82. Why You Might Gain Weight on HRT & What to Do About It
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Many women start hormone therapy expecting relief from hot flashes, brain fog, and mood swings – only to be frustrated when the scale starts creeping up. While providers often dismiss it, weight gain on HRT is a real experience for many. In this episode, Claudia explains why it happens, which hormones play a role, and what you can do to support your metabolism in midlife.
What you’ll learn in this episode:
- How progesterone can sometimes trigger water retention (even though it’s a diuretic)
- Why estrogen balance matters for fat distribution, insulin sensitivity, and fluid shifts
- The risks of too much testosterone and how it impacts weight and symptoms
- The natural metabolic changes over 40 that make weight management harder
- Key nutrition strategies: prioritizing lean protein, fiber, and smart carbs while watching hidden calories from fats
- The importance of gut health, daily detox, and pooping regularly for hormone balance
Links Mentioned
Ep. 67: Understanding Cortisol After 40: Why You Need It, Why It Becomes Imbalanced & What To Do About It
Ep. 78: Undereating After 40: The #1 Habit Wrecking Your Hormones & Metabolism
Progesterone Therapy & Thyroid Function
Optimizing Adult Protein Intake
Do Hormones Really Cause Weight Gain? The Truth About HRT and Midlife Metabolism
If you’ve ever been told, ‘Hormones don’t cause weight gain,’ yet you experienced weight gain after starting HRT—you’re not imaging it and I get just as frustrated when I hear hormone experts, especially online saying this. It’s very dismissive, not to mention that some of the women who say it never had weight struggles.
So today, I want to share how different hormones can influence weight, what’s really happening, and most importantly, what you can do to support your body so you feel your best.
Progesterone and Weight Gain
Let’s start with progesterone. Technically, progesterone is a diuretic—it helps your body excrete sodium and water. That’s why in theory, it shouldn’t cause weight gain..
But many women do notice water retention when they first start it. It’s almost like being pregnant, when progesterone is at its highest.
Hormones influence your fluid balance. So your body has to go through an adjustment period, and that can look like puffiness or a couple extra pounds on the scale.
It’s usually not fat gain—it’s more fluid. But it can feel discouraging if you’re not expecting it.
Estrogen and Fat Storage
Next is estrogen, a key player in metabolism, insulin sensitivity, and fat storage.
If estrogen is too low? We often see central weight gain, more belly fat, higher cholesterol markers in labs, and insulin resistance. This is why when women are on progesterone only and their provider refuses to give estrogen, I strongly encourage them to advocate for it.
Now if you’re on estrogen HRT and it’s too high a dose or you don’t have enough progesterone to balance it out, it can lead to water retention and fat storage, especially around hips and thighs.
That’s why the dose and delivery method really matter. With HRT, the same way the lowest dose is not necessarily better, more is also not always better—it’s really about finding your sweet spot. And this does take time and fine-tuning with your provider.
Testosterone and Belly Fat
Now, let’s talk about testosterone. For some women, it can help with energy, libido, and muscle strength.
But if the dose is too high, you can see the opposite: increased visceral fat, fluid retention, acne, hair growth, irritability. That’s why some experts (many of my mentors) are against pellets and even injections – though injections can be wonderful for some women, when dosed appropriately. With pellets, once they are inserted, the dose cannot be adjusted and women’s levels often go really high.
IMO, in women, testosterone should be replaced at physiological doses, not men’s levels. I’m sure some providers may argue that viewpoint. But if you’re gaining belly fat, feel edgy, aggressive, maybe your voice is getting deeper, or your libido uncontrollable since starting testosterone, it’s important to check your levels and dosage.
Midlife Metabolism Shifts
Now, when it comes to midlife metabolism…in your 40s and above, your metabolism starts to change. Certain things start to shift like…
- Muscle mass starts to decline, which lowers your calorie burn. It’s why strength training is especially important as we age to ensure we hold onto that muscle as long as possible.
- Cortisol often runs higher or becomes more dysregulated, which can promote excess weight or make it harder to lose.
- And insulin resistance becomes more common—even if you eat ‘healthy.’ This is why I go on an on about eating ample lean protein, fiber and eating enough to keep blood sugar balanced. Listen to the episode I did a few weeks back on the consequences of Undereating as a woman Over 40 – I’ll link to it in the show notes.
- Many women also tend to move less because they’re exhausted from not sleeping well or just not motivated, after years of overdoing, overfunctioning coupled with declining hormones.
