09/05/2026
Your BHRT level is not driving uterine thickening. Your bodyfat is!
A new clinical study from Newson Health has found that body mass index (BMI) may have a greater impact on unscheduled bleeding in menopausal women using hormone therapy than previously thought - challenging assumptions about the role of hormone dosage alone.
The research, which looked at a group of over 200 menopausal women using both standard and off-label doses of transdermal estradiol and different progesterone doses (common form of body identical HRT), found that it was a person’s BMI rather than their dose of estradiol that was linked to increased womb lining thickness, a potential indicator of bleeding risk.
The findings are particularly important given that up to 40% of menopausal women taking HRT experience unscheduled bleeding, which can be worrying and often leads to unnecessary tests and procedures.
Current guidelines often focus on adjusting hormone doses to manage bleeding, but this new evidence suggests that a woman’s body weight and how she absorbs hormones may play an even bigger role and should be taken into consideration when tailoring care and treatment plans.
Of the 235 women who were part of the study, 74% of participants had a normal womb lining thickness on ultrasound scans, compared to 20% had a thickened lining (not needing any treatment), while the remaining 6% had unclear results needing further investigations but also did not need further treatment.
However, women who were overweight were more likely to have a thicker womb lining. It is known that fat cells produce an inflammatory type of estrogen (estrone) and also other chemicals (cytokines) that can increase inflammation and affect the womb lining.
The research found there was no link between hormone doses and womb lining thickness – women taking lower doses of estradiol sometimes had thicker linings of their womb than those taking higher doses. Also, there was no difference in womb thickness with different doses of progesterone.
https://www.drlouisenewson.co.uk/knowledge/bmi-may-impact-menopausal-bleeding-in-women-taking-hrt-more-than-hormone-dose
https://www.drlouisenewson.co.uk/knowledge/bmi-may-impact-menopausal-bleeding-in-women-taking-hrt-more-than-hormone-dose
