As blogged previously,  the hormone changes that happen during and after the menopausal transition favor weight gain.  What can we do to put the brakes on weight gain during perimenopause, or help with weight loss?

While lifestyle changes alone don’t result in weight loss for most people, it’s important to integrate healthy lifestyles into any strategy. Eating well is always important.  Increasing physical activity can help to preserve muscle and prevent some of the muscle loss that otherwise naturally happens during and after the menopausal transition (as blogged previously).

From the psychological pillar of weight management come many important strategies.   Mindful eating is important – focusing on what you are eating for the most possible enjoyment, stopping when you are feeling full, and recognizing that unfortunately, smaller portion sizes will be needed to fit the slowing of metabolism and change in hormonal milieu. Good sleep hygiene is super important, to do your very best to have good sleeps in the midst of loss of progesterone and possibly hot flashes working against you. Improving hot flashes disruptive to sleep may be helpful, which may require hormonal or other medication options. Some women struggle with emotional eating during and after the menopausal transition – let’s face it, it’s an emotional time for many of us – and cravings may present additional struggles as well.

I am often asked whether hormone replacement therapy (estrogen, and progesterone for uterine protection for women who have a uterus) can help with weight management during or after the menopausal transition.  HRT can help to manage hot flashes and thereby perhaps improve sleep, and good sleep is an important part of weight management (note, there are non-hormonal medications that can improve hot flashes as well, and weight loss can reduce hot flashes too). However, HRT does not result in weight loss, and should not be used as a weight loss strategy.   

We also don’t have convincing evidence that HRT helps to maintain a favorable body composition (more muscle, less fat).  Studies are conflicting as to whether or not HRT has an effect on fat distribution (visceral vs subcutaneous fat).  The timing of HRT may be important here, with at least some data suggesting that there may be less central fat deposition in women who received HRT immediately after menopause.  

Can HRT prevent weight gain?  Some studies have suggested that there may be a little less weight gain in women using HRT, but the effect is very small, about 1-2lb (0.5-1kg).  And remember, HRT comes with its potential risks as well.

And of course, we have weight management medication as an option to help women struggling with weight management in/after the menopausal transition. We don’t have any studies on whether weight management medication can be used to prevent weight gain in menopause, and I think that’s an important avenue that needs to be explored.    Bariatric surgery may be an appropriate treatment option for some women with obesity as well.

Share this blog post using your favorite social media link below!

Follow me on X/twitter! @drsuepedersen

www.drsue.ca © 2025