Hormone Replacement Therapy and Weight Loss: What Should I Know?

Research has shown a link between estrogen levels and obesity in menopausal women.

Postmenopausal women — those who have been through menopause — experience higher rates of obesity than men of the same age.

Hormonal imbalances are responsible for many of the changes women experience during menopause, and hormone replacement therapy may be able to help.

In this article, we'll discuss hormone replacement therapy, how it is linked to weight loss, its benefits and risks, and alternatives.

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How Do Hormones Affect My Weight?

Hormones regulate almost all the functions in the human body. They are essential for ensuring healthy growth and development, and they also regulate our mood and sleep cycles.

As women grow older, hormones that are essential for controlling weight, such as estrogen and testosterone, decrease. So it becomes increasingly difficult to get rid of excess weight and body fat — especially abdominal fat.

All hormones are important — and a hormonal imbalance can cause many health problems, including decreased bone mass, insulin resistance, high blood pressure, and weight gain.

Estrogen is one of the main hormones that regulate weight, but there are many others that also play an important role when it comes to weight loss.


Although testosterone is generally thought of as a male hormone, women also produce it.

It is essential for preventing fat storage in the abdomen. Low testosterone is associated with sugar cravings and insulin resistance.


Falling estrogen levels can result in weight gain as estrogen is responsible for regulating glucose and controlling where fat is stored.

Decreased estrogen can cause increased belly fat even if you don’t have weight gain elsewhere.


If your insulin levels are high, your body is unable to burn fat. And instead, it stores it in the body.

So when your insulin level increases due to insulin resistance — which can arise because of low estrogen levels — weight gain occurs.


While progesterone doesn’t directly impact weight gain, when there is an imbalance of estrogen and progesterone, the body may retain more fluid — this can result in a bloated appearance.


Together with adrenaline and noradrenaline, cortisol is the main hormone that controls the body’s response to stress.

It is essential for survival, but it also increases your appetite — especially cravings for sweet, salty, or greasy foods.

What is Hormone Replacement Therapy (HRT)?

Hormone replacement therapy—also called menopausal hormone therapy or estrogen replacement therapy—is a treatment that relieves the symptoms of menopause.

The two main hormones used in HRT are estrogen and progesterone.

Both hormones are typically administered during therapy, but estrogen-only therapy may be prescribed for those who’ve had a hysterectomy (womb or uterus removal).

Testosterone may also be prescribed in HRT as it aids fat loss, improves sex drive, and increases muscle mass.

How Does Hormone Replacement Therapy Work?

When menopause begins, the body produces less estrogen and progesterone, which causes several bodily changes — weight gain is often one.

To reduce some of the effects of menopause, you can ask your doctor about starting hormone therapy. Hormones used in HRT may be synthetic or bioidentical hormones.

What are the different types of hormone replacement therapy?

There are many forms of HRT, and they all have their own advantages and disadvantages. Your doctor will talk you through the different options before you start treatment.

Some ways HRT may be administered include:

  • Tablets
  • Skin patches
  • Estradiol gel or spray
  • Implants inserted under the skin
  • Vaginal estrogen, such as a cream or ring that’s inserted
  • Testosterone gel

Your age, the regularity of your period, and other risk factors will be considered when deciding which hormone therapy is best for you. An endocrinologist (hormone specialist) can best advise you.

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How long does it take for hormone therapy to work?

It may take a couple of weeks before you start to feel the effects of hormone replacement therapy.

Your doctor may recommend a 3-month trial with HRT, and your dosage may be adjusted based on your body’s response.

Key Point: What is Bioidentical Hormone Replacement Therapy?

Also called natural hormone therapy, bioidentical hormone replacement therapy uses plant-based hormones that have the same structure as our own hormones.

Synthetic hormones that are traditionally used in HRT, have been chemically altered and do not resemble natural hormones.

The FDA has approved certain brands that use bioidentical hormones, and some evidence shows that some bioidentical hormones may be safer than synthetic hormones. For example, progesterone may be safer than progestin.

Why Should I Consider Hormone Replacement Therapy for Weight Loss?

If you've tried to lose weight the traditional way — by exercising, reducing calories, and eating a balanced diet — and nothing seems to be working, you may benefit from HRT.

Hormone replacement therapy can be a great weight loss solution if:

  • You gained weight when you started menopause
  • You have excess abdominal fat
  • You have any of the other symptoms that accompany menopause, such as night sweats and hot flashes
  • You stopped menstruating at an early age
Key Point: What About Hormone Replacement for Men?

Men, much like women, also experience menopause — which is sometimes called male menopause or andropause.

Andropause is characterized by low testosterone levels which may be rectified with testosterone replacement therapy (TRT).

However, this treatment is not approved by the FDA for use in men who experience a decrease in testosterone due to age.

TRT is only approved to treat other causes of hypogonadism, where the body cannot produce enough testosterone due to a genetic disorder, medication, injury, infection and other causes.

What Are the Benefits of Hormone Replacement Therapy?

Hormone replacement therapy can rebalance your hormones and help your body to function normally again. Simply put, HRT can help you feel like yourself again.

