Obesity is a major risk factor for many noncommunicable disease including myocardial infarction, diabetes and osteoporosis. Research suggests that there is an association between menopause and obesity, however this relationship is not completely understood. So, what are the facts?
Not only do some studies indicate that post-menopausal women are at higher risk of developing obesity, but also that obese women may experience worsened menopausal symptoms.[1,2]
What causes postmenopausal weight gain?
Since 1975, the rate of worldwide obesity has tripled. According to the World Health Organization (WHO), in 2016 more than 650 million adults over 18 years old were obese and over 340 million children and adolescents aged 5-19 were overweight or obese. The negative associations of obesity are well documented and regrettably the many physical, mental and environmental factors relating to the issue means that tackling it is very complex.
Menopause is one factor linked with weight gain and possible obesity. A prospective cohort study published in April 2019, demonstrated that aging and the menopause are independently connected to increases in Body Mass Index (BMI). In fact, the study indicated that the mean BMI of menopausal women was 0.9 (95% CI: 0.8-1.0) higher than BMI of premenopausal women.
The publication also suggested that women who experience menopause at a higher age are more likely to experience a lower future BMI.
So, why is this?
The reasons for higher incidence of obesity in menopausal women are not clear. However, estrogenic signalling has been highlighted as one factor that may play an important role. Estrogens and estrogen receptors help regulate aspects of glucose and lipid metabolism, meaning that disturbances of this metabolic signal may contribute to development of metabolic syndrome, including weight gain.
However, this is not the whole story. Various genetic, hormonal and exogenous factors are linked with increases in body weight and increase and redistribution of fat mass in post-menopausal women. These include genetic predisposition, unhealthy nutrition and low physical activity.
Obesity and symptoms of menopause
For women who are obese during menopausal transition, the symptoms experienced may be worse than low, normal-weight women. Women with higher abdominal adiposity, particularly subcutaneous adiposy, have been shown to be more likely to report vasomotor symptoms (VMS) during the menopausal transition and early postmenopause.
While the mechanism for this association is not well understood, there are hypotheses. It may be that adipose tissue interferes with the normal thermoregulatory mechanisms of heat dissipation, or that adipose tissue has an endocrine function mediating VMS.
In addition, other symptoms such as severe vaginal discharge, severe itching and irritation are more likely in obese women when compared with women of a normal or low weight.
More research is needed
Despite studies suggesting different associations between obesity and menopause, the causative factors are not clear and the data is not conclusive. More research is required both into how menopause affects weight gain and visa versa. Also, research is needed to understand how best to approach obesity in postmenopausal women and what treatment strategies could be used.
On May 15-17, the EMAS conference in Berlin is hosting a range of unmissable sessions focussed on menopause and andropause, including a look at MHT, obesity and diabetes. We can’t wait to hear the latest research on this exciting topic!
1. Montazeri SA, Tehrani FR, Yarandi RB et al. Effect of aging, menopause, and age at natural menopause on the trend in body mass index: a 15-year population-based cohort. Fert Steril. 2019;111(4):780-786
2. Al-Safi ZA, Polotsky AJ. Obesity and Menopause. Best Practice & Research Clinical Obstetrics & Gynaecology. 2015;29(4):548-553
3. WHO. Obesity and overweight. World Health Organization.2018. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed April 2019.
4. Lizcano F, Guzmàn G. Estrogen Deficiency and the Origin of Obesity during Menopause. Biomed Research International. 2014. 2014:1-11
5. Kozakowski J, Gietka-Czernel M, Leszczynska D et al. Obesity in menopause – our negligence or an unfortunate inevitability? Prz Menopauzalny. 2017;16(2):61-65