at the start and usually part of finding the right dose
• Slightly increased risk of thrombosis: mainly with tablets; patches and gel are safer in that respect
• Slightly increased chance of breast cancer: mainly with use for longer than five years

Do not be alarmed by this list. For many women with significant symptoms, the benefits far outweigh the drawbacks. But it does underline why you only use hormone therapy on medical advice, and never as a way to tackle the kilos.

What does help against hormonal weight gain?

The foundation for tackling hormonal weight gain is a combination of mindful eating, strength training, enough sleep and less stress. Not spectacular, but proven to work. At this stage, your body simply asks for a different maintenance plan than it did when you were thirty.

• Eat more mindfully and include more protein. Your energy needs fall after menopause. The Voedingscentrum (the Netherlands Nutrition Centre) advises women going through menopause to get enough protein, dairy and fibre, among other things, and points to the greater chance of fat being stored around the belly.
• Do strength training. Muscle mass is your best weapon against a slower metabolism. Two to three sessions a week with weights or resistance bands slow down muscle loss.
• Get enough sleep. Lack of sleep disrupts your hunger hormones and makes snacking more tempting. Aim for seven to eight hours a night.
• Limit stress. The stress hormone cortisol actually stimulates the storage of belly fat.

You can find more practical tips in our guide to weight loss during menopause. Are the scales not moving despite all your efforts? Then more factors may be involved. In our article on why you are not losing weight we set out the most common causes.

Tried everything, but the scales will not budge? Our own BIG-registered doctor (the BIG register is the Dutch register of healthcare professionals) looks at whether medical weight loss suits your situation, with no obligation. Take the eligibility check →

Medical weight loss when lifestyle and hormone therapy are not enough

If your weight remains too high despite a healthy lifestyle, with a BMI of 30 or higher, medical weight loss can be a responsible next step. With medical weight loss with injections you use GLP-1 medication that suppresses the feeling of hunger. Well-known medicines are semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro) and liraglutide (Saxenda). For women going through menopause in particular, this can make the difference: the medication takes away the constant cravings, making it possible to keep eating less despite your slower metabolism.

Important to know: these medicines are prescription-only and, like any medicine, have side effects, such as nausea in the first weeks. You can read a full overview in our article on GLP-1 side effects. Never buy this medication online without a prescription: you do not know what you are getting and you miss out on any medical supervision. The safe route is always through a doctor.

How do the two treatments compare?

At Qlinic, such a programme is fully supervised by our own BIG-registered doctor. You start with a personal intake, receive your medication at home and have a follow-up with the doctor every 4 weeks. Most participants notice the first effect after about 4 weeks.

We have now helped around 50 clients; they rate us 5.0 on Google based on more than 20 reviews.

Curious whether medical weight loss is right for you? Take the eligibility check with no obligation and find out whether support from our own doctor is something for you. Take the eligibility check →

Frequently asked questions about HRT and your weight

Why am I gaining weight so quickly on hormone therapy?

Rapid weight gain shortly after starting is almost always caused by fluid retention, not fat. This is part of getting used to the hormones and usually disappears within two to three months. If the gain persists, discuss with your doctor whether a different dose or form of administration would suit you better.

Why do some women stay slim during menopause?

Women who stay slim during menopause usually actively adjust their lifestyle: they eat a little less, move more and maintain muscle mass with strength training. Hereditary factors and the way your body responds to the hormonal changes also play a role. So staying slim is not just a matter of luck, but mainly of making adjustments.

Which medicines do you get with hormone therapy for menopause?

With hormone therapy you usually receive estradiol, as a tablet, patch, gel or spray. If you have a womb, a progestogen or a hormonal coil is added to protect the lining of the womb. Your GP or gynaecologist decides together with you which form and dose suit you best.

Is natural or bio-identical hormone therapy better for your weight?

No, bio-identical or natural hormone therapy does not make you lose weight either. Bio-identical means that the hormone has the same structure as the oestrogen your body produces; most standard products already contain this. The form makes no demonstrable difference to the effect on your weight.

Does hormone therapy help against a menopause belly?

Hormone therapy is not a treatment for belly fat. Some studies see a slightly more favourable fat distribution in users, but that effect is small and in itself no reason to start the treatment. If you want to lose belly fat in a targeted way, diet, strength training and possibly medically supervised weight loss achieve considerably more.

Can you combine hormone therapy with medical weight loss?

Yes, in many cases hormone therapy can be combined with a medical weight loss programme. Whether that is sensible in your situation depends on your health and the medicines you use. At Qlinic, our doctor assesses this during the intake, and where necessary we coordinate with your GP or gynaecologist.