If you’re approaching the age range of menopause or are already in it, your body has likely started showing signs of major hormonal shifts. This typically happens for women between age 45-55 and can last 7 to up to 14 years depending on health, lifestyle, and genetic factors (1). From mood swings to hot flashes, there are many frustrating challenges that come with menopause. For many, weight gain is at the top of the list. 

Your suspicions are true – hormones do play a role in body weight and fluctuate greatly when menopause hits. Imbalances in estrogen, and particularly a decline in estradiol, are known to lead to weight gain (2). Here’s what you need to know about keeping estrogen in check and whether your unexpected weight gain is connected to your hormone levels.

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What Is Estradiol and What Causes It To Fluctuate?

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Estradiol is a form of estrogen, an essential hormone produced during a woman’s reproductive years from puberty until menopause. Estrogen plays a key role in menstruation cycles, ovulation, and preparing the uterus for pregnancy. It’s important to understand that estrogen fluctuates normally throughout your lifetime. The body makes three different types of estrogen (3): 

1. Estradiol: The primary, and most potent, form of estrogen produced by your body during reproductive years

2. Estriol: The form of estrogen that is ramped up during pregnancy

3. Estrone: The primary form of estrogen produced by your body after menopause 

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Signs of Hormonal Imbalances 

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Hormones play a crucial role in your overall health. When they fall out of balance, a wide range of functions are impacted, which is why symptoms vary greatly.  Estrogen is just one of many different types of hormones that all work in synchronicity to keep your body functioning at its best. 

When a hormonal imbalance occurs, it can be difficult to detect and diagnose since there is no single tell-tale sign. Common, yet nonspecific, signs you may be experiencing a hormonal imbalance include: 

• Weight gain or difficulty losing weight (one of the most common signs) 

• Feeling sleepy and fatigued all the time

• Mood swings

• Depression

• Low sex drive

• Vaginal dryness or irritation (possibly leading to painful sex)

• Hot flashes

• Irregular periods or absence of periods

• Breast tenderness

• Excessive hair growth (especially facial and arms)

• Difficulty sleeping throughout the night or falling asleep

• Brain fog

• Headaches or migraines

• Skin problems such as dry skin or acne

• Constipation

• Digestive problems

The above symptoms can be a sign of a hormonal imbalance, but may also be a sign of something more serious.  It’s always a good idea to communicate with your provider if you’re experiencing any of them.

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What Causes Hormonal Imbalances? 

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While there are many possible causes of hormonal imbalance, the following are some of the most common:

• Obesity

• Long-term stress

• Diabetes

• Thyroid dysfunction (hyper- or hypothyroidism)

• Polycystic Ovarian Syndrome

• Menstruation

• Pregnancy, childbirth, and breastfeeding

• Perimenopause, menopause, and postmenopause

• Certain medications (i.e., thyroid or certain diabetes medications)

• Autoimmune conditions

• Birth control medications

• Eating disorders such as anorexia

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How Do Estradiol Levels Impact Weight Gain?

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Estradiol naturally decreases during menopause. As one of estradiol’s main functions is to help regulate metabolism and body weight, lower levels of estradiol may therefore lead to weight gain (4).

According to one study, menopausal women are 3x more likely to develop obesity than premenopausal women (5). 

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How Is Hormonal Weight Gain Diagnosed?

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Your provider can help you determine if your weight gain is due to a hormonal imbalance. They will perform a physical exam and ask questions about your overall health to understand the root cause better.

Various factors, including age, family history, your described symptoms, and physical exam, can help you decide whether further testing is necessary and, if so, which ones you should pursue. A typical starting place is to get an updated blood sample and review your latest lab values regarding your hormones, cholesterol, and blood sugar. This is to screen for hormonal imbalances and your risk for high cholesterol and diabetes. Your provider may suggest further testing involving imaging or more invasive tests depending on what they think is the driving force behind your specific set of symptoms.

