Effects of Hormone Replacement on Belly Fat in Menopause

Recent studies are suggesting that menopause hormone replacement is a worthy option to combat belly fat in menopause. Hormone therapy reduced levels of belly fat compared to women not using hormone therapy.

In a study published in The Journal of Clinical Endocrinology & Metabolism both total fat and belly fat were reduced with menopause hormone therapy. Further, in a study published by the Journal of Menopausal Medicine, the Academic Committee of the Korean Society of Menopause endorses hormone therapy to support life expectancy for women.

In South Korea, life expectancy is reaching 90.82 years and officials perceive HRT as an effective therapy with more advantages than disadvantages for women below 60 or less than 10 years past menopause.

In the study those on therapy used either:

  • Estrogen
  • Estrogen and progesterone
  • Estrogen and progestin (synthetic)

So, if you’ve been given the answer already: HRT reduces belly fat in menopause, how was it tested as the reason for change? Well, subjects stopped HRT as a part of the study.

Stopping hormone therapy quickly regained belly fat.

There was a loss of estrogen with a rebound increase in cortisol. Cortisol attempts to do estrogen’s job and does it very poorly. Yet the cortisol increase coupled with insulin:

  • Increases number of fat cells
  • Increases size of small fat cells to big fat cells
  • Relocates fat cells to the belly
  • Creates new fat cells

If you’re a woman in menopause, the next statement is no secret to you. The majority of weight gain experienced by women during and after menopause is abdominal fat, also called visceral fat, or adipose tissue. There are two types of that fat to consider.

  • Pinch an inch (muffin top)
  • Visceral: Surrounding internal organs (Imagine a marbled steak)

Loss of estrogen can increase visceral fat by 10% in just 5 months.

  • My story of belly fat in menopause came mid-year in 2019, even while Ironman training, and actually, compounded by Ironman training (cortisol control during training has always been top of mind for me and my athletes but together with hitting menopause, a sudden and unwelcome move following a very stressful start to the year… tipped the scale and the tape measure.

This visceral fat is not just embarrassing. It’s a health risk in many ways.

  • Associated with risk for Type II Diabetes
  • Associated with risk of heart disease (waist-to-hip ratio)
  • Associated with risk of cancerous cells (visceral fat produces large amounts of fibroblast growth factor 2 a protein that turns healthy cells cancerous)

4 ways Decreased Estrogen can Trigger Belly Fat:

  • Slowing metabolic rate – related to decreased ovarian function (studies have shown when estrogen-only the metabolic rate was restored). This alone can result in weight gain of a pound in three months. (Coupled with cortisol and insulin, via wine consumption, continued eating same diet not realizing carbohydrate sensitivity weight gain is amplified. It’s not “moderation” it’s the type of carbohydrates you’re consuming. White sugar, flour, pasta, bread, rice, will increase weight significantly, and for those with thyroid issues a lack of resistant carbs can cause a similar effect. There is a sweet spot.)
  • Changing cell type – in women not men. Comes from bone-marrow and has a GPS set for the belly. They produce cytokines, we’ve heard more about in 2020 than we wanted to, which produce inflammation. To enhance your immunity and decrease belly fat, you need to make significant changes in your behavior.
  • Disrupted sleep patterns- symptoms of menopause like hot flashes/night sweats and related insomnia or cortisol issues – may keep you from sleep. Compounded with poor sleep hygiene (not prioritizing sleep, no bedtime/waketime habits, exercise at the wrong time, alcohol and caffeine, low blood sugar from poor nutrition or overeating too close to bedtime)
  • Reduced Activity – if sleep disruptions, lethargy or fatigue or simply reduced mojo equate to reduced activity levels… can be tied to reduced estrogen levels. But the evidence is pretty clear that for many women you’re not a little less active, like 5, 10 or 15%, you’re activity is reduced by 50, 60 or 70%. That’s true of mice. In humans, there’s only preliminary evidence. The result? Less activity, less metabolism, but also long term less activity (or the right activity) equals less muscle (sarcopenia). Muscle mass is a primary determining factor in determining metabolic rate.

Steps to Decrease Visceral Belly Fat:

  1. Maintain physical activity
  2. Prioritize sleep before exercise additions
  3. HIIT
  4. Strength training (full body, to muscular fatigue, adequate recovery)
  5. Plus, Increased low to moderate activity post menopause
  6. Carb – consciousness (ditch white and sugars/increase resistance starches)
  7. Stop bingeing by increasing protein, fiber, fat, and resistant starches regularly and evenly distributed. (If you don’t have a daily schedule of timed meals… you’re setting yourself up for failure)
  8. Protein increased to adequacy beyond outdated RDAs
  9. Fiber to boost satiety and aid in fat loss (toxins)
  10. Hydrate with pure water
  11. Avoid more than 2 cups caffeine
  12. Avoid alcohol while trying to reduce belly/visceral fat

Why You May Be Physically Active and It’s Still Not Working

  • You’re not strength training to muscular fatigue.
  • Your strength training has too many fluffy, creative movements but it’s missing the type that boost a sluggish metabolism. (and build bone density)
  • You’re not doing full body workouts.
  • You do too many small muscle group exercises (trying to tone your arms?)
  • You don’t feed that muscle with enough protein at the right time.

Myths you believe about Physical Activity

  • Strength training will bulk you up.
  • Strength training will cause injury.
  • Strength training (or any exercise) takes time I don’t have.

Busting Myths You Believe About Physical Activity:

  • Strength training that builds bulk requires extreme amounts of volume, higher calories and protein than you’re likely eating, and hormones you simply don’t have enough of now for sure.
  • Strength training decreases risk of injury when done correctly with adequate progression.
  • Strength training may make you aware of injuries waiting to happen so you can correct them before they result in a bigger issue.
  • Strength training is one of the only ways to reverse signs of aging in the human body as you age. (signs in muscle, bone, and mitochondria – where energy production occurs)
  • Strength training takes as little as 10 minutes twice a week. The less time you have the less likely you are to do that 1980’s workout that will throw your hormones under the bus.
  • Exercise takes a commitment but usually adds to your productivity. Check in with your most successful, energetic and happy friends… you’ll find an exerciser.


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