Weight Gain in menopause

HRT and Weight Gain

My therapist told me the way to achieve true inner peace is to finish what I start. So for today, I have finished 2 bags of M&M and a chocolate cake. I feel better already. – Dave Barry


Summary: Weight gain in Menopause.

Women at menopause often experience weight gain, particularly around the abdomen. This is often due to declining oestrogen levels, age-related loss of muscle tissue and lifestyle factors such as diet and lack of exercise. Contrary to common belief, weight gain is not linked to hormone replacement therapy (HRT)

Menopause occurs when a woman stops ovulating and her monthly period (menstruation) stops. Many menopausal women experience weight gain. Normal hormonal changes are thought to be partly responsible, although the exact process is not understood.

Body changes at menopause

As we age, our muscles decrease in bulk and the metabolism slows down. These changes can contribute to weight gain around the time of menopause. Other physical changes associated with menopause may include:

  • Skin changes, such as dryness and loss of elasticity
  • Vaginal dryness
  • Hair growth (or loss).

These changes may affect a woman’s body image and self-esteem. Taking steps to manage the symptoms of menopause can be a powerful antidote.

Oestrogen and fat distribution

It seems that oestrogen may influence body fat distribution. Oestrogen is the female sex hormone responsible for ovulation. Women of childbearing age tend to store fat in the lower body (‘pear-shaped’), while men and postmenopausal women store fat around the abdomen (‘apple-shaped’). Animal studies have shown that a lack of oestrogen leads to excessive weight gain, although the exact mechanisms are not yet understood.

Hormone therapy does not cause weight gain

Contrary to common belief, various studies prove that weight gain is not linked to hormone replacement therapy (HRT). If a woman is prone to weight gain during her middle years, she will put on weight regardless of whether or not she uses HRT. Some women may experience symptoms at the start of treatment, including bloating and breast fullness, and these may be misinterpreted as weight gain. These symptoms usually disappear once the therapy doses are modified to suit the individual.

The link to cardiovascular disease

As women get older there is an increased risk of cardiovascular (heart and blood vessel) disease. This may be partly due to the postmenopausal tendency to put on weight around the abdomen. Body fat that is stored within the abdominal wall and around the internal organs (visceral fat) is a risk factor for the development of cardiovascular disease.

HRT can reduce the risk of cardiovascular disease by preventing the shift in body fat distribution to the abdomen. In addition, oestrogen replacement boosts ‘good’ blood cholesterol (high density lipoproteins, or HDL) and lowers ‘bad’ blood cholesterol (low density lipoproteins, or LDL).

Other contributing factors

Apart from declining oestrogen levels, other factors that may contribute to weight gain after menopause include:

  • Loss of muscle tissue with age
  • Lowered metabolism
  • Reduced physical activity
  • Altered habits – for example, more freedom to eat out.

Managing menopause-related weight gain

To manage your weight after menopause, you should try to:

  • Eat a low fat, high fibre diet.
  • Have regular and sustained aerobic exercise. This will give your metabolism a boost. Aim for at least 30 minutes of moderate physical activity every day.
  • Build up and maintain your muscle mass with strength training such as weight training or weight-bearing exercise like walking. (See your doctor before starting a new exercise program.)
  • Accept the changes to your body.

Avoid crash diets

A crash diet is when you severely reduce the amount you eat over a short time. Your body responds to this reduced energy supply by using muscle tissue as fuel. Muscles use up a lot of kilojoules in your body. If you lose muscle tissue, it means you have further reduced your body’s ability to burn kilojoules. This means you are likely to put on more weight when you start eating normally again.

It seems that the ‘fat hormone’ leptin plays an important role in this process. Leptin contributes to appetite control and metabolic rate. Studies show that leptin levels drop after a crash diet, which increases the appetite and slows the metabolism.

Consult with your doctor

Your doctor can help you manage your menopause-related weight gain and other symptoms. If you have a pre-existing medical condition or haven’t been very physically active for some time, see your doctor before you start any new fitness program.

Where to get help

  • Your doctor
  • An Accredited Practising Dietitian, contact the Dietitians Association of Australia
  • Jean Hailes for Women’s Health Tel. 1800 JEAN HAILES (532 642)
  • Summary

    Women at menopause often experience weight gain, particularly around the abdomen. This is often due to declining oestrogen levels, age-related loss of muscle tissue and lifestyle factors such as diet and lack of exercise. Contrary to common belief, weight gain is not linked to hormone replacement therapy (HRT).

