Hormone replacement therapy (HRT) is a treatment for symptoms of menopause, including hot flashes, difficulty sleeping, muscle pain, and vaginal dryness.

While people may gain weight while taking HRT during menopause, there’s little research to support that HRT is the primary cause of weight gain.

Weight gain during and after menopause is more likely due to the hormonal changes that occur when going through menopause.

During menopause, a decrease in estrogen and progesterone, along with aging, can trigger metabolic changes in the body. A person may lose lean tissue (muscles) and bone mass, which can lower their metabolic rate and increase their total fat and abdominal (belly) fat.

Hormonal changes can also decrease:

  • Energy expenditure: This is the amount of energy the body uses to perform functions.
  • Fat oxidation: This is the metabolic process by which the body converts stored fat into energy.

At the same time, changes in diet (such as eating more saturated fat and less protein and fiber) can increase weight gain.

In addition, symptoms of menopause, such as lack of sleep and muscle pain, can decrease energy levels and reduce the amount of daily movement and exercise, also leading to weight gain.

Doctors believe that the benefits of HRT typically outweigh the risks. This is especially true if you’re under 60 and not at high risk of breast cancer or blood clots.

The primary benefit of HRT is that it can relieve most symptoms of menopause, including:

  • hot flashes
  • night sweats
  • urinary urgency
  • difficulty sleeping
  • sudden shifts in mood
  • irritability
  • vaginal dryness

Other benefits of HRT include preventing osteoporosis (by increasing your level of estrogen) and maintaining muscle strength.

The risks of taking HRT are usually low and depend on the type of HRT you take, how long you take it, and any existing health risks you already have.

Potential risks of HRT include:

  • Breast cancer: HRT can slightly increase the risk of breast cancer, depending on the type of HRT you take. If you’re taking estrogen-only HRT, there’s little to no risk. If you’ve already had breast cancer, your doctor will probably advise you against taking HRT.
  • Blood clots: HRT tablets can increase the risk of blood clots. If you’re at risk of blood clots, your doctor will typically advise you to use a patch, spray, or gel form of HRT rather than tablets.
  • Stroke: As with blood clots, HRT tablets can increase the risk of stroke. Using a patch, spray, or gel form of HRT can reduce that risk.

Have a conversation with a doctor if you’re considering HRT and are concerned about weight gain or potential health risks

If you’re going through perimenopause or menopause, talk with a doctor about what you can do to relieve symptoms and whether hormone replacement therapy (HRT) is right for you.

If you’re concerned about weight gain during menopause, exercising regularly, eating a balanced diet, and improving the amount of sleep you’re getting can help you manage your weight and keep you healthy.