Does HRT Help with Weight Loss? Here’s What the Science Says

For many women, midlife weight gain seems inevitable. Even those who maintain the same diet and exercise routine often find their bodies change in ways they didn’t expect. Willpower isn’t the issue—it’s biology. Hormones like estrogen, progesterone, and testosterone help regulate metabolism, body fat distribution, and appetite. When these hormones fluctuate and eventually decline during the menopause transition, fat storage shifts to the abdomen, metabolism slows, and insulin resistance increases ¹.

Hormone replacement therapy (HRT, also called menopause hormone treatment or MHT) isn’t prescribed as a weight loss treatment, but experts say rebalancing your hormones can remove some of the biggest barriers to weight loss.

About the Experts

Deb Matthew, M.D., is a board-certified integrative medicine physician and author of This Is Not Normal: A Busy Woman’s Guide to Symptoms of Hormone Imbalance.

Jennifer Roelands, M.D., is a board-certified OB-GYN and integrative medicine physician.

Heather Swain, D.P.T., is a doctor of physical therapy and certified personal trainer.

Tara Scott, M.D., is a board-certified OB-GYN functional and integrative medicine physician and menopausal specialist.

Does HRT Help with Weight Loss?

HRT can help women in menopause lose weight by stabilizing metabolism, regulating appetite hormones, and alleviating perimenopause symptoms that can contribute to weight gain.

During perimenopause, estrogen and progesterone—which influence how the body burns energy, regulates hunger, distributes fat, and responds to insulin—decline. Research suggests that hormone replacement therapy (HRT) may support weight loss in menopausal women by stabilizing metabolism, reducing fat accumulation, and improving body composition—specifically by redistributing fat away from the abdomen, where it tends to accumulate during menopause. HRT may also enhance the body’s ability to process glucose. ²

HRT also reduces perimenopause symptoms—like poor sleep, chronic stress, and hot flashes—that make weight management harder. ³ “It’s not that HRT makes you lose weight,” says Deb Matthew, M.D., a board-certified integrative-medicine physician specializing in hormonal imbalances. “However, it makes your weight-loss efforts more effective and helps prevent weight gain.”

Research also suggests HRT influences cortisol, leptin, and ghrelin—hormones that affect metabolism, fat storage, and appetite regulation.

Improves metabolism

HRT can help improve metabolism in women going through perimenopause or menopause by stabilizing estrogen and progesterone levels.

“Our hormones fluctuate wildly in the years leading up to menopause, affecting whether we burn or store fat,” says integrative physician Deb Matthew, M.D.

Estrogen helps preserve lean muscle mass, which is metabolically more active than fat. ⁴ It also plays a key role in fat and glucose metabolism.

As estrogen levels decline, the body metabolizes glucose and fat differently than during childbearing years. With fewer estrogen receptors available to break down fat and sugar, the body becomes less efficient at converting food into energy, leading to increased fat storage and a slower metabolism. ⁵

At the same time, progesterone influences how efficiently the body uses carbohydrates for energy. When levels drop, blood sugar fluctuations and insulin resistance can make fat storage even more likely. By stabilizing hormone levels, HRT helps your cells break down fat more efficiently, which can potentially lead to weight loss, Matthews says.

Women on HRT also often report feeling more energetic and motivated to exercise and eat well, says OB-GYN and integrative medicine physician Jennifer Roelands, M.D. “Many women say, ‘I feel like myself again. I can finally work on these things without feeling too frustrated or exhausted.’”

Reduces appetite

HRT regulates key appetite hormones like ghrelin (which signals hunger) and leptin (which signals fullness). Research suggests estrogen HRT may restore leptin levels and lower ghrelin. ⁶

However, it’s not just about changing leptin levels—it’s about reversing leptin resistance. Normally, rising leptin levels signal your brain that you’re full, helping maintain your body’s natural “set point” weight. But menopause can trigger leptin resistance, meaning your brain no longer responds properly to these signals, leaving you hungrier despite higher leptin levels. ⁷

Estrogen helps regulate appetite by binding to receptors in the hypothalamus, the area of the brain responsible for controlling hunger and fullness, says Mathews. As estrogen and progesterone decline, those signals become disrupted, leading to cravings for sugar and refined carbohydrates. ^{8 9}

Testosterone levels can also increase during menopause, further driving appetite. ¹⁰ The introduction of estrogen and progesterone through HRT rebalances testosterone and regulates appetite signals.

Reduces belly fat

HRT might reduce belly fat during perimenopause by influencing fat distribution. Before menopause, women tend to store fat in their hips, thighs, and buttocks. “Estrogen is the hormone that gives us a waist,” Matthew says. “It gives us kind of that hourglass figure.” As levels of the hormone decline, fat accumulation shifts to the abdomen—even if the number on the scale doesn’t move much.

When estrogen declines in perimenopause, the amount of free testosterone increases and takes over fat storage—favoring the belly.