  • =======================================================================

    Understanding weight gain at menopause.


    Women’s Health Research Program, Department of Epidemiology and Preventive Medicine, Monash University , Melbourne , Australia.


    ABSTRACT Objective The aim of this review was to summarize the literature regarding the impact of the menopause transition on body weight and body composition. Methods We conducted a search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2012) for English-language studies that included the following search terms: ‘menopause’, ‘midlife’, ‘hormone therapy’ or ‘estrogen’ combined with ‘obesity’, ‘body weight’ or ‘body composition’. Results Whereas weight gain per se cannot be attributed to the menopause transition, the change in the hormonal milieu at menopause is associated with an increase in total body fat and an increase in abdominal fat. Weight excess at midlife is not only associated with a heightened risk of cardiovascular and metabolic disease, but also impacts adversely on health-related quality of life and sexual function. Animal and human studies indicate that this tendency towards central abdominal fat accumulation is ameliorated by estrogen therapy. Studies mostly indicate a reduction in overall fat mass with estrogen and estrogen-progestin therapy, improved insulin sensitivity and a lower rate of development of type 2 diabetes.

    Conclusion The hormonal changes across the perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. There is strong evidence that estrogen therapy may partly prevent this menopause-related change in body composition and the associated metabolic sequelae. However, further studies are required to identify the women most likely to gain metabolic benefit from menopausal hormone therapy in order to develop evidence-based clinical recommendations.

The Medical Vitadiet

I originated and started the medical Vitadiet. I had 5 clinics running in Queensland with up to 10 doctors monitoring and helping people lose weight. The program was very successful so I sold it and moved into nutrition and natural medical treatment. In my opinion it is still the best weight loss program around, run by a local family, and very professional as well.

More information is available at:   http://www.medicalvitadiet.com.au

A lot of people are afraid of heights. Not me. I’m afraid of widths. – Stephen Wright

You know what is a “diet” is, don’t you? It’s “die” with a “t,” that’s what it is! – Garfield

Hormone replacement therapy has no effect on body weight and cannot

prevent weight gain at menopause.

Kongnyuy EJ, Norman RJ, Flight IHK, Rees MC
Published Online:
April 13, 2011

Hormone replacement therapy (HRT) is used to reduce the symptoms of menopause and bone loss after menopause. Some women decline to take HRT because they believe it causes weight gain. The review of trials found no evidence that unopposed oestrogen and combined oestrogen and progestogen have an effect on body weight additional to that usually gained at the time of menopause. The review did not find any evidence that HRT prevents weight gain experienced at menopause.

Hide Abstract (click to read)


Hormone replacement therapy (HRT) is commonly prescribed to treat menopausal symptoms and to prevent post-menopausal bone loss. However, many women are concerned about hormonal replacement therapy because they believe that such treatment will result in weight gain. The effect of HRT on body weight and fat distribution has not yet been examined in systematic reviews.


To evaluate the effect of unopposed oestrogen or combined oestrogen and progestogen hormone replacement therapy (HRT) upon the body weight and fat distribution of peri-menopausal and post-menopausal women.

Search strategy:

We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register, MEDLINE, EMBASE, Current Contents, Biological Abstracts and CINAHL, most recently in July 2005.

Selection criteria:

All randomised, placebo or no-treatment controlled trials (RCTs) that detailed the effect of HRT on body weight or fat distribution. Previous HRT use should have ceased at least one month (in the case of patches, cream or gel) or three months (for oral preparations or subcutaneous pellets) before commencement of the study.

Data collection and analysis:

Twenty-eight RCTs with 28,559 women fulfilled the inclusion criteria for this review. Data was pooled for continuous variables and the weighted mean difference (MD) with 95% confidence intervals reported.

Main results:

Outcomes were evaluated separately for unopposed oestrogen and oestrogen combined with progestogen regimens. No statistically significant difference was found in mean weight gain between those using unopposed oestrogen and non-HRT users (0.03kg, 95% CI -0.61 to 0.67) and those using oestrogen with progestogen therapy and non-HRT users (0.04 kg, 95% CI -0.42 to 0.50). There was no significant difference in body mass index (BMI) between women using unopposed oestrogen and non-HRT users (-0.14, 95% CI -0.40 to 0.12) or oestrogen combined with progestogen and non-HRT users (-0.10, 95% CI -0.27 to 0.07). Insufficient data were available to enable meta-analysis of the effect of HRT on waist to hip ratio, fat mass or skinfold thickness.

