When women consider hormone replacement, one of the factors they need to consider is the potential for weight gain. Weight gain can result from low levels (not doing hormone replacement) as well as high doses of hormones. If replacement is not done with knowledge of this possibility and how to avoid it, there is a pretty good chance the woman will add 10 or more pounds within a short time.
Before we dig into the details, let’s look at the main classes of hormones in women: Estrogen, Progesterone, and Testosterone. We will discover that it is not the hormones themselves which cause weight gain, but an imbalance between the hormones (too high or too low).
Estrogens affect weight by several mechanisms including improvement of insulin sensitivity and increasing the metabolic rate (at normal levels). So if estrogen is too low, weight gain could occur by those mechanisms. And if estrogen is out of balance with other hormones (usually too high with low or normal progesterone), the result is frequently weight gain around the abdomen, hips and thighs. Other signs of an imbalance of estrogen related to weight gain are: depression, abdominal bloating, fatigue, and water retention. Depression and fatigue usually lead to weight gain due to over-eating.
Progesterone is involved in weight by several mechanisms also. At normal levels, it helps the body use and eliminate fat, increases metabolism, and increases the effect of thyroid hormones. An excess of progesterone can lead to increased appetite (particularly carbohydrate cravings) and fat storage. It is also associated with increased insulin production and resistance, and to high cortisol levels.
Testosterone, though commonly thought of as a male hormone, is also very active in the female body. It increases metabolism, both directly and by increasing lean muscle mass. And indirectly it can help control weight by easing depression and increasing the sense of well-being. Because of those last 2 effects, a person is more likely to embrace an active lifestyle, leading to better weight control.
There are multiple female conditions associated with weight gain which are hormone related, but we will focus on PMS (Pre-Menstrual Syndrome), PCOS (Polycystic Ovary Syndrome), and Peri-menopause/Menopause. We will explore the different ways the hormones contribute to the condition and to weight gain.
PMS is quite common, affecting up to 75 percent of menstruating women in the U.S. to at least some degree. While there are dozens of symptoms attributed to PMS, bloating, carbohydrate/sugar and salt cravings, and other appetite changes are directly involved in weight gain. Indirect factors which can affect weight include additional stress raising cortisol levels and thus appetite and avoiding your exercise routine since you don’t feel good.
To avoid weight gain during PMS, there are several techniques shown to be effective. Dietary changes, including smaller meals more frequently and reducing salty snacks can help. Avoidance of caffeine and alcohol along with drinking more water is helpful. Regular exercise and relaxation techniques can improve symptoms. There are many supplements which can help symptoms, including multivitamins, omega-3 fatty acid sources and more. If symptoms are severe enough, progesterone can help balance the excess estrogen and resolve those symptoms.
Another common female condition associated with weight gain is PCOS. The incidence is as much as 1 woman out of 15. This condition occurs when ovaries do not produce the proper balance of hormones to cause the eggs to mature. The primary problem is excess production of testosterone. Symptoms vary, but commonly include infertility, irregular or absent menstrual cycles, and excess weight. Many women develop diabetes and/or obesity. The excess weight can be the result of insulin resistance causing excess glucose to be converted to fat and stored by the body. Additional weight gain factors include the excess cortisol production from the stresses caused by the condition and reduced ability to make the brain chemical serotonin. Serotonin can be helpful in reducing food cravings. There is no cure for PCOS, but there are ways to manage many of the symptoms. Diabetes medications can help regulate insulin and blood sugar levels. Certain nutritional supplements are also helpful, but as always should be taken on the advice of a health care professional.
The last condition we will look at is Perimenopause and Menopause. Perimenopause is the time between fully functioning menstrual cycles and 1 year past the last menstrual cycle. It is a time of sometimes wildly fluctuating hormones, and it is known that fluctuating estrogen and progesterone alone can cause an increase in the appetite. While symptoms of this condition like hot flashes and night sweats are well known, weight gain is also common. There are multiple factors but we know that before menopause the primary source of estrogen is the ovaries but after menopause the primary source (at much lower levels) is fat cells. So the body works harder to convert calories into fat, which lowers the metabolic rate and thus accumulates even more fat. At the same time, lower levels of progesterone increase water retention and bloating. And for many women testosterone levels (which help burn calories and create more lean muscle mass) decline, causing more weight gain. If the woman also has stress issues (higher cortisol) this can add even more weight gain.
Of course hormones are not the only factors in weight control, (start with over-eating) but as we see they can be a big reason for weight creeping up as we age. Too low levels and too high levels of the hormones can contribute to weight gain. The main point is to get the right amount of hormone into the body in the right balance, which will give the body a chance to respond normally to these challenges and maintain a healthy weight.