The short version
- Hormone therapy is the most effective treatment for hot flashes, night sweats and vaginal symptoms, and it prevents bone loss.
- The position statement does not list weight loss among its uses.
- For most healthy women under 60 and within 10 years of menopause, benefits outweigh risks when symptoms are bothersome.
- Starting later carries higher absolute risks of heart disease, stroke, blood clots and dementia.
- Treating symptoms that wreck your sleep may make exercise and eating well easier, which helps weight indirectly.
What hormone therapy is for
The Menopause Society reviewed the evidence in 2022 with a panel of clinicians and researchers. Its position statement, endorsed by more than 20 international organizations, says hormone therapy:1,2
- is the most effective treatment for hot flashes and night sweats,
- is the most effective treatment for the genitourinary syndrome of menopause, which covers vaginal dryness and related urinary symptoms,
- has been shown to prevent bone loss and fracture.
Weight loss is not on that list. Hormone therapy is not prescribed to reduce weight or belly fat.
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Who it suits
| Situation | What the statement says |
|---|---|
| Under 60, or within 10 years of menopause, no contraindications | Benefit-risk ratio is favorable for treating bothersome hot flashes and preventing bone loss |
| Starting more than 10 years after menopause, or over 60 | Benefit-risk ratio appears less favorable, because absolute risks of coronary heart disease, stroke, blood clots and dementia are greater |
| Vaginal symptoms only | Low-dose vaginal estrogen or other local treatments are recommended when over-the-counter options have not helped |
Source: 2022 hormone therapy position statement.1
Risks are not the same for every product. They differ by type, dose, how long you take it, the route, when you start, and whether a progestogen is used.1 Patches and gels, and lower doses, may carry a lower risk of blood clots and stroke than tablets.3
So why do women say it helped their weight?
There is a plausible indirect route. Night sweats break sleep. Poor sleep leaves you tired, hungrier and less likely to exercise. If hormone therapy gives you your nights back, the habits that control weight become easier to keep.
The reverse link also exists. The Menopause Society recommends weight loss as one way to reduce hot flashes, although with a lower evidence rating than its top options.5
What does change body composition
The shift toward more fat and less muscle begins with the menopause transition and levels off about two years after the final period.4 The tools with trial evidence are the unglamorous ones: across 101 trials, exercise reduced fat mass and waist size and increased muscle in postmenopausal women.6
- Menopause belly fat: what causes it and what reduces it
- Cardio or weights in menopause
- Mediterranean diet for menopause
Questions to take to your doctor
- Given my age and when my periods stopped, am I a candidate for hormone therapy?
- Which type and route would you suggest for me, and why?
- What are my personal risks, given my family and medical history?
- How long would I take it, and how will we review it?
- If it is not right for me, what are the alternatives?
Common questions
Will HRT make me gain weight?
The body changes most women notice at this age are happening anyway. In a large study of women through the menopause transition, fat gain sped up and lean mass fell from the start of the transition, and hormone therapy use was accounted for in the analysis. If you gain weight after starting treatment, tell your prescriber so the dose and type can be reviewed.4
Is HRT the same as bioidentical hormones?
Regulated hormone therapy includes hormones identical to those the body makes. Custom-compounded 'bioidentical' products are different: the 2022 position statement raises safety concerns about them. Ask your doctor for a regulated product.1
I cannot take hormones. What are my options for hot flashes?
Several treatments without hormones are recommended by specialists, including cognitive behavioral therapy, clinical hypnosis and some prescription medicines. See our guide to hot flashes without hormones.5
References
- The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. https://pubmed.ncbi.nlm.nih.gov/35797481/
- The North American Menopause Society. Press release: NAMS releases its 2022 hormone therapy position statement. July 7, 2022. https://www.eurekalert.org/news-releases/958174
- Let's Talk Menopause. Highlights from the 2022 hormone therapy position statement of The Menopause Society. https://letstalkmenopause.org/our-articles/nams-2022-hormone-therapy-position-statement
- Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865. https://doi.org/10.1172/jci.insight.124865
- The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. https://pubmed.ncbi.nlm.nih.gov/37252752/
- Khalafi M, Habibi Maleki A, Sakhaei MH, et al. The effects of exercise training on body composition in postmenopausal women: a systematic review and meta-analysis. Front Endocrinol. 2023;14:1183765. https://pubmed.ncbi.nlm.nih.gov/37388207/
Every health claim above links to its source. Before publication the article was read and approved by Claudia Muresian, health psychologist, fitness coach and healthy nutrition specialist. It is general information and cannot take your personal history into account, so use it to prepare for a conversation with your own clinician.
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