Navigating Weight Gain When Estradiol & Progesterone are LOW
If you’ve been asking yourself, “Will hormone replacement therapy help me lose weight?”—you’re not alone. For so many women, weight gain around perimenopause and menopause feels frustrating, confusing, and at times, completely out of their control.
You might be eating the same way, exercising more, and still watching the number on the scale creep up. It’s not in your head. Hormonal shifts during this time fundamentally change the way your body stores fat, builds muscle, and manages energy.
I’m Dr. Sarah Daccarett, a hormone and longevity specialist and the founder of Inner Balance. Every day, I help women make sense of these changes—especially the connection between hormone replacement therapy (HRT) and metabolic flexibility, and weight loss.
In this article, we’ll dive into what the science says, what I see in clinical practice, and how you can make empowered decisions about your body, metabolism, and long-term health.
The Real Link Between Hormones and Weight
Weight gain is not just about willpower or lifestyle. It’s about biology. As estrogen and progesterone decline—often beginning in your late 30s or early 40s—your metabolism slows, your body composition shifts, and fat tends to redistribute to the abdomen.
How Estrogen Affects Weight
- Regulates fat storage and metabolism Estrogen plays a role in how your body burns fat versus stores it—especially around the midsection.
- Influences insulin sensitivity Low estrogen can lead to more blood sugar instability and insulin resistance, making weight loss harder.
- Supports muscle mass Less estrogen means more muscle breakdown and lower resting metabolic rate.
- Brain signaling related to hunger and satiety
The Role of Progesterone
- Supports thyroid function Progesterone is a key player in helping your metabolism stay efficient.
- Reduces cortisol reactivity When progesterone drops, cortisol (your stress hormone) may stay elevated longer, contributing to fat storage and inflammation.
- Regulates and lowers insulin resistance
Hormones and weight are deeply connected—and often overlooked by traditional care.
As estrogen declines in perimenopause and menopause, many women experience weight gain, especially around the abdomen, and develop increased resistance to insulin. That’s not just frustrating—it’s a warning sign of declining metabolic flexibility.
GLP-1 + Estrogen: A Powerful Synergy
1. Blood Sugar and Insulin Support
Both GLP-1 and estrogen help regulate glucose and insulin responses. In fact, research shows estrogen can enhance GLP-1’s ability to stimulate insulin and improve insulin sensitivity in skeletal muscle. This means better blood sugar control and less fat storage—especially around the belly.
2. Appetite and Craving Control
Estrogen impacts appetite-regulating hormones like leptin, ghrelin, and serotonin—and may amplify the effects of GLP-1 on satiety. It also increases the number of GLP-1 receptors in the gut and brain, boosting how effectively your body responds to the medication. Estrogen even promotes natural GLP-1 secretion from intestinal cells. The result? More appetite control and fewer emotional cravings.
3. Cardiovascular Protection
GLP-1 agonists and estrogen both protect the cardiovascular system. Together, they may:
- Improve nitric oxide (NO) production for better circulation
- Reduce inflammation in blood vessels
- Lower blood pressure and cholesterol
- Decrease the risk of plaque buildup and clotting
These combined benefits help protect against heart disease, the leading cause of death in women over 50.
4. Bone Density and Strength
Estrogen is essential for bone health, and GLP-1 may also support bone metabolism. While more research is needed, the two together could enhance bone preservation and reduce osteoporosis risk—especially important for postmenopausal women.
What Does This Mean for You?
If you’re on a GLP-1 medication for weight loss, or considering it, adding bioidentical estrogen therapy may:
- Improve the drug’s effectiveness
- Support long-term weight maintenance
- Protect metabolic and cardiovascular health
- Help reduce side effects like muscle loss or fatigue
If you’re not on a GLP-1, estrogen alone can still make a meaningful difference in metabolism, especially if you’re experiencing perimenopausal weight gain, insulin resistance, or midsection fat that just won’t budge.
Will Hormone Replacement Therapy Help You Lose Weight?
