Does HRT cause weight gain?

No — HRT does not cause weight gain. The weight changes women notice in midlife are driven by menopause itself and ageing, not by the treatment.

This is a common worry that puts women off HRT unnecessarily. The evidence is reassuring: studies don't show that HRT causes weight gain, and it may actually help by reducing the tendency for fat to shift to the abdomen after menopause. What does cause midlife weight gain is the combination of falling oestrogen (which redistributes fat to the middle), a naturally slowing metabolism, muscle loss with age, and often poorer sleep and lower activity — all of which happen with or without HRT.

Some women do notice temporary bloating or fluid retention when starting HRT, which can feel like weight gain but isn't fat and usually settles. The type and dose can be adjusted if it bothers you.

What to do: don't avoid HRT for fear of weight gain — that fear isn't supported by the evidence. To manage midlife weight, focus on what works at this stage: enough protein, strength training to preserve muscle, a Mediterranean-style diet, good sleep, and limiting alcohol. If you start HRT and feel bloated, ask your GP about adjusting the regimen.