So if you’re on HRT and gaining weight, it could be a mix of the hormone therapy needing to be adjusted and these natural metabolic shifts.
Don’t Forget Your Thyroid
The other thing to consider and talk to your provider about is your thyroid. So many women do not get tested properly for thyroid function. As we age, our thyroid function becomes more compromised and when you start HRT, especially estrogen therapy, your thyroid can be affected. So it’s really important that your provider also assesses your thyroid as you optimize your HRT regimen.
In a perfect world and if I made the rules, I would have all women assess their thyroid health first, before going on any HRT. Then, I’d have all women start on progesterone therapy because it supports thyroid health, and then if after a few months of optimizing those, the woman has symptoms of low estrogen, that would be the time to add it. Then once that’s optimized, a conversation about testosterone should happen. That’s how I learned how to do HRT, that’s how I did it personally. I did not gain weight when starting HRT b/c I had the right thyroid support in place as well as all the other things I mentioned.
What to Do If You’ve Gained Weight on HRT
So besides adjusting your regimen with your provider, what can you do if you’ve started to gain weight?
- Move your body: Daily walking plus 2–3 days of strength training protects lean muscle and supports your metabolism; I’m not huge on tracking a million things, but so many women think they’re moving enough but they’re not even getting 5k steps per day. You want to aim for 5-7k or more. An Oura ring is pricey, there’s another ring I’m checking out and will link to it in the show notes that’s way more affordable and you can even use an old school pedometer. I actually bought one for Mike recently because he had no idea he was getting so few steps per day. It’s become a fun game for us – every night, we check in with each other to see how many steps we each did that day.
- Eat your protein: I know, you’re so sick of hearing this. But there’s a reason for it. Most women under-eat protein. Aim for 100–120 grams per day to support muscle and satiety. Typically you’re going to want .75-1 g per ideal pound of body weight in grams of protein per day.
- Eat your fiber & smart carbs: Think beans, lentils, all varieties of vegetables, a variety of fruits (mostly low glycemic high fiber like berries) – these help balance blood sugar and keep you full. Also consider leftover cooled potatoes as they are less starchy or a small amount of rice or oats. Like ¼ cup alongside protein + fat.
- Fats: healthy fats like raw nuts, seeds, olives, avocados, even nut butters (without added sugar or oils) can be really nutritious – but also very calorie-dense, and they add up fast. So watch out for the healthy fat trap. Especially if you’re someone who follows a more plant-based diet, avoiding animal proteins. Many women rely on nuts and seeds for protein but you have to eat a lot to get the required protein your body needs and that will really increase your fat intake and thus your calories.
- Gut health & detox: Hormones are metabolized in the gut and liver. If you’re constipated or bloated, that’s a problem. Aim to poop daily, hydrate well, sweat, and support your liver with real food and the right nutrients for you.This is why we use an HTMA test and functional blood work to assess what your body needs.
Lastly, there are some supplements that can help — I wouldn’t say these will directly cause weight loss, but they support detoxification and blood sugar balance such as magnesium, inositol, or berberine, depending on your needs.
The Bottom Line
So the bottom line is: HRT can be life-changing when dosed properly and combined with the right nutrition and lifestyle support.
If you’ve noticed weight gain after starting hormones, it doesn’t mean hormones don’t work for you or you’re resistant to them. I believe it’s your body’s way of saying it needs adjustments—whether that’s dose changes, nutrition tweaks, or better support for metabolism and gut health.
And remember—you don’t have to choose between feeling better hormonally and struggling with your weight. With the right plan, you can have both. But please know it does take patience and time, so give yourself and your changing body some grace.
Thanks for listening. If this episode resonated with you, share it with someone who’s also navigating midlife. And don’t forget to subscribe to the show whether you listen on Apple, Spotify or watch on Youtube – so you never miss an episode. See you next week.
Claudia Petrilli is a Functional Health Coach, Integrative Nutrition Coach, Women’s Health Educator, and creator of The Perimenopause Method program. Having experienced debilitating periods, digestive issues, a sluggish thyroid, a pituitary tumor, and perimenopause symptoms in her late 30s, she knows exactly what it’s like to get dismissed by doctors and spend years searching for answers.
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FREE RESOURCES:
Mini Training: Why You’re Exhausted, Moody & Inflamed – And Why It’s Not Just Your Hormones
Peri-What?! The Must-Have Guide for Women 40+ Navigating Hormone Changes
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