Authors’ conclusions:

There is no evidence of an effect of unopposed oestrogen or combined oestrogen with progestogen on body weight and on the BMI increase normally experienced at the time of menopause. Insufficient evidence currently exists to enable examination of the effect of HRT on waist-hip ratio, fat mass or skinfold thickness.

This record should be cited as:
Kongnyuy EJ, Norman RJ, Flight IHK, Rees MC. Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD001018. DOI: 10.1002/14651858.CD001018
Assessed as up to date:
July 1, 2005

 Do You Skip ?

 Do you sometimes skip breakfast, maybe thinking:

“I’ll skip breakfast so I will decrease my calories to lose a few pounds”  Or –
“I’ll grab something quick to give me some extra energy” – usually something sugary or caffeinated OR BOTH!
Or-“I don’t have anything prepared, and I’m in a hurry”

Well, Let me tell you about a client of mine . . .

I have a menopause coaching client named Sheila who gave me permission to tell her story.

When she worked in her husband’s medical practice, she hardly ever ate breakfast.  Most doctor offices have split hours to accommodate those patients who go to work early and don’t get off from work until 5 p.m. or after.

Some medical offices don’t usually finish with patients until almost 7:30 p.m. most days.

Sheila and her husband would eat dinner out late, which made Sheila not-so-hungry the next morning when it was time to eat.  She knew it wasn’t a healthy thing to do but with the hours as they were, she didn’t feel like she had much choice.

In the morning, sometimes she would grab an apple or banana on her way out of the door and ALWAYS had her coffee on the way to the office.  There were times when she had only coffee for her breakfast while she was getting ready for work.

Sheila says, “Eating this way, I remember being starved by lunch time!  Then I wanted to eat everything in sight when it was time to sit down to eat.  Also, my energy levels were so low by mid-morning I probably could have taken a nap!  I guess my excuses were that I was too much in a hurry; I stayed in bed until the very last minute and then had to rush, or felt that I didn’t have time or I just wasn’t hungry.  There were times when I couldn’t even think straight.  I felt so tired and run down.  My husband noticed I was making too many mistakes with scheduling patients and it was becoming costly for the office.  I had a hard time focusing or completing the tasks that were my responsibility.”

What is breakfast anyway?  During the night while you are sleeping, your body is taking a break from eating.  You are fasting.  Breakfast time is when you “break that fast” and start the day by giving your body the fuel it needs to perform at the highest level.

causes your body to be under more stress and the stress hormone, cortisol goes up.  Your blood sugar is low to start with.  When your blood sugar drops, it causes you to crave sweets.

Keeping the blood sugar as level as possible throughout the day will help in the prevention of insulin resistance which can ultimately lead to diabetes.

Did you realize by not eating breakfast, it affects certain hormones and causes a cascading effect in your body?

One of the most important things you can do for yourself to prepare for a productive day is to have a “good” breakfast before leaving home.  It will give you what you need to be able to concentrate, have mental clarity, focus and have energy.

Here is your guide to having a healthy breakfast:

Eat a breakfast that includes some protein such as real eggs. (Animal protein is easier to digest in the early part of the day than later.)

You will perform much better and feel better by having some protein with each meal throughout the day.  It doesn’t have to be a lot, whatever is the right amount for you.


If you don’t feel very hungry, it will greatly benefit you to still eat something small or a small amount of:

  • Fruit – apples and berries are best
    Some raw nuts (walnuts and/or almonds)
    ·      Slice of cheese
    ·      Cottage cheese
    ·      Ezekiel toast with Almond or Peanut Butter
    ·      Hard-boiled egg

Start eating breakfast, no matter how small.

  • ·       Use a journal for seven days.
  • ·       Write down how you feel after eating breakfast.
    See if you feel or see an increase in your energy.
  • ·       This will also give you a guide to which foods you
    may want to start avoiding.
  •         Sit down to eat and relax. Taking time to eat and enjoying it
    affects that make you feel full

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