This is one of the most common questions I hear—and the answer is: yes, but with nuance.
What the Research Says
Several studies suggest that hormone replacement therapy can help prevent or reduce menopause-related weight gain:
- A study published in the International Journal of Obesity found that HRT was associated with less abdominal fat gain and improved lipid profiles.
- The ZOE PREDICT study confirmed that menopause is linked to slower metabolism, increased fat storage, and blood sugar dysregulation—changes that HRT may help moderate.
- A meta-analysis in ScienceDirect showed that women using bioidentical hormone therapy had improved body composition and were less likely to experience central obesity.
At Inner Balance, women often report:
- Easier fat loss (especially belly fat) once hormones are stabilized
- Improved energy and motivation for workouts
- Better sleep and mood, leading to healthier habits
- Less bloating, fluid retention, and insulin resistance
Patient Story: “I Finally Recognized My Body Again”
One of my patients, Lauren, came to me after gaining 20 pounds during perimenopause. She had tried every diet and workout plan under the sun. Her labs showed low estradiol, low progesterone, and borderline thyroid dysfunction.
We started her on an Oestra protocol—Starting low on Oestra and gradually increasing over time. Over the next few months, her energy stabilized, her cravings disappeared, and she naturally began to lose weight—without extreme dieting.
She told me, “I finally feel like myself again—not fighting against my body, but working with it.”
Addressing the Fear: Will HRT Cause Weight Gain?
Let’s clear this up: There’s no strong evidence that HRT causes weight gain.
In fact, research shows the opposite: women who use hormone therapy tend to have less weight gain and better fat distribution than those who don’t.
However, some women do notice temporary bloating or water retention when starting HRT. This is typically due to:
- Over conversion to testosterone
- Incorrect progesterone dosing
- Poor progesterone formulations such as topical or oral
- Poor hormone clearance (often related to an oral and liver health)
These symptoms are usually short-term and reversible with proper supervision and dose, or formulation adjustment. Often women report less bloating and weight gain with vaginal delivery of hormones. If you’ve been told that “HRT makes you gain weight,” it’s time to rethink the narrative. It’s not the hormones—it’s about using the right hormones, in the right amounts, in the right way. If you are on a regimen that made you gain weight – its time to rethink the way you are taking them and is it causing an imbalance like testosterone dominance that caused your fluid retention and weight gain.
Signs HRT May Help With Weight-Related Symptoms
You may want to consider hormone therapy if you’re experiencing:
- Weight gain around the belly
- Slowed metabolism despite healthy habits
- Intense sugar or carb cravings
- Fatigue and low motivation to exercise
- Sleep disruptions (which impact hunger and metabolism)
- Mood swings or anxiety that drive emotional eating
- Increased bloating or fluid retention
These symptoms are more than just “aging.” They’re hormone signals your body is asking for help.
The Bottom Line: HRT and Weight Loss
- Hormone imbalances, especially after a decrease in hormones significantly impact weight, metabolism, and body composition.
- HRT won’t replace healthy habits—but it can make those habits finally work again.
- With the right plan, HRT can reduce fat storage, support lean muscle, improve energy and sleep, and help you feel like yourself again.
- Fear of weight gain from HRT is outdated and largely unsupported by data—what matters most is personalization and oversight.
- Unbalanced regimens that result in testosterone dominance can lead to weight gain
Considering HRT? Here’s What to Do Next:
You don’t have to wait until you’ve gained pounds or feel completely lost in your body.
If you’re asking the question “Will HRT help me lose weight?”—you’re already tuned in to what your body is telling you. And you deserve answers, not guesswork. Metabolic health isn’t just about calories in and calories out—it’s about working with your hormones, not against them. And now more than ever, we have tools that can do just that. If you’re already using a GLP-1, estrogen may help optimize your results. If you’re just beginning your weight loss journey, HRT alone might be the missing link you’ve been looking for. At Inner Balance, we take an integrative, science-based approach to metabolic healing. Your hormones don’t need to be fixed—they need to be supported.
