Weight gain and hormone replacement therapy: are women's fears justified?

Fear of weight gain is one of the main factors contributing to the poor compliance seen with hormone replacement therapy (HRT). Although an increase in weight can be a result of rehydration, (which in turn may alleviate some of the effects of skin ageing), many women consider weight gain to be cosmetically unacceptable. Moreover, excess body weight or certain patterns of body fat distribution can lead to health problems such as cardiovascular disease and breast cancer. The menopause is associated with a decrease in the resting metabolic rate that reduces the utilisation of calories and hence increases body weight. A number of studies have shown that weight gain is greatest in the peri-menopausal years. There also appears to be a redistribution of fat mass at the time of the menopause, with an increase in the waist-to-hip ratio. Although it is a common belief that HRT inevitably causes weight gain, available evidence suggests that this is not true. Indeed, some HRT regimens, such as continuous 17beta-oestradiol 2 mg/day combined with sequential dydrogesterone 10 mg/day for 14 days/cycle (Femoston), may actually help to prevent an increase in body fat mass and fat redistribution. Informing women about the effects of the menopause on body weight/fat distribution and the potential beneficial effects of some HRT regimens should help to improve HRT compliance.