Most women will experience some weight gain in the years around the menopause. The cause for this is complex and poorly understood, certainly the hormonal changes occurring at this time can predispose to weight gain but the metabolic changes occurring with age, reduced physical activity, reduced muscle mass, poor sleep quality and reduced physical activity are also important factors. Fat distribution also changes at this time with more tending to accumulate around the abdomen, this is called visceral fat and is known to have a more pronounced effect on metabolism and increases the risk of type 2 diabetes and heart disease. Women who are overweight also tend to experience more troublesome menopausal symptoms.

Many women are concerned that HRT may cause further weight gain but clinical studies have shown that hormonal treatment does not cause weight gain and some studies suggest that it may avoid or reduce the likelihood of weight gain and central fat distribution. This may be a direct effect of oestrogen on metabolism or because it can help sleep, energy and mood which can increase the ability to exercise. However, some women report bloating when first starting HRT which may be due to water retention. This is usually related to the progesterone component and usually settles within a few weeks, but if it persists changing the type, dose or route of administration can help.

A healthy lifestyle will help reduce or avoid the weight gain associated with the menopause and also reduce the risk of heart disease and type 2 diabetes. This includes a healthy balanced diet with adequate protein intake; alcohol is rich in calories so it is advisable to keep this to a minimum. Exercise is particularly important around the time of the menopause it can help weight loss and may further help with some menopausal symptoms such as moods and sleep. Resistance exercise can help reduce the loss muscle mass (sarcopenia) and osteoporosis.

GLP-1 drugs such as Ozempic, Wegovy or Mounjaro are increasingly prescribed for women with significant obesity but are not usually appropriate for the majority of menopausal women who gain weight but who are not defined as obese. Women taking one of these drugs can still take HRT if they need to, but in some cases, they can interfere with absorption of oral hormonal treatment such as the progesterone component of HRT and the dose or route of administration may need to be modified.

The weight gain seen around the time of the menopause is very concerning for many women who are suffering from menopausal symptoms and considering HRT. However, they can be reassured that HRT will not lead to more weight and may in fact help reduce the tendency to put on weight and especially around the waist. A healthy lifestyle is particularly important at this time; it can help with weight, reduce the risk of heart disease, ease menopausal symptoms and improve long-term health. Excess weight also increases the risk of breast cancer and this another benefit of maintaining a healthy lifestyle.