Does estrogen cause weight gain?

You’re not alone if at some point near your 50th birthday you encounter that moment while trying on pants in the fitting room that you say to yourself: “Either they are making waistlines much smaller, or somehow mine is bigger.” And then you reluctantly accept the fact that your figure has changed and that you have become much fuller around the middle. It’s not a coincidence that this generally happens right around the time of menopause. So, what gives?

Women tend to gain approximately one and a half pounds per year after the age of 50 – and this has been attributed to a number of things – such as being less active, or changes in diet (perhaps eating out more?). Some women shy away from hormone replacement therapy because they think it will make them gain weight. Does it? No. Estrogen has not been shown to increase weight. In fact it is possible that the loss of estrogen actually contributes to our midlife weight increase. While studies haven’t agreed on this, one thing that is clear is that estrogen plays a major role in directing where our fat accumulates. When we lose our hormones at the time of menopause we start piling on abdominal fat cells. These are the ones that not only form the bulging around our middle, but actually show up inside our abdomen in and around our organs. Besides being cosmetically undesirable, this central fat is associated with a number of adverse health effects. While we tend to think of fat cells as inert storage containers, they actually play an active role in our metabolism and energy expenditure. The central fat cells, in particular, produce hormones that affect how we handle blood sugar which can lead to a condition called insulin resistance – which is a forerunner of diabetes. They also contribute to the development of another condition called the metabolic syndrome. The hallmarks of this disorder are high cholesterol and triglyceride levels and an increased risk of a future heart attack. This is why you may have heard that women with an “apple shape” (more prominent tummy) have higher health risks than women with a “pear shape” (slimmer waist but larger bottoms). And it is also why many employer health screening program questionnaires have a box where you need to enter your waist circumference along with your height and weight and blood pressure. All of these numbers are used to assess your cardiovascular risk.

So beside giving up desserts and exercising like crazy, what can be done to prevent this accumulation of belly fat? Since estrogen plays a major role in preventing the deposition of central fat – taking estrogen after menopause has been shown to retard it. This has been confirmed by a number of studies. In addition, this may also explain why women who take HRT at the time of menopause have lower rates of the metabolic syndrome as well as diabetes. Both oral and transdermal estrogen appear to be beneficial – but the addition of a synthetic progestin may diminish the effects. Natural progesterone appears to have a neutral effect, but has not been studied extensively.

After reading this, you may be a little skeptical, because you may have heard that HRT is not good for your heart. The negative press on hormones’ effects on the heart came from the WHI study, which did show a slight increase in heart disease in women treated with HRT. However the majority of the women in this study were older than 60 when hormone therapy was initiated, and many had other risk factors for heart disease such as hypertension. But even in these older women, those taking HRT had lower rates of diabetes then women taking a placebo pill, and gained less weight!

So the overall message in this blog is that estrogen therapy does not cause weight gain, and in fact appears to help prevent one of the more serious consequences of weight gain, which is diabetes. A number of studies have confirmed this finding. It is amazing to me that diabetes is such a big problem in the world today, and yet you never hear that hormones have been shown to be a preventative therapy. Women don’t seem to be getting the whole story on the benefits and risks of HRT and that is the main goal of this website.