HRT may help slow or reverse hormone fluctuations that lead to menopause belly. One study found that estrogen in HRT increases lipid oxidation (fat breakdown) and improves insulin response, helping to reduce belly fat. ^{11 12} According to a systematic review published in 2014, while women’s total body weight remained stable on HRT, their waist-to-hip ratio decreased, indicating a slimmer middle section. ¹³

Vanity aside, belly fat—also known as visceral fat—is dangerous because it wraps around organs and increases the risk of diabetes, heart attack, and stroke, even if you’re at an overall “healthy” BMI. ¹³

Improves insulin sensitivity

According to a 2021 American Journal of Pathology study, HRT may improve insulin sensitivity in perimenopausal women and make it easier for the body to burn fat for weight loss.

Think of estrogen as the body’s insulin manager—it determines whether glucose is used for energy or stored as fat. When estrogen drops during menopause, your body compensates by producing more insulin to manage blood sugar, Matthews says. “And insulin is the fat-storing hormone; when it increases, people tend to store fat around our middle,” she says.

On top of that, lower estrogen levels also mean higher uric acid, which independently disrupts insulin sensitivity. Elevated uric acid nudges your body into converting glucose into fructose—a process that encourages fat storage, especially around your midsection, and raises the risk of fatty liver and hypertension.

The good news? Research suggests HRT can help lower uric acid levels, improving insulin sensitivity and your overall metabolic health. ^{14 15}

HRT also supports muscle mass, creating more storage space for glucose. Muscles are far more effective at handling excess sugar compared to the liver or other tissues, which further enhances insulin sensitivity and metabolic function.

Increasing estrogen levels through HRT can make the body more responsive to insulin, allowing it to store less fat, according to research in PLoS ONE. ¹⁶

Improves mood

Estrogen, progesterone, and testosterone shifts in perimenopause can throw your mood into chaos, thanks to their influence on serotonin, dopamine, and cortisol. ¹⁷

Perimenopause symptoms like irritability, anxiety, depression, brain fog, and mood swings aren’t just mentally challenging—they can also sabotage weight loss. For many women, HRT helps even out mood fluctuations, making it easier to stick to healthy habits.

Estrogen acts like a natural antidepressant, progesterone is like a natural anti-anxiety, and testosterone is a mood stabilizer. ^{18 19}

Improves sleep

HRT can reduce night sweats, hot flashes, and other symptoms of menopause insomnia. Progesterone has calming, sedative-like effects that help you fall asleep, says Scott, while estrogen helps regulate melatonin and body temperature to keep you asleep. ²⁰

When the body doesn’t get enough sleep, levels of the stress hormone cortisol remain elevated. Too much cortisol negatively impacts your hunger, appetite, fat storage, and metabolism, causing you to gain weight. ²¹ Elevated cortisol levels also prevent the body from entering deep sleep, creating a feedback loop.

Restless sleep from elevated cortisol levels can disrupt the production of ghrelin and leptin, hormones that regulate hunger. ²² Ghrelin, which signals hunger, increases, while leptin, which signals fullness, decreases.

The result? You eat more—and research shows sleep deprivation makes you more likely to crave high-calorie, carb-heavy comfort foods. ²³ One 2103 study in Nature Communications suggests this is because the brain needs more energy to function after a stormy night of sleep. As a result, the parts of the brain (the hypothalamus and amygdala) that control hunger and satiety crave more high-calorie (think quick-energy) food.

HRT supports these sleep challenges in perimenopause and, therefore, might support menopause weight loss by preventing an impulse late-night pizza delivery.

Does HRT Cause Weight Gain?

Some women initially gain a small amount of weight when starting HRT, often due to temporary water retention. However, Roelands says weight typically stabilizes within a few months.

While estrogen can indirectly help with weight loss, a higher dose isn’t necessarily better. “Hormones exist in a bell curve, in the sense that low and high levels of hormones can have the same symptoms,” says Tara Scott, M.D., an OB-GYN specializing in menopause. “Too much estrogen can cause weight gain, but so can too little estrogen.”

The Best HRT To Support Weight Loss

No single type of HRT works best for weight loss. ^{24 25} The best option depends on age, symptoms, and medical history, says Roelands. Your provider may recommend a combination of:

• Estrogen (Estradiol & Estriol): Helps regulate metabolism, insulin sensitivity, and appetite.
• Progesterone: Supports sleep, mood, and blood sugar stability.
• Testosterone: Helps preserve muscle mass and energy levels.
• DHEA: Supports estrogen and testosterone production.

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Progesterone

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HRT comes in a variety of forms and types: oral pills, transdermal patches, pellets, creams, gels, sprays, suppositories, and injections.

A few small studies have indicated that oral estrogen increases ghrelin, while estrogen delivered through a transdermal patch could lower it. ²⁶ Researchers believe that patch allows hormones to enter the bloodstream faster, avoiding the liver, which can alter the metabolic pathway because it causes ghrelin to increase.

HRT Alternatives for Weight Loss

While HRT can help with weight loss in menopause, it’s not a magic bullet. Smart lifestyle tweaks can significantly support weight management:

• Prioritize lean protein to maintain muscle mass.
• Limit sugar and refined carbs to reduce insulin resistance
• Incorporate strength training several days a week to boost metabolism, improve insulin resistance and burn more fat, particularly belly fat.
• Weight loss medications like GLP-1s can reduce appetite and support a healthy lifestyle.