For many women, menopause feels like a turning point in how their body manages weight. Clothes fit differently, fat seems to shift towards the midsection, and strategies that once worked don’t always deliver the same results. It’s easy to feel like menopause makes weight loss impossible.

The reality is more nuanced. While menopause does bring real changes to body composition and metabolism, weight loss and weight maintenance are still achievable. One area of growing interest is whether hormone therapy (HT)—prescribed to manage menopausal symptoms such as hot flushes, night sweats, and bone density loss—can also help with weight management.

The research suggests hormone therapy can support fat distribution, metabolic health, and in some cases even enhance weight loss, but it’s not a magic solution. Here’s what the evidence really shows.

---

Body Composition and Menopause

The story isn’t about sudden, dramatic weight gain once periods stop. Instead, it’s about how body composition changes:

• Fat distribution shifts toward the abdomen, with more visceral fat (the type stored around internal organs).
• Lean muscle mass declines, making resistance training and protein intake even more important.
• Energy expenditure drops, partly due to lower estrogen, but also lifestyle changes such as less movement or reduced activity.

This matters because visceral fat is metabolically active. It increases the risk of insulin resistance, type 2 diabetes, and cardiovascular disease—conditions that become more common after menopause.

---

Hormone Therapy and Weight Regulation

Hormone therapy was developed to ease menopausal symptoms, not to manage weight. But research shows it can influence how the body stores fat and uses energy.

Prevention of Fat Gain with Hormone Therapy

One of the strongest findings is that hormone therapy helps prevent abdominal fat gain.

• A large cross-sectional study (Papadakis et al., 2018) found that women currently using HT had lower body mass index and significantly less visceral fat compared with non-users.
• Prospective studies also suggest HT users are less likely to experience the rapid central fat gain often seen during the menopausal transition.

Supporting Fat Loss: What Studies Show

In some cases, HT goes beyond prevention.

• A controlled study by Chmouliovsky et al. (1999) showed women on combined HT lost about 2 kg of fat over three months, while the control group saw no changes.
• The fat loss was linked to increased lipid oxidation (burning more fat for fuel), higher energy expenditure, and improved insulin response.

Hormone Therapy and Weight Loss Medications

Another area of interest is the interaction between HT and newer weight loss medications.

• Hurtado et al. (2024) studied postmenopausal women on semaglutide, a GLP-1 receptor agonist. Women using HT alongside semaglutide lost more weight than those not on HT and were more likely to achieve clinically significant weight loss milestones (≥5% and ≥10% of body weight).

This suggests hormone therapy may make structured interventions—whether medication or behavioural—more effective.

---

Estrogen vs. Combined Therapy

The type of hormone therapy matters.

• Estrogen-only therapy, used in women who have had a hysterectomy, appears most effective for reducing visceral fat and improving fat distribution.
• Combined estrogen and progestin therapy also provides benefits, but some research suggests slightly less effect on body composition than estrogen alone.
• Delivery method makes a difference. Oral estrogen and transdermal estrogen (patches or gels) have different impacts on lipid metabolism and insulin sensitivity. For some women, transdermal therapy may offer a better metabolic profile.

Personalisation is key—there’s no one-size-fits-all answer.

---

Why Hormone Therapy Alone Is Not Enough

Despite the benefits, hormone therapy should not be seen as a “weight loss drug.”

• It does not guarantee weight loss. Many women experience prevention of fat gain rather than large-scale fat reduction.
• It works best with lifestyle strategies. Nutrition, exercise, and behavioural habits remain the foundation of successful weight management in menopause.
• It is not suitable for everyone. The decision to start HT should be based on a full health evaluation, weighing the benefits against potential risks. Current guidelines suggest it is most beneficial when started before age 60 or within 10 years of menopause.

---

The Lifestyle Foundation for Weight Management

Research is clear: lifestyle change remains the cornerstone of managing weight during and after menopause. Hormone therapy can provide support, but it does not replace the basics.

• Resistance training is essential. With lean muscle naturally declining, lifting weights or using resistance exercises helps preserve muscle, maintain metabolic rate, and improve body shape.
• Protein intake matters. A higher-protein diet supports muscle retention and keeps you fuller for longer.
• Cardiovascular activity supports health. Walking, cycling, swimming, or other aerobic exercise improves heart health and helps with calorie balance.
• Sleep and stress management are often overlooked. Both play a big role in appetite regulation, fat storage, and overall energy.

For women using hormone therapy, these lifestyle habits make HT more effective. For women who cannot or choose not to use HT, these habits are even more important.

---

Risks, Timing, and Suitability of Hormone Therapy

Hormone therapy is not right for everyone, and medical supervision is essential.

• Best timing: The benefits are greatest if HT is started within 10 years of menopause onset or before age 60.
• Individual factors matter: Family history, cardiovascular risk, and personal medical background must be considered.
• Different options exist: From oral tablets to patches, gels, or vaginal forms, delivery methods can be tailored to minimise risks and maximise benefits.

This is why a personalised conversation with a healthcare professional is essential before starting HT.

---

Take-Home Message

Menopause does change body composition. Muscle mass declines, fat shifts towards the abdomen, and metabolic health risks increase. But weight loss after menopause is not only possible—it is achievable.

Hormone therapy can:

• Help prevent abdominal fat accumulation
• Support modest fat loss in some women
• Improve the effects of weight loss medications when used together

But it is not a standalone solution. Strength training, balanced nutrition, regular activity, and sustainable lifestyle habits remain the foundation of weight management in midlife.

Think of hormone therapy as a supportive tool, not the whole toolbox. For some women, it may provide a meaningful advantage, but lasting results still come from daily choices that support strength, health, and confidence through menopause and beyond.

---

If you’d like more evidence-based insights on menopause, weight loss, fitness, and nutrition, follow me on Instagram: @sarahcurranfitpro.