Does estradiol cause weight gain?

In this article:

• Hormones and weight
• Estradiol weight gain
• Weight loss on estradiol
• Tips for weight management
• Alternatives

In this article

• Hormones and weight
• Estradiol weight gain
• Weight loss on estradiol
• Tips for weight management
• Alternatives

Estradiol (E2) is the most potent and biologically active form of estrogen. Estrogen is one of the key sex hormones in people assigned female at birth (AFAB). Along with estrone (E1), estriol (E3), and estetrol (E4), estradiol helps regulate reproductive health, bone strength, and even how the body stores fat. 

When estrogen levels (particularly estradiol) drop, human and animal studies have shown it can affect metabolism, appetite, and contribute to weight gain. Estradiol therapy supports weight regulation and helps maintain a healthy body weight in people with low hormone levels. However, elevated estrogen can also lead to weight gain for different physiological reasons. 

Healthcare providers prescribe estradiol to address low estrogen levels caused by hormonal changes or medical conditions. It is also commonly used to manage menopause symptoms like vaginal dryness, hot flashes, and osteoporosis (bone loss). Estradiol comes in different forms, including oral tablets, injections, patches, vaginal inserts, gels, and sprays. 

How hormones and weight intersect

Hormones are chemical messengers made by different glands and organs in the body. They help regulate a wide range of functions, including metabolism, appetite, satiety, and how your body stores fat. Think of them as “different coaches on your metabolic team,” says Bronwyn Holmes, MD, a board-certified provider specializing in hormonal transitions based in Silicon Valley, California.

“Hormones and metabolism are like the ultimate team sport, and when one player is off their game, the whole team feels it,” Dr. Holmes adds. Estrogen, primarily produced in the ovaries, is like the strategic coach; it tells your body where to store fat, favoring the hips, thighs, and glutes instead of your midsection. It also helps keep visceral belly fat (the deep layer of fat that wraps around the organs in your belly) in check.

Aside from regulating fat distribution, estrogen also influences weight by regulating metabolism and appetite. It acts on certain parts of the brain to decrease appetite and increase feelings of fullness, helping maintain a healthy weight. When estradiol levels drop, it may contribute to weight gain in AFABs.

Other hormones have different effects on metabolism and weight. For instance, testosterone and growth hormone are fat-burning hormones, instructing the body to break down stored fat and build muscle, while cortisol and insulin encourage the body to store fat, Dr. Holmes says. Maintaining a hormonal balance, therefore, is essential to keeping your metabolic team working together smoothly. 

Save up to 80% on Estradiol with SingleCare

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.

Estradiol 42.5 gm of 0.1 mg/gm (1 Tube)

23666 - Hampton, VA

$32.51

i Price with signup

Get free coupon

$32.51

i Price with signup

Get free coupon

See Estradiol prices at all pharmacies

Can estradiol cause weight gain?

“Estradiol itself doesn’t cause weight gain. ​​In fact, multiple studies show it may actually have a protective effect against weight gain,” says Dr. Holmes. Studies indicate that when estrogen levels decline during menopause, women start accumulating more abdominal fat, particularly the dangerous visceral kind that surrounds internal organs.

Weight gain occurs when you take in more energy (in the form of food) than your body expends. Some studies on animals help illustrate estradiol’s role in this process. When researchers removed the ovaries of female mice (creating a menopause-like state), the mice without estrogen replacement gained body fat. These findings suggest that low estrogen may reduce physical activity levels and energy expenditure, leading to gradual weight gain.

As Dr. Holmes explains, “If estradiol causes weight gain, teenage girls and women in their reproductive years [when estrogen is highest] would be the heaviest.” But we see the opposite. It’s actually when this hormone level drops during menopause that we see significant weight gain, particularly around the midsection.

Still, some people with high estrogen or those taking estradiol as a hormone replacement therapy (HRT) may experience weight gain. This isn’t necessarily due to the medication. There are possible reasons this may occur, such as timing and life stage.

