There is little evidence that HRT causes people to gain weight. Weight gain during menopause has more to do with the changes in metabolism than whether a person takes HRT.

Hormone replacement therapy (HRT) is a treatment for menopause symptoms that works by replacing the hormones estrogen and progesterone. Many individuals worry about gaining weight during menopause and might also think that taking HRT will cause more weight gain. However, the main reason for weight gain during menopause is the changes in the metabolism rather than HRT.

This article will review HRT and weight gain, what HRT is, its potential side effects, and how people can manage and reduce the risk of weight gain while on HRT.

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Weight gain may be a side effect of HRT. However, there is little scientific evidence to confirm that HRT is a primary cause of weight gain. It is common to experience some weight gain during menopause and aging, whether a person takes HRT or not.

A frequent concern for individuals considering HRT is whether it leads to weight gain. However, research does not strongly indicate that HRT directly causes weight gain. Although limited studies exist, many women still report gaining weight while on HRT.

During menopause, people may experience a natural decrease in their resting metabolic rate, reducing calorie usage and potentially contributing to gradual weight gain. During menopause, the metabolic rate may decrease by about 250 calories per day. Maintaining a calorie intake similar to before menopause could lead to weight gain.

If an individual notices a significant increase in weight after starting HRT, they should consult a healthcare professional to investigate its underlying cause.

What is HRT?

HRT is a type of therapy that can help relieve symptoms people may experience due to menopause. HRT helps increase the levels of the hormones progesterone and estrogen, which naturally become lower as people age and get closer to menopause.

HRT can help treat menopause symptoms such as:

The side effects people may experience when taking HRT can vary depending on the medication and the hormones they take. Also, not everyone experiences side effects when taking HRT, and the severity of the side effects can also vary among individuals.

People taking progesterone may experience:

The side effects of estrogen may include:

Medications containing a mix of estrogen and progesterone, also known as combined HRT, may cause people a combination of side effects both from estrogen and progesterone therapy.

People taking tibolone may report side effects such as:

While there is little evidence that HRT can cause weight gain, several strategies can help people prevent increasing their body weight. Leading a healthy lifestyle is crucial to managing body weight, particularly during menopause.

Some lifestyle strategies people can try to help manage their weight include:

  • Quitting smoking, if applicable: This is crucial not only for managing body weight but also for promoting better health. Smoking damages bones, increases the risk of heart disease, and causes various cancers. People should also avoid secondhand smoke and seek medical support if they find it difficult to quit.
  • Being active: Individuals should aim for at least 30 minutes of physical activity most days of the week. This includes activities such as running, cycling, swimming, and walking. Physical exercise benefits the bones, heart, and mood and helps burn fat and manage weight. Experts recommend 2.5 hours of moderate aerobic activities weekly or 1.25 hours of vigorous exercise, along with muscle-strengthening exercises twice per week.
  • Eating well: Older individuals need fewer calories but still require essential nutrients. Females over 50 years old should get 2.4 micrograms (mcg) of vitamin B12 and 1.5 milligrams (mg) of vitamin B6 daily. Calcium needs rise to 1,200 mg daily after menopause, and vitamin D intake should be 600 to 800 IU, depending on age. People should consider speaking with a doctor to ensure their diets meet their nutritional needs and get recommendations on whether to take supplements.
  • Managing stress: High levels of stress can cause people to eat more, even when they are not hungry. Managing stress can help people who experience menopause not to overeat and gain weight.
  • Getting enough sleep: Poor sleep quality can increase stress levels and make it more challenging to manage body weight. People who do not get enough sleep are more likely to increase their calorie intake, primarily by snacking and eating sugary foods.

There is little scientific evidence to confirm that HRT causes weight gain. This is because menopause naturally decreases the metabolic rate, and this can make people gain weight regardless of whether they take HRT. Also, most individuals experience weight gain before starting HRT.

Being active, getting enough rest, quitting smoking, managing stress, and eating a healthy and balanced diet can significantly help control weight gain.