“Long-term post menopausal hormone use, obesity, and fat distribution in older women” by Donna Oritz-Silverstein in the January 3rd, 1996 issue of the Journal of the American Medical Association found hormone replacement therapy, whether used intermittently or continuously for 15 years or more, is not associated with weight gain and central obesity that is commonly observed in post menopausal women. A total of 671 women, average age 60.5 at the beginning of the study and 76.3 at the end, enrolled in the Rancho Bernardo Study were examined for hormone use and body mass and size. Those who used hormones continuously had an average use of 25.6 years (range 15 to 49 years).
Weight gain at the time of menopause is believed to be common, especially an increase in abdominal fat. The effect of estrogen therapy on weight is not well established, with studies showing loss, gain, and no change. These women were well-educated, white, middle-class women who started the study at a weight lower than the average American woman. Women on hormone replacement therapy are generally better educated and more affluent than women who do not take hormones — either because they are more knowledgeable about potential benefits of hormones or they can afford more contacts with doctors who like to prescribe HRT. Most importantly, better educated women are more likely to follow healthier diets and exercise, which may be the reason there was no weight gain observed in these women taking hormones.
If HRT had a reputation for making women fat, its popularity would vanish. (Certainly much faster than the knowledge that it causes breast and uterine cancer has hindered its acceptance). Looking great is more important than the risk of early death and disease, for most of us. HRT has benefits and risks — see the November/December 1995 issue of the McDougall Newsletter for recommendations on the safest way to replace hormones after menopause.
John McDougall, MD