During the menopause transition, declining levels of estrogen, progesterone, and testosterone can cause a deep metabolic shift within the body and will affect how fat is accumulated and stored.

Weight will be redistributed in different places, especially around the abdomen and internal organs, and the ratio of fat to muscle will increase.

This in turn affects the metabolism and makes it more difficult to maintain a healthy weight and body composition.

As weight gain tends to be related to hormonal shifts during the menopause transition, starting HRT can help manage this. Once hormone levels are optimal and the metabolic effects of declining hormone levels are reversed, weight loss can then be possible.

However, it's important to note that HRT is not a weight loss drug. And lifestyle factors, age, genetics, and diet and exercise habits will also play a role in how quickly hormonal weight gain in menopause can be addressed.