HRT, Weight Gain and Confusion: Why Some Women Feel Worse, Not Better
If you're a woman who started HRT expecting it to make you feel lighter, brighter, and more balanced — but instead you've found your weight creeping up and your body feeling bloated or sluggish — you are not alone.
There’s a growing wave of women reporting that despite taking HRT (in some cases, in high doses), they’re struggling more than ever with their weight, digestion, or energy. And often, they’re left feeling confused, unheard, or unsure who to trust.
This blog is here to offer clarity, compassion, and a more nuanced look at what might really be going on.
What Women Are Told About HRT and Weight
Many women are understandably hopeful that HRT will help them lose or manage weight — especially after being told that oestrogen “redistributes fat” or “supports metabolism.”
While there is some truth to the idea that hormones affect weight regulation, it’s rarely as simple as topping up a missing hormone. The body is more complex than that. And when oestrogen is given in doses significantly above what's physiologically needed — particularly without adequate monitoring — other imbalances can arise.
What the Science Says About Oestrogen, Weight Gain & the Gut
While many women feel significantly better on HRT — with improvements in sleep, mood, and joint pain — others are left wondering why bloating, weight gain, or sluggish digestion have worsened.
Let’s explore some of the lesser-discussed physiological reasons why this can happen, especially when oestrogen is high:
1. Oestrogen & Fluid Retention
Oestrogen plays a role in regulating the renin-angiotensin-aldosterone system (RAAS), which governs fluid and electrolyte balance. High oestrogen levels can stimulate aldosterone, leading to increased sodium and water retention — experienced as puffiness, breast tenderness, or general bloating.
2. Oestrogen & Gut Motility
There’s growing research linking sex hormones to gut motility and the enteric nervous system. Oestrogen, in particular, influences the contraction and relaxation of smooth muscle in the gut.
High oestrogen can slow transit time, particularly in the colon, contributing to constipation and bloating.
This is one reason why many women experience changes in bowel movements during the menstrual cycle — and it can continue into perimenopause if hormone levels fluctuate or are elevated.
A 2020 review in Frontiers in Endocrinology discussed how oestrogen modulates visceral sensitivity and pain perception, making women more prone to noticing digestive discomfort — including bloating — at different phases of the cycle or during HRT adjustment.
3. Oestrogen & the Microbiome
Oestrogen also interacts with the gut microbiota, especially through the estrobolome — a group of gut bacteria that regulate circulating oestrogen levels via enzymes like beta-glucuronidase.
If oestrogen is reabsorbed via the gut rather than excreted (due to dysbiosis or sluggish transit), this can raise systemic oestrogen even more.
This can become a vicious cycle, where high oestrogen slows motility, alters microbial balance, and further impairs oestrogen clearance — increasing symptoms like bloating, brain fog, and water retention.
This is why gut support is such a critical piece of hormone support, especially when using HRT.
4. High Oestrogen Doesn’t Mean Better Metabolism
Many people assume more oestrogen = more muscle or better metabolism. But excess oestrogen (especially without enough progesterone) can impair insulin sensitivity, increase fat storage, and shift body composition in ways that feel frustratingly out of our control.
Add in the fact that perimenopause is a time of shifting cortisol, thyroid function, and inflammatory signalling, and it’s easy to see why weight gain isn’t solved with a prescription alone.
When “More” Isn’t Better: The Risks of Overprescribing HRT
Many private clinics now prescribe HRT in doses significantly above those recommended by NICE (National Institute for Health and Care Excellence). This often includes oestrogen gel or patches at double or even triple standard doses.
And while some women do well with slightly higher doses for symptom control, the ‘more is better’ approach can backfire — especially without regular, personalised monitoring of:
Oestrogen metabolism (how your body clears hormones)
Progesterone balance
Thyroid function
Liver and gut health
Nutrient status
Ignoring these aspects can increase the risk of symptoms being misattributed or missed altogether.
Functional Testing Can Add Clarity — But It’s Not the Whole Story
Some women I work with choose to use a DUTCH test (a dried urine test for hormones) to get a broader picture of what’s happening with their hormone metabolism.
These tests can highlight elevated levels of oestrogen metabolites or imbalances in how hormones are processed, which may explain persistent bloating, breast tenderness, mood issues, or weight changes — even if “on paper” everything looks right.
That said, these tests should never be interpreted in isolation. Nor are they meant to override your doctor’s recommendations. But when used in context — with clinical history, symptoms, and goals — they can offer powerful insights.
So What Should You Do If You Feel Worse on HRT?
Listen to your body. If you're more bloated, heavier, or just not feeling right — that's valid. Don’t let anyone dismiss your lived experience.
Be open to adjusting. Sometimes it's not about stopping HRT, but about finding the right dose, delivery method, or supporting strategies.
Don’t ignore digestion. Gut health is tightly linked to hormone health. Supporting motility, liver clearance, and microbial balance can make a big difference.
Work with someone who sees the whole picture. That might mean a nutritional therapist, functional medicine practitioner, or open-minded doctor who can help piece the puzzle together — including looking at diet, stress, sleep, and lifestyle.
Final Thoughts
If you're navigating HRT and feel blindsided by weight gain, bloating, or a return of symptoms you hoped to leave behind, you're not alone. And you're not imagining it.
You deserve more than a one-size-fits-all approach.
This is your health, your body, and your life. It's absolutely okay to ask more questions — and to expect better answers.
Want support understanding your hormones and the whole-body picture?
I offer a Hormone Insights & Support Service designed to give you practical, personalised insights that help you feel informed and empowered in your health journey.
