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One of the most common questions my patients ask me is about HRT & weight gain, about starting hormone replacement therapy is: Will it make me put on weight?

The answer is ‘No’, not as a direct result of being on HRT. It is not a question of starting HRT and then, as a direct side effect, starting to put on weight.

Hormones, whether produced by our own body or those that are replaced, have the potential to stimulate our appetite centre. If you already watch what you eat and maintain a healthy, active routine, your weight should not shift upwards.

Women naturally gain fat around their middles during the menopause. Often referred to derogatively as ‘belly fat’. This is the result of two different naturally occurring processes. First, whether you are on an HRT plan or not, the stress of hormonal changes that occur as we grow older lead to visceral fat.

Stress can be from anything, be that smoking, work-related stress, relationship issues, money worries or hormonal changes. It automatically increases the production of cortisol from our adrenal glands. Unfortunately, cortisol, encourages the body to deposit more fat on our bellies and tops of shoulders. This is because the fat cells in these areas have four times more receptors that are sensitive to cortisol.

A fat redistribution may be noted where the tummy feels fatter than our buttocks and legs.  Also, muscle tone and strength start to weaken as we grow older and this pushes our visceral fat forward.

So, when we look in the mirror and all we see is a big stomach, possibly shrunken buttocks and skinny legs, we need to take a step back and understand what is going on. If we choose, we can work to improve things involving diet and exercise with or without hormone therapy. The latter does make it easier for the other two to work.

However, from the peri-menopause onwards, our metabolic rate will naturally slow down, largely due to the reducing amount of the hormone progesterone available. Our thyroid gland, which regulates body temperature and metabolism is supported by progesterone, so, unless this hormone can be supplied in another way, such as hormone replacement therapy, a slower metabolic rate and weight gain can result.

Although committing to a regime of abdominal exercises, including sit ups and stomach crunches, can help improve our ‘abs’, it may not, however, help reduce visceral fat. If we don’t do something about our visceral fat we could expose ourselves to other health issues, such as increased risk of heart disease, stroke, Type II diabetes and asthma.

Ways to reduce visceral fat in addition to exercise are to reduce our intake of alcohol and processed foods. Excess calories from alcohol are stored as fat. Alcohol itself actually slows down fat burning and metabolism. Processed foods contain trans fats, which are fats that have had hydrogen added to them to increase the shelf life of the product. Thirty minutes of moderate exercise per day can speed up our metabolic rate, which helps to burn that visceral fat.

It is important to maintain a daily exercise regime, but it is critical to include aerobic exercise and strength training. Yoga and pilates are very good, low impact ways to focus on muscle tone, particularly our core. They also help to improve balance and reduce stress. Cycling, walking, swimming and exercise classes can all improve our aerobic capacity and strengthen muscles and maintain flexibility. The more lean muscle we have the more calories we will burn at rest.

Some of the symptoms of the menopause are known to be unhelpful if we are concerned about whether or not we are gaining weight. For many women, night sweats, the need to urinate or an overactive mind causing restlessness all have a detrimental impact on how well we sleep at night. Lack of sleep, or poor quality sleep, have been linked to weight gain. If we can improve these symptoms through hormone replacement therapy and our quality of sleep improves this type of weight gain will become less of an issue. One can have the mental energy to focus on positive lifestyle changes.

But there are some simple ways we can change our lifestyles to suit this stage of our lives. We need about 200 fewer calories a day than we did in our thirties and forties. Evidence points to a diet that comprises healthy fats, is low in carbohydrates and allows the body periods of rest from food i.e. fasting. For example, pure or virgin coconut oil can be used to fry with, or include in a smoothie – it can help to reduce visceral fat.  Phytoestrogens mimic the effects of oestrogen in the body: edamame beans, linseeds, sesame seeds, broccoli, cauliflower and cabbage all contain phytoestrogens. It is therefore useful for those women who are low on their estrogen to include these foods in their diets.

In essence, HRT prescribed appropriately should not lead to cause and effect style weight gain. This is the time of our life where our body is going through a change and its needs and requirements are changing. We therefore have to work with it and give it nutrients and support that will make it works to its best potential.