Isabel, who considered stopping HRT a birthday gift to herself, is an example of a woman on HRT for whom the “cure was worse than the disease.” Her situation doesn’t have to be yours. When an HRT regimen isn’t relieving your symptoms or is making you feel worse, it’s clearly not working. Then you and your health care provider will need to do some adjusting: you may have to change medications, switch to a different form of administration, or take less or more of a hormone.

“I’m fat since I started HRT,” Laura stated flatly. “I was never slender to start with, but now I’ve gone from a size ten to a twelve, and I’m barely fitting into those.”

Weight gain can be an unwanted companion of HRT, as the estrogen component of the regimen seems to slow down our ability to burn body fat. Laura’s concerns about her weight echo those of many women who are considering HRT. I explained to her that because our basal metabolic rate decreases during our perimenopausal years, it takes our bodies longer to burn the calories that we ingest, whether or not we’re on HRT.

Because Laura’s uterus was intact, her HRT regimen included a synthetic progestin, to prevent estrogen from stimulating abnormal cells in the uterus. One side effect of the synthetic progestin that Laura was taking can be weight gain. The Physicians’ Desk Reference (PDR), commonly used by physicians as a source of product information about drugs, says that among the potential reactions to Provera are “fluid retention” and “weight change (increase or decrease).”

Taking HRT doesn’t have to mean an automatic weight gain. Laura and I discussed the importance of choosing foods wisely and the benefits of getting enough exercise. Then we identified three options for adjusting her HRT:

- First, we would talk with her health care provider about switching her from synthetic progestin to micronized natural progesterone. If, after two to three weeks on this regimen, her weight gain, bloating, or both were still problematic, we’d go to the next step.

- Step two would be to change the type of estrogen she was taking. Laura was currently taking Premarin, which contains estrone and other estrogens that are unique to horses and that may have had a role in her weight gain. Changing to Estrace, which is estradiol, could help. Again, I recommended evaluating this regimen after two to three weeks.

- If there were still no improvement in the weight problem, the third step would be to lower the dosage of Estrace. Sometimes a smaller dosage of estrogen can provide the protection we want without contributing to weight gain.

Related posts:

1. The Basics of Perimenopause – language barriers during hormone replacement therapy

2. The Basics of HRT alternative perimenopause treatment – black cohosh

3. The Basics of Hormones For Perimenopause – Natural versus Synthetic

4. The Basics of Managing the Side Effect of Antidepressants

5. The Basics of Perimenopause – HRT and Genitourinary Changes

6. The Basics of the Effects of Smoking Leading Up to and During Perimenopause

7. The Basics of the Thyroid and Weight Changes During Perimenopause

8. The Basics of the Effects of Antidepressants In Perimenopause

9. The Basics of Testosterone for Women for Treatment During Perimenopause

10. Differences between Progesterone and Progestin