ask: I had a complete hysterectomy 6 years ago and I am now 44. I battle belly fat even after loosing 25 lbs. I've been told it is because I don't have hormones any more and I have never been on HRT since my hysterectomy. Would a natural HRT help me?

Anon, congratulations on that 25 pounds!! Wow!! That's a huge accomplishment and shows that you made a big commitment to yourself and your health. I hope you take time out to pat yourself on the back for that, often. You deserve it.

You mustn't feel like you're alone in your fight over belly fat. The editors of Prevention Magazine have just come out with a book called "The Flat Belly Diet," based on exactly the thing you (and I) wrestle with. They were motivated to come up with the book due to research that says even small amounts of extra belly fat increases our risk of heart disease, diabetes and some cancers. (It doesn't hurt that 67% of Americans say their belly is the body part they most want to change!)

Here is a bit from the introduction, written by Liz Vaccariello, editor-in-chief of the magazine:

"For countless reasons that I will outline throughout this book, the belly starts letting us down around age 40. Sometime between our 35th and 55th birthdays (some earlier, some later, and some, God willing, never), the belly pooches, puffs, and starts spilling over our waistbands. First we suck it in, yet it refuses to achieve its formerly flat shape. Then we crunch until our necks scream, while the fat over the sculpted abs muscles remains. And eventually we diet, then watch with frustration as the weight disappears from our breasts and our faces and the belly fat stays put. Eventually, belly fat starts to feel like our destiny -- something that even hours on the treadmill or the strictest diet in the world won't budge."

Feel a little better? Me too. She goes on to say that she hired Prevention's nutrition director, Cynthia Sass, MPH, RD to comb the research on belly fat and develop a diet that would target it. The book is their result. It deals with both subcutaneous fat -- that fat that is directly beneath our skin -- and visceral fat, which is deep within our torsos and is more dangerous because of the proximity to our organs.

Their eating plan restricts calories and bad fats, of course, but it also deliberately includes a bit of monounsaturated fatty acids (which they call MUFAs) to the diet at each meal. Through the research that the Prevention editors studied, they found that the MUFAs are an essential part of getting rid of that abdominal fat. They occur naturally in olive oil, avocados, nuts, olives and dark chocolate, for starters.

Here is Prevention's site:
http://www.prevention.com/cda/homepage.do

and their diet basics:
http://www.prevention.com/flatbellymufaslideshow/

and an amazon link if you're interested:
http://www.amazon.com/Flat-Belly-Diet-Liz-Vaccariello/dp/1594868514/ref=...

The Mayo Clinic has a great page explaining why fat gathers in our abdomen and a few ways to target those abs (you may already be doing this):

http://www.mayoclinic.com/health/belly-fat/WO00128

This study seems to find a small connection between HRT and less abdominal weight gain, but cautions that it needs to be studied further:

http://findarticles.com/p/articles/mi_m0887/is_8_25/ai_n26968771

This study researched whether HRT affected abdominal fat and insulin sensitivity; there was a slight connection for insulin sensitivity, but not in body composition changes:

http://jcem.endojournals.org/cgi/content/abstract/jc.2004-1479v1

And this study did find some changes in cholesterol, but not in weight. HRT did seem to affect somewhat the distribution of body weight:

http://www.nature.com/ijo/journal/v27/n9/full/0802371a.html

I know those studies are kind of dense, but it's always good to be able to sort through the information and find the results that seem consistent.

And here's an overall U.S. News and World Report article on HRT and healthy women:

http://www.usnews.com/blogs/on-women/2008/5/20/hrt-is-safe-for-healthy-w...

Bottom line -- HRT may not have much of an effect on belly fat, but it may not be as worrisome as we thought if you and your doctor want to give it a try. And in the meantime, check out those MUFAs! (I know I am, lol. Meet you back here in a few months and we'll see how we do!)

Anony, you're so welcome. Come back any time you need a pep talk! I know that when I hit the 25-pound mark, I'll want to throw a party!

How did you lose your 25 pounds, besides your 5-days-a-week workout, if I can ask? Did you just work on calories and portion size, or did you go with an actual program?

Diane, I changed what I ate and portion size. I try to eat salmon and another white fish every week. I didn't watch "calories" just what I ate and amount. I find that if I eat as soon as I get hungry, I stay satisfied throughout the day. I believe in eating every two hours. It might just be a handful of almonds or a piece of fruit, whatever healthy item I can think of. I have also been trying to incorporate more MUFAs such as almonds and olives, etc., and that seems to be helping too. I do splurge on weekends but I continue to watch my portions. So I will order say, a hamburger but only eat half of it. It takes will power and if I fail, I just change the next day. In other words, if I eat all the french fries, I don't beat myself up. I just eat really good the next day. Life happens, and as long as I don't go crazy day after day, I should be able to maintain. I watch what I eat Monday thru Friday, slack on Saturday night and Sunday. Works well for me! Best of luck to you on your weight loss and DO throw yourself a party when you hit that 25 lb mark! :o) Anon

Hey Anon, we asked an Ernestine Bustamante Roman, MD, FACOG of New Horizon Women's Care for her thoughts on your post and here's what she shared with us.

