Gynecologist Yekaterina Volkova explained why being overweight is often a contraindication for prescribing hormone replacement therapy and certain contraceptives.
The expert notes that it is extremely important to individualize medical practice and approach to each patient. Especially when it comes to overweight patients in the 40+ age category.
“It is impossible to take and prescribe hormones without looking back at the reasons that led to such weight and the existing consequences in the form of concomitant diseases. We are looking for other ways and at the same time we are working with weight, ”says the doctor.
One of the important restrictions in the presence of overweight is COCs. We are looking for other ways of protection. The thing is that oral contraceptives have a negative effect on the work of the gallbladder.
Against the background of long-term use, even the appearance of stones and problems with the outflow of bile is possible. In this case, the liver also experiences a huge load.
Admission of progesterone with excess weight is possible, but the consequences are also not excluded. There may be swelling, headache, increased blood viscosity. In addition, such a “treatment” eliminates the symptoms, not the problem itself.
“Hormone therapy is a great tool for solving many problems, but being overweight limits us in many ways.”
It is especially important to take this into account after 40 due to changes in hormonal levels, which will only contribute to the accumulation of visceral fat around the internal organs.
The algorithm of actions is as follows: first we get rid of excess weight, and only then we deal with its consequences, including with the help of hormonal therapy, if another is not suitable. 
Ekaterina Volkova Health Gynecologist