Those who start hormone replacement therapy can expect to:

  • Experience less severe symptoms of menopause
  • Have an improved sex drive
  • Experience less vaginal dryness and discomfort
  • Lose weight and reduce body fat — especially belly fat
  • Feel less anxious and have fewer mood swings
  • Sleep better
  • Experience less chronic pain
  • Have a reduced risk of heart disease and dementia
  • Enjoy softer, smoother, and more youthful skin
  • Improve or protect bone health
  • Reduce colon cancer risk

What Are the Risks or Side Effects of Hormone Replacement Therapy?

Although hormone replacement therapy offers several potential benefits, like any other treatment it also comes with risks and side effects.

Some initial side effects of hormone replacement therapy that may pass within the first three months of treatment include:

  • Indigestion, stomach cramps, or bloating
  • Headaches and nausea
  • Feeling sick
  • Swollen or tender breasts
  • Skin irritation
  • Irregular menstruation

Women who use hormone therapy typically stay on the treatment for five years or fewer.

Long-term usage of HRT carries an increased risk of the following side effects:

  • Heart attacks
  • Strokes
  • Blood clots
  • Breast cancer
Key Point: What is the Link Between Cancer and Hormone Replacement Therapy?

An observational study conducted by the Women’s Health Initiative found that:

  • Estrogen-only HRT lowers the risk of breast cancer.
  • Combination HRT — which uses estrogen and progesterone or progestin — slightly increases the risk of breast cancer depending on type or hormone, length of treatment and other factors

Women with a family history of breast cancer should not consider hormone replacement therapy and should consult their doctor about alternate treatments.

What Are Some Signs of Hormone Imbalance?

If you’ve been struggling to lose weight and the scale won’t budge no matter how hard you try, you may be experiencing a hormonal imbalance.

Here are some symptoms to watch out for:

  • Irregularities in the menstrual cycle, such as missed periods
  • Sleep disturbances, such as struggling to fall asleep or waking frequently
  • Acne that won’t go away
  • Excessively dry skin
  • Difficulty remembering things
  • Bloating, nausea, constipation, diarrhea, and other digestive problems
  • Stomach cramps or back pain during a period
  • Chronic fatigue
  • Depression
  • Mood swings
  • Chronic headaches
  • Low sex drive
  • Vaginal dryness and changes in the shape and density of breast tissue
  • Joint pain and/or fractures

Do I need to check my hormone levels?

You can have your hormone levels tested at a doctor’s office or with an at-home hormone test kit. However, if you’re already displaying symptoms of menopause, it isn’t necessary.

According to the North American Menopause Society, hormone levels tested during perimenopause (usually the period between ages 40 and 45) are not typically accurate, as hormone levels fluctuate too much.

However, a hormone test may provide useful fertility insights when menstruation stops too early.

What Else Could Be Preventing Me from Losing Weight?

If you’re struggling to lose weight, your hormone levels may be responsible for those extra pounds — or it might be those late-night snacks or all those Frappuccinos with extra cream.

Below are some other reasons why you may be gaining weight:

  • You’re not eating a balanced diet
  • You’re consuming too many calories
  • You’re drinking too many sugary drinks—or consuming “empty calories”
  • You aren’t getting enough quality sleep
  • Your stress levels are too high
  • You’re not getting enough physical activity
  • You have a medical condition — such as depression or hypothyroidism — that’s making you gain weight

Before seeking hormone replacement therapy, determine whether a few simple lifestyle changes can help you lose the extra pounds.

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Who Should Not Have Hormone Replacement Therapy?

While hormone replacement therapy can be really beneficial to some women, a doctor may advise against this course of treatment for those who:

  • Come from a family with a history of blood clots, or ovarian, uterine, or breast cancer
  • Have uncontrolled high blood pressure, or liver or heart disease
  • Are currently pregnant
  • Experience unusual vaginal bleeding
  • Are smokers

What Are Some Alternatives to Hormone Replacement Therapy?

If you’re someone who's not a suitable candidate for HRT, but you still want to regulate your hormones for weight loss and other benefits, you may want to explore the following options:

  • Alternative medicine treatments, such as acupressure and acupuncture
  • Herbal medicines, such as essential oils
  • Medical treatments that can rebalance hormones, such as antidepressants
  • Lifestyle changes, such as a healthy diet and increased exercise
  • Homeopathic remedies

When Should I See a Doctor for Weight Gain?

If you’ve experienced sudden or unintentional weight gain, you should seek medical attention.

Maybe you've just been snacking more often due to stress — in which case, more mindful eating and a good meal plan may solve the problem.

However, if your hormones are causing weight gain or you have a more serious underlying medical issue, only a healthcare professional can help.

If eating moderately or incorporating more exercise into your routine doesn't change the way you look and feel, get in touch with a doctor.

Where Can I Learn More About HRT and Weight Loss?

Are you heading toward menopause? Are you worried that your hormones are affecting your weight? Have you tried everything, but the scale still won’t budge? Book a telehealth appointment with a board-certified doctor or nurse practitioner to find out if hormone replacement therapy is right for you.

Dr. Danielle Weiss

Dr. Weiss earned her MD from NYU School of Medicine, completed her residency at Scripps Mercy San Diego, and an endocrinology fellowship at Stanford University. She’s Board Certified in both Internal Medicine and Endocrinology, Diabetes, and Metabolism.

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This article is intended for informational purposes only and should not be considered medical advice. Consult a healthcare professional or call a doctor in the case of a medical emergency.

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