"This patient needs to have a complete history and physical exam. She needs a consultation to discuss the risks and benefits of HRT.

Some of her risks of starting HRT will depend on whether she had her ovaries removed at the time of hysterectomy. If she had her ovaries removed, called a bilateral salpingoophorectomy or BSO, that would make her 6 years menopausal.

Women who are many years menopausal and then started on estrogen preparations do have an increased risks of blood clots, heart attacks and strokes. If she did not have a BSO at the time of hysterectomy, she could be perimenopausal. (average age of menopause in the United States is 48 to 52 years old.) And would be a better candidate for HRT.

There are many formulations of HRT: patch, pill, vaginal preparations. There are "bio-identical" options out there. As these are not well regulated by the FDA. I often hesitate to prescribe these.

The decision to place her on HRT would largely depend on her symptoms and her knowledge of the risks of starting HRT. The present recommendation for patients is to try the lowest dose possible for the shortest time possible. However, If I have a patient who has been on HRT for years and never had a problem and is otherwise healthy, I don't stop their HRT. These patients have proven themselves, "estrogen worthy".

Interestingly, the professional group who use HRT the most... ob/gyns."

I've been fighting the battle of the bulge for several years. It started creeping up on me in my late 40's, about when menopause hit. It's the main reason why I started running, then marathon training. I'm still fighting the bulge, although it's not as prominent, anymore, and fighting the weight issue. My body shape has changed, albeit slowly. But, the muffin top is still an issue.

Anyway, my OB/Gyn wasn't a huge fan of HRT, and I couldn't tolerate what she did try to put me on. So, we just opted to let nature takes its course and deal with it as best I could. Who knows whether or not HRT would have helped, had I been able to tolerate it (I have lupus and a multitude of sensitivities to a multitude of substances).

On the Flat Belly Diet, I have the book. Interestingly enough, I've been a MUFA maven for most of my life, without knowing it. All the same, I'm still trying to deal with the subcutaneous fat, let alone the fat, period!

Well, while I'm still trying to deal with that, I call myself the "Slow Fat Runner," and even have a running team by that name. We're mostly women who, for whatever reason, fight the bulge, but are also distance runners. At least, we're rather fit.

Thanks for your inspiring story! It makes me feel that there's still hope, even at my age.

I am a 61 year old who has always had a very small waist until the last two years. I have had a complete hysterectomy at the age of 48 and have been on estrogen ever since. I had migraines before the surgery and the estrogen helped eliminate them. I exercise every day with different combinations of walking, biking, swimming, golfing, Wii Fit and kickboxing, dance, and weight lifting classes.. I would like to take off the 15 pounds that have mainly shown up around my stomach and love handles. I also seem to have a thicker pubic mound than ever before. I am happy with my general muscle tone. I am just now reading up on estrogen imbalances and wonder if I should go off all estrogen and take a chance on my migraines. I have also noticed mood swings. I also have developed dry eyes.

Anon - you had posted a response. Unfortunately, it got lost when I deleted an empty post right above yours. All I remember is that you were saying something about your dry eye.

My apologies - could you repost your response (and I promise I won't accidentally delete it!)?

Thank you for all your info on dry eye. I have had my tear ducts permanently plugged, and I use restasis twice a day along with eye drops. I have severe astigmatism and must wear hard contact lenses. Luckily I have a goddess for an optician who has been able to fit me so I can wear my contacts all day and evenings also.
I need to check into a heart monitor and determine my burn rate. I lost weight with Suzanne Sommers diet 5 years ago and have used her maintenance program, but still have no significant loss. I lose a pound and gain it back the next day. Very frustrating. I am on no sugar, alcohol, or white flour and eat lots of green vegetables as well as meat. My cholesterol is "highly desirable". My chiropractor has been able to reduce my goiter from 43cm to 36cm in just 6 weeks and my energy level has been improving. I do not take any thyroid medication. I now wonder if I should back off gradually on the ortho est I take and see if that contributes to the belly fat. Most of my problems seem to have a relationship to hormones! I don't see my obgyn until my regular visit in Nov. How long should I be taking estrogen and what are the benefits of continued use are questions I need to find answers to.