Female patients may benefit from estrogen therapy to treat menopausal symptoms that could interfere with their quality of life. Although the issue of weight is inconclusive, it’s still a good idea to discuss the overall modality with patients.

“We do not have enough information yet to use a woman’s weight to decide if they might benefit from hormone replacement therapy for this condition,” said Jonathan Q. Purnell, MD, professor of medicine, Division of Cardiovascular Medicine, Oregon Health & Science University School of Medicine in Portland, Oregon.

Instead, he said, doctors still use traditional indications in women experiencing the menopausal transition, such as hot flashes, night sweats, and mood disruptions. Purnell said that patients who have a history of or are at high risk for blood clotting and hormone-responsive breast cancer should not use estrogen therapy.

Explaining How Menopause Can Cause Weight Change

Women experience several hormonal transitions in their lives that can alter what clinicians refer to as the body weight “set point,” or the weight that the brain perceives as normal and defends in the face of changes in lifestyle and dieting, said Purnell. These states include puberty, pregnancy, and menopause.

“During the menopausal transition, affecting approximately 20%-30% of women by current estimates, both an increase in weight and accelerated central distribution can occur,” he said. “The cause or causes of this remain unknown but are obviously linked to the dramatic drop in estrogen. This is a current focus of research in humans.”

Replacement studies in women after menopause reveal small improvements in waist circumference measurements compared to women assigned a placebo, but the results don’t indicate meaningful changes in total body weight, Purnell cited. “Additional studies of initiating hormone replacement therapy earlier, such as in the perimenopausal transition, are needed,” he said.

Does Hormone Replacement Therapy (HRT) Help Reduce Belly Fat?

Research has shown that HRT can help reduce abdominal fat accumulation in postmenopausal women.

“HRT is associated with lower visceral and total fat mass, reduced waist circumference, and a smaller increase in abdominal adiposity compared to nonusers or placebo,” said Amber Naresh, MD, associate professor at Tulane University School of Medicine in New Orleans.

Naresh said that research confirms a reduction in abdominal fat of approximately 6%-7% with HRT use. However, these benefits are not sustained after discontinuation of therapy.

HRT is generally not viewed as a treatment for obesity or to help promote weight loss, said Naresh, but HRT can mitigate the effects of menopause on body composition and abdominal fat distribution. It can also help reduce menopause-associated weight gain, but starting HRT typically does not result in significant weight loss.

Can Estrogen Help Regulate Appetite?

Preclinical research studies have shown that estrogen can help regulate and inhibit appetite. However, clinical studies show that HRT’s impact on body composition is primarily due to direct metabolic effects rather than significant changes in appetite or eating behavior, said Naresh.

Can Estrogen Affect Metabolism?

Research shows that estrogen administration, such as through HRT, can increase resting energy expenditure by up to 200-220 kcal/day, which may help prevent weight gain and obesity in postmenopausal women, Naresh said.

HRT is available in estrogen-only treatments for individuals without a uterus and combined estrogen-progestogen regimens for those with an intact uterus.

“These can be administered as oral tablets, transdermal patches, gels, sprays, lotions, vaginal preparations, and combination pills or patches,” said Naresh.

Both oral and transdermal HRT regimens modestly reduce central fat accumulation and do not cause additional weight gain compared to placebo or nonusers, she said. “Benefits do not differ by route of administration. The main benefit of HRT is prevention of menopause-related central fat redistribution, not weight loss,” she added.

Disclosures:

Purnell is an advisory board member for Novo Nordisk, Boehringer-Ingelheim, and Zealand Pharmaceuticals. He is also a clinical trialist for Novartis and Amgen. Naresh reported receiving a research grant from Merck Pharmaceuticals.