What Hormone Therapy Can and Can’t Do for Your Body Composition

I get asked this question almost every day: Should I be on hormone therapy?

The information that’s out there on this topic is a mess — twenty years of fear and avoidance, followed by a wave of influencers selling it as the answer to all your problems.

I’m not going to tell you what to do; that’s a decision for you and your provider, based on your history. What I want to give you is the low-down on what menopause hormone therapy (MHT, used to be called HRT) does, what it doesn’t do, and where it might fit alongside the things we talk about here every Tuesday.

Some necessary history. In 2002, the Women’s Health Initiative results were released and reported in a way that caused a mass exodus from hormone therapy. What the following two decades of reanalysis showed us is that the risk depends heavily on a woman’s age, how far she is from menopause, and whether she’s getting the medication in a pill or through her skin. For many healthy women who begin therapy before age 60 or within about 10 years of menopause, the benefit-risk ratio is much more favorable than the 2002 report made it seem — while for women starting much later, it may not be.

What MHT is good at. MHT is very effective for hot flashes and night sweats. It can help with genitourinary symptoms like dryness, irritation, pain, urinary frequency, and recurrent UTIs. It can reduce bone loss and fracture risk. By improving sleep in women whose nights are wrecked by vasomotor symptoms like hot flashes, chills, and a pounding heartbeat, it can indirectly improve lots of things we care about — appetite, motivation, energy, and recovery, to name a few.

Now the part relevant to trading fat for muscle — and I want to make sure you understand this.

MHT is not a fat-loss drug, and it’s not a substitute for strength training or for eating well — mostly whole foods and plenty of protein. However, it can influence where fat is stored, slowing the shift toward belly fat that comes with estrogen decline. And if your sleep is regularly disturbed by hot flashes and insomnia, you’re always tired, you have poor energy for workouts, and your cravings take over your day, then removing that obstacle can make a huge difference in your fat loss efforts.

If you’re considering it:

If your provider can’t or won’t have a real conversation with you about your individual risk-benefit ratio, find a provider who will. The Menopause Society has a directory of certified practitioners, including many who do Telehealth visits. Go in with your symptoms written down, your personal and family history, and specific questions. And know that whether or not you end up on MHT, the foundation is the same regardless: fuel properly and build strength.

And if you’d rather not guess at the strength half of that foundation, take a look at Your First Strength Program. It’s a simple, physician-designed plan that tells you exactly what to do and when — so the part that’s fully in your control is handled while you sort out the rest with your provider.