“Many women start estradiol therapy during perimenopause or menopause, when metabolism naturally slows down. It’s easy to blame the medication when it’s really age-related metabolic changes,” Dr. Holmes says. Several factors may contribute to weight gain during HRT:

• Individual hormonal changes and complexity: Your body doesn’t just run on estrogen alone. Fluctuations in insulin sensitivity, cortisol levels, thyroid function, hormonal imbalance, and sleep patterns all influence weight.
• Lifestyle shifts: Starting hormone therapy often coincides with other life changes, such as less physical activity, different eating patterns, or increased stress, which can all promote weight gain.
• Fluid retention: Some women experience temporary water retention when starting estrogen, which shows up on the scale but isn’t actual fat gain.

Additionally, “genetics, age, metabolism, and concurrent medications also play a role in whether someone gains weight or not,” says Elizabeth Lumpkin, MD, Clinical Advisor at Southeast Addiction Center.

Does estradiol make it hard to lose weight?

“Estradiol may actually make weight loss easier, not harder,” says Dr. Holmes. In contrast, reduced estradiol levels, which typically occur around menopause and in people who have undergone procedures like oophorectomy (removal of the ovaries), may make it harder to lose weight and cause abdominal fat accumulation.

Dr. Holmes explains that when estrogen levels are optimal, your body tends to:

• Store fat in healthier locations (hips and thighs versus belly)
• Maintain better insulin sensitivity
• Preserve muscle mass more effectively
• Regulate appetite more consistently
• Achieve satiety more easily

Additionally, estradiol helps the body use energy more efficiently. It suppresses glucose production in the liver, helps prevent insulin resistance, and supports the breakdown of stored fat for use as energy (lipolysis)—all of which may support weight loss.

Dr. Holmes also notes that the challenge isn’t estradiol itself—it’s when estrogen levels are inconsistent or imbalanced with other hormones. “If you’re struggling with weight while on estradiol, we need to look at the bigger picture: What’s happening with your insulin? Your cortisol? Your sleep quality? Your protein intake?” she says.  

Tips for managing your weight on estradiol

If you are concerned about weight gain, you may want to take some steps to help your body more efficiently regulate weight, even when taking hormone replacement medications like E2. Consider the following tips:

• Eat smaller meals. Limiting your food portion size can help you control your daily calorie intake.
• Consume more low-calorie, nutrient-dense foods, such as seafood, lean meats, eggs, nuts, legumes, fruits, and vegetables. These choices are rich in healthy fats, proteins, complex carbohydrates, vitamins, and minerals, which help you feel fuller while eating less.
• Limit your intake of high-calorie foods, such as those with high amounts of refined sugar and saturated fat.
• Reduce alcohol intake. These beverages add empty calories and can mess with your hormones.
• Drink plenty of water and limit beverages with added sugar.
• Manage stress and get enough sleep, at least 7 hours, at night.
• Be more physically active. Health experts recommend that adults get at least 150 minutes of moderate-intensity exercise per week. You can choose to go with about 30 minutes of exercise five days a week. Dr. Lumpkin notes that regular strength training helps counteract fat gain.

You can also work with a healthcare team that includes a registered dietitian and an exercise physiologist to create a healthy dietary and physical activity plan.

Alternatives to estradiol

According to Dr. Lumpkin, there are alternatives to estradiol, including: 

• Other forms of estrogen, like conjugated equine estrogen or transdermal estrogen
• Non-estrogen hormone options, such as progesterone and selective estrogen receptor modulators (SERMs)
• Non-hormonal medications like selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), or gabapentin.

“The alternatives depend on the reason it’s being used (menopause symptom relief, bone health, gender-affirming therapy),” Dr. Lumpkin explains. Transdermal estrogen is often considered the most tolerable option, with fewer cardiovascular risks compared to oral estrogen, steadier hormone levels, and fewer side effects.