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What Are the Risks of Untreated Hormonal Weight Gain?

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The risks of untreated hormonal weight gain can vary depending on which hormonal imbalance contributes to your weight gain. For example, polycystic ovarian syndrome (PCOS) is commonly associated with weight gain and if left untreated, can lead to infertility.

There are a number of risks associated with any weight gain that leads to obesity.  Being overweight (BMI >25) or obese (BMI >30) is linked to the development of conditions such as type 2 diabetes, high blood pressure, high cholesterol, non-alcoholic fatty liver disease, obstructive sleep apnea, heart disease, and stroke (6).

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Can You Treat Low Estrogen? 

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Women in menopause who are suffering from low estrogen levels may benefit from hormone replacement therapy (HRT). For women who are at higher risk for breast cancer or forming blood clots, non-hormonal treatments are preferred. 

HRT is commonly prescribed for women in menopause or perimenopause, which is the period leading up to menopause when your ovaries gradually stop working. HRT helps replenish hormones such as estrogen and progesterone, both of which naturally decrease with age. These hormones dip more dramatically around menopause and can cause some unpleasant yet common symptoms such as hot flashes, mood swings, vaginal dryness, and weight gain. 

HRT can help treat symptoms related to low estrogen and progesterone either in the form of a pill, patch, cream, gel, or injectables. Your provider can help you decide if estrogen or a combination estrogen-progesterone replacement plan is right for you. 

Estrogen replacement can help manage your hormonal imbalances while also reducing the risk of bone fractures and developing heart disease. Your provider will likely try to get you on the lowest effective dose to minimize the risks that come along with HRT, such as blood clots and stroke. 

‍For those with obesity, weight loss can be crucial to manage the hormonal fluctuations during menopause. GLP-1 RA medications, such as semaglutide and tirzepatide, can be effective solutions. These medications target hormones controlling appetite and blood sugar to promote weight loss. Women at the perimenopausal or menopausal stage can benefit greatly from exploring these options if they meet the following criteria:

• BMI over 30

• BMI over 27 with a weight-related health condition such as diabetes, high blood pressure, or high cholesterol
  
  
  

Key Takeaways

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Low estrogen levels, especially estradiol, can increase your risk of weight gain, osteoporosis, and heart disease. Talk with your provider to see if low estrogen levels may be contributing to your weight gain, especially if you’re nearing or at the age of menopause. There are a few therapeutic options available to help you manage your weight during menopause, including hormone replacement therapy and GLP-1 weight loss medications for those who need a more intensive weight loss management solution.

If you’re interested in exploring your options for medication-assisted weight loss, Mochi Health can help you access affordable, holistic care. The program offers 1-on-1 provider support from licensed physicians, 24/7 customer support, direct provider messaging, and medications delivered to your door. Find out if you’re eligible today.

Sources

1. Gold, E. B. (2011). The Timing of the Age at Which Natural Menopause Occurs. Obstetrics and Gynecology Clinics of North America, 38(3), 425. https://doi.org/10.1016/j.ogc.2011.05.002 

2. Vigil, P., Meléndez, J., Petkovic, G., & Del Río, J. P. (2022). The importance of estradiol for body weight regulation in women. Frontiers in endocrinology, 13, 951186. https://doi.org/10.3389/fendo.2022.951186

3.  Hariri, L. (2023a, June 28). Estradiol. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK549797/ 

4. Lizcano, F., & Guzmán, G. (2014). Estrogen Deficiency and the Origin of Obesity during Menopause. BioMed research international, 2014, 757461. https://doi.org/10.1155/2014/757461

5. Eshtiaghi R, Esteghamati A, Nakhjavani M. Menopause is an independent predictor of metabolic syndrome in Iranian women. Maturitas. 2010;65(3):262–266. https://www.sciencedirect.com/science/article/abs/pii/S0378512209004034

6. Lim Y, Boster J. Obesity and Comorbid Conditions. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574535/#

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