The Real Reason Women Can't Lose Weight in Perimenopause, and Why HRT Doesn't Always Fix It

Added: 2026-05-30

[00:00:00]Why is it that some women in midlife gain weight and some women find it hard to lose weight, uh but but not every woman? That's a a really good question and in so far what my research has been able to do, um mostly through survey-based research, is identify the number of women who make the claim that it's very hard to lose weight versus the number of women who who are going through menopause who say, "Yeah, I haven't really gained any much weight or if I try to lose it, I I can."

[00:00:36]So, let me start with with those numbers and then we can get into well, why is this happening?

[00:00:41]So, it seems that about um 15% of women don't have that problem. So, 15% of midlife women who go through menopause, they just don't have a real bad experience.

[00:00:56]Um they haven't gained a lot of weight or if if they if they try to lose weight, in their experience, they don't really have a problem. So, the normal calorie deficits or doing more exercise seems to work for them. And I also want to say that the the women that I'm talking about are are women who already embrace a fitness-oriented lifestyle. So, that's that's who I like to study. So, women who lift weights, who do some type of conditioning. So, that's that's the context for for for everything that I'm going to talk about at least related to my research. So, just to be clear then, so all the women that we're talking about are women who exercise and of those and and I guess pay attention to their diet and things like that. And of those women, around 15% of them will not experience weight gain or if they have had a bit of weight gain, they find it easy or easier to lose with normal calorie deficits or increase in physical activity. Exactly.

[00:01:52]Yep. That small percentage. Yeah. Yeah, it is. And it's self-reported, so it's not like we validated this in a lab, but it's self-reported.

[00:02:01]So, now let's look at the other women to differing, you know, to different degrees they gain weight, sometimes a little, sometimes a lot.

[00:02:13]And also would suggest, "Hey, the things that used to work 5 years ago, 10 years ago, don't seem to be working as well." So, what you asked is what I would say the >> [laughter] >> the the question to ask. Why is this happening?

[00:02:30]I I I my thinking, and this is hard to to prove because it's uh one, we have women that are aging as they go through menopause.

[00:02:42]So, some people say, "Hey, and even some research um reviews suggest, 'Hey, there's nothing special about menopause here. This is just the act of aging. Of course, people gain weight when they age.'"

[00:02:53]Other research reviews or longitudinal studies would say, "No, it's not just aging. It's menopause-specific."

[00:03:03]And as a researcher, it's very hard to separate them because you can't separate going through menopause with aging.

[00:03:10]Everybody that goes through menopause is also aging. Every woman that's aging at some point is going to go through menopause.

[00:03:18]So, we can get into the nuance of how best to study that. But I think the what most people will attribute this increase in weight gain to.

[00:03:29]And what research shows is associated with this is the change in the hormonal environment. So, specifically, we know that estrogen, estradiol in particular, is decreasing during this time when research um has reported that women are gaining an accelerated rate of fat gain.

[00:03:49]So, estradiol levels are going down. at the same time FSH follicle stimulating hormone levels are going up and we also have declining progesterone levels.

[00:03:59]So I think the most common explanation as to why this is happening is it's the change in hormones. Now, one other thought to this.

[00:04:10]If that's true, one would think or I would think, well, let's just give hormone therapy as soon as we start seeing this and that should that should lessen the amount of body fat. And that's not always what we see with estrogen therapy. Sometimes we do, sometimes that has no impact and sometimes there's actually weight gain or fat gain with estrogen therapy.

[00:04:40]So when I first started looking at this, I was all excited and I'm like, well, this is great. This is pretty, you know, if it's the hormones, we can address that. Let's just give hormone therapy.

[00:04:49]And to my surprise, it's it doesn't seem as though that consistently solves this issue. But nonetheless, it is the change in hormones that seem to be highly associated with the changes in body composition. Interesting. So what you're saying there is some women who then go on to have menopause hormone therapy, that helps improve body composition or improve the results that they're getting, but it doesn't seem to universally do that in all cases. Let me discuss that from two perspectives. I I communicate a lot with women. Like I'm I'm I'm loving the learning environment that I'm in right now cuz I have I wasn't doing this research five I mean, I've always been doing body composition research, but not historically um as it related to menopause. So one of the things was I keep getting feedback some women, oh my gosh, I started hormone therapy and I I lost all this fat, and I um gained muscle, lean lean muscle mass, and obviously a lot of women feel better. That's pretty universal.

[00:05:57]Other women would say, "Yeah, I started it. I didn't really notice any changes in my body composition, like it whether I was on it or not." And then I even have other women who communicate with me, like I I I gained more weight when I started. And then I started looking at the research, and it really matched the variability of the personal stories that that that women would give me. Some research HRT, again, I'm going to usually go to estradiol therapy as as the main mover, reduces body fat. Some research um has suggested that it actually prevents the loss of of body fat, like you it's harder to lose it when you're on estradiol.

[00:06:36]So, to my dismay, there's a there seems to be a lot of variability around the the the effects of hormone therapy on body fat changes.