Does hormone replacement after menopause help or hinder weight loss?


Does hormone replacement after menopause help or hinder weight loss? Are ketones dangerous while pregnant? And could semen volume be reduced by low carb?

Here are the answers, from the fertility specialist Dr. Michael Fox.

Cramps and semen volume

Hi Dr. Fox,

I asked Andreas this question as well but since the second item is related to fertility I figured I’d like to get your opinion too. I’m now on my fourth week and I’m still feeling some of the keto-flu. There are two things that concern me:

  1. I get cramps, not just on the legs but everywhere. I get them on my chest too. Have people experienced this before? I’m just concerned it may hint at something more sinister, such as angina. Although I was perfectly healthy when I started LCHF and never had this feeling before.
  2. I noticed my semen volume decreased to almost nil. I tried to do research but could not find any authority article on it, except for this reddit post where people experience the same issue.

Do you think this is just part of the keto-flu and it would go away after a few weeks? I hope this has not damaged my reproductive system. My wife and I are planning to do IVF sometime next year and I hope the volume ramps up again to normal.

All in all, have you encountered people where LCHF simply could not work for them because of these issues? Or do they all subside as people plow through the induction phase? How long can induction phases last?


Dr. Fox:
I haven’t yet read Andreas’ response. I have not heard the decrease in volume as an issue with my patients. Dehydration is common due to salt wasting with low insulin and low salt foods (non processed). Increasing water and salt with salt or broth would be helpful maybe. The cramps speak to this as an issue. I would tend to believe that this might increase semen volume as well.

Keto flu really only lasts about a week. Ketoadaptation on the other hand could be a 2 week to 2 month process. I don’t think though that your symptoms relate to ketadaptation specifically. What we see there is hypoglycemia with >3-4 hours between food intake. After adaptation this doesn’t happen and people can then pursue intermittent fasting without any adverse effects.

Great question.

Ketones and the fetal brain

Hi Dr. Fox,

For women who do LCHF pre-conceptually and are in ketosis (for fertility or general health reasons), do you recommend either staying in or avoiding ketosis once pregnant?

I have heard some providers express concerns re: brain development (i.e. that we generally don’t know what ketones do to the developing brain), but I have to think that evolutionarily, it’s something that our species was regularly exposed to.


Dr. Fox:
True, we don’t know for sure. Practically though, think about the Cave Man that lived in North Carolina or central to northern Europe from September to May, what carbohydrate would a pregnant woman find? They had to be ketotic.

In my practice, we have utilized ketotic diet in our pregnant patients with success but don’t claim to have a scientific series and to my knowledge there is no such research in existence. We recommend it to our patients regularly and support patients who want to continue.

If the adult brain is better served by ketones, so should be the fetal brain? Blood sugars in the mother and hence in the fetus remain consistently normal and stable throughout the pregnancy.

Great question.

Thank you!

Will hormone replacement help or hinder weight loss?

Hi Dr. Fox,
for women post menopause, will taking replacement hormones therapy (HRT) help with weight loss or hinder it? what kinds work best? For preventing excess skin after weight loss the same questions, will taking HRT help and if so what kind/mix? I know there are other health concerns with HRT but I am asking specifically about these two issues. Thank you.


Xtina, estrogen supplementation or replacement in menopause always will result in better metabolics, i.e. weight control. Progesterone works against that slightly but with combination therapy, the overall metabolic tendency would be in a healthier direction. If you have a uterus you need balancing progesterone, and if not there is no need for progesterone. I know of no association between hormones and the amount of excess skin after weight loss. Best of luck.

Dr. Fox

Earlier Q&As

Can Yo-Yo Dieting Break People’s Metabolism?

I’m Not Losing Weight on LCHF – What Should I Do?

More with Dr. Fox

What to Eat to Get Pregnant – Dr. Michael Fox
Stressing Less to Get Pregnant – Dr. Michael Fox
Is Coffee Bad for You? – Dr. Michael Fox
The Cure for Morning Sickness
Women, Hormones and Nutrition – Presentation by Dr. Michael Fox
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