10/12/2025
Does HRT Cause Weight Gain? Letâs talk about it. âŹď¸
One of the most common concerns about hormone replacement therapy (HRT) is weight gain. So here's the truth:
đ HRT does NOT directly cause weight gain.
Research shows that most women tend to gain some weight during midlifeâwith or without HRTâdue to aging, hormonal shifts, and lifestyle changes.
đ Estrogen in HRT may actually help reduce abdominal fat, improve insulin sensitivity, and support lean body mass in some people.
As estrogen levels drop, inflammation rises, and insulin resistance increases. Even without changing your diet or exercise habits, women see visceral (deep abdominal) fat jump from around 8% preâmenopause to approximately 23% during menopause. Thatâs nearly a threefold increase!
Visceral fatâunlike subcutaneous fatâis metabolically active and produces inflammatory signals. It's strongly linked to higher risks of heart disease, diabetes, stroke, and metabolic syndrome.
HOW TO COMBAT VISCERAL FAT:
1. Boost Fiber Intake
Most women only get ~12 g/day, aim for 25 g or more daily to lower inflammation, slow glucose absorption, support gut microbiome health, and reduce visceral fat.
2. Minimise Added Sugars
Limit added sugars (not just natural fruit sugars) to < 25 g/day. People who do often see significantly lower levels of visceral fat and inflammation.
3. Prioritise Protein
Menopause accelerates muscle loss (sarcopenia), which further slows metabolism. Adequate protein intake supports muscle synthesis, satiety, and metabolic health.
4. Strength Training & Movement
Weight-bearing or resistance training at least twice a week is vital to preserve muscle mass, increase bone density, reduce visceral fat, and support insulin sensitivity.
5. Support the Gut & Consider Probiotics
Estrogen loss disrupts gut microbiome balance. Eat probiotic-rich fermented foods (e.g. yogurt, sauerkraut)
6. Lifestyle: Sleep, Stress & Vitamin D
Low vitamin D levels, chronic stress, and poor sleep amplify inflammation and insulin resistanceâfueling the storage of abdominal fat. Optimising these supports metabolic health.
Visceral fat gain during perimenopause isn't a personal failureâitâs a predictable hormonal shift, one that insulin resistance, inflammation, and body composition changes can amplify.
Rather than calories-in/calories-out, itâs about creating metabolic resilienceâso your body stays strong, healthy, and functional as you navigate the hormonal transition.
HRT can help ease symptoms and support metabolic balance, but it works best alongside the lifestyle strategies listed above.
We hope you found this helpful. If you wish to discuss menopause more then please call or email the surgery to book onto our group consultations at gram.gwgroupconsultations@nhs.scot