Question 10 - HRT & Weight Gain

Dr. N,

In April of 1998 I had to have a hysterectomy, I was 40. The doctor had to remove both ovaries. Since then I have been trying different forms of HRT. Should a person be gaining weight while taking HRT? I have worked out more and had a healthier diet in the past year however I have gained almost 20lbs. I heard that HRT can have the same affect on women as birth control pills as far as gaining weight. Is this true? What can a person do?

Since my surgery I have tried the Vivelle patch at .1mg(once a week and twice a week method), Premarin .625mg and .9mg and I have tried vitamins and Ostaderm-V. With Vivelle and Premarin I feel okay for a couple of weeks, after that I feel bloated, tired and very unenergetic. With the vitamins and cream, I felt good for about 3 days and then started experiencing severe hot flashes and headaches. The vitamins I was taking consisted of a Multi-Vitamin, Calcium, Flax Borage, St. John's Wort and Vitamin E. So far the patch seems to do the best to control hot flashes but I don't feel good while I'm on it. My exercise will very from day to day. I am on my feet for 10-12 hours a day at work. This is constant walking while running machinery. I do sit ups every morning and evening. I try to walk about a mile in the evening or if the weather is bad then I go to the gym at work and walk on the treadmill.

I am now only 5'4" and now weigh 142 lbs . I have not had any other health problems other than fact that I smoke and haven't been able to quit yet. I normally will have a breakfast shake at 4:30 in the morning, a bowl of hot cereal, half a bagel or a bowl of fruit salad around 8, a sandwich, soup or leftover chicken for lunch and for dinner maybe a bowl of cereal, a plain hamburger patty, chicken or fish with some vegetables. I have maybe 2 cups of coffee each day. I drink about 8- 8oz glasses of water, 16oz of 1% milk and 20oz of ice tea a day.

I have been to a regular MD and Naturopath and we keep trying different things for my hormones but they don't seem concerned about my weight. I do and hopefully you can help me figure out something. The last time I gained this much weight in a year I was on birth control pills and 20. Can HRT cause a person to gain weight and what can a person do?
Help!

Reply:

This a problem that I get asked about frequently and it is an important issue. There are a number of factors that may be making things difficult for you.

As one ages, especially after 40, metabolisms slows and fewer calories are required for routine daily activities. Often you will hear, "I just can't understand it, I'm eating the same as I ever did and I'm gaining weight!"

Your diet and exercise program seem reasonable. It is necessary however, to assess your caloric intake by measuring your food portions and fat content. This will give you a more accurate idea if the level of your intake is appropriate for you.

I don't know if there are any studies that support my impression that women who have had their ovaries removed have a harder time keeping their weight down. I believe that the loss of testosterone levels associated with ovarian removal ultimately result in a reduction of muscle mass. The lost tissue is replaced by fat and further reduces the amount of calories metabolized daily. Testosterone deficiency reduces energy levels and may be contributing to your fatigue.

Smoking reduces your estrogen levels. This effect of tobacco use has been known for some time and less hormone is available to control your flushes and to act as a preventative against cardiovascular disease, osteoporosis and other consequences of long-term hormone deficiency.

The studies that I am familiar with do not suggest that HRT causes weight gain, however I suspect it occurs on an individual basis.

What to do ?

If you can stop smoking, do it. Don't do it alone, go to your doctor for help and/or a support group.

Consider testosterone replacement, it may eventually help increase your metabolism and would increase your energy levels. Speak to your Doctor about this and the possible ways to increase your effective blood levels of estrogen by the use of higher dose patches, estrogen and testosterone gels, sublingual tablets, or subcutaneous hormone implants. Read the "symptoms" and "methods of HRT" pages of the website for more about this.

Many physicians are not familiar with the existence or effectiveness of these products. Information for you and your physician, regarding their availability and usage can be obtained from "College Pharmacy" , a pharmaceutical resource for women.

Good luck,

Dr N