• Obesity is a risk factor for many serious health conditions, including high blood pressure, cardiovascular disease, and type 2 diabetes.
• New research suggests that obesity may also increase the severity of menopausal symptoms, such as hot flashes.
• In addition, the study found that hormone therapy to relieve menopause symptoms may be less effective in women with obesity.

Obesity is increasing worldwide, with some 13% of all adults now having obesity. Worldwide, the condition is more common in women than men (15% vs. 11%) and more prevalent in developed countries. In the United States, according to a survey by the Centers for Disease Control and Prevention (CDC), in 2020, 41.9% of people aged 20 and over had obesity.

Obesity increases the risk of many health conditions, including heart attacks, strokes, type 2 diabetes, respiratory conditions, and musculoskeletal problems.

New research now suggests that obesity may also increase the severity of menopausal symptoms and reduce the efficacy of hormone therapy in relieving those symptoms. Lead author Dr. Anita Pershad, from the Eastern Virginia Medical School, told Medical News Today:

“The main takeaway of our study is that obesity may worsen a woman’s menopausal symptoms and limit the amount of relief she gets from hormone therapy (HT).”

However, Dr. Kara McElligot, obstetrician-gynecologist, NAMS-certified menopause practitioner, and medical advisor at Mira, cautioned:

“This was a pilot study (only 119 participants) and was performed retrospectively by chart review. This type of study has a high risk of bias, which means that it cannot prove whether women with obesity have worse menopause symptoms nor whether the efficacy of hormone therapy is lower in women with obesity.”

The findings were presented at the 2023 Annual Meeting of The Menopause Society in Philadelphia, September 27-30. The research hasn’t been published in a peer-reviewed journal.

How obesity may worsen menopause symptoms

This five-year study examined the health records of 119 women who presented to a menopause clinic. The women were divided into two groups — those with a body mass index (BMI) greater than 30 (classified as having obesity), and those with a BMI lower than 30. (A healthy BMI is between 18 and 25.)

There was no significant difference between the two groups in age, duration of menopause, use of hormone therapy, and therapy acceptance.

The researchers found that women with obesity were more likely to report symptoms, including vasomotor symptoms (hot flashes), genitourinary/vulvovaginal symptoms, mood disturbances, and decreased libido.

Dr. Sherry Ross, OB/GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, told MNT why this might be the case:

“It’s thought that obese women experience more hot flashes and night sweats because fatty tissue acts as an insulator trapping heat in the body, generating additional heat.

Others believe that obesity can lead to hormonal imbalances, causing an increased level of estrogen, that contributes to more intense menopausal symptoms.”

Dr. Ashley Parr, D.O., OB/GYN at The Women’s Hospital at MemorialCare Saddleback Medical Center in Laguna Hills, CA, agreed:

“Women with obesity may have a different experience with menopause and treatment. Fat cells have the ability to produce estrogen, so even when the ovaries shut down in menopause, women with obesity could still have a significant amount of estrogen circulating in their bodies. This has a cascade of effects that change the entire hormone balance of the body. “

Why hormone therapy may be less effective with obesity

The women with obesity were also less likely to experience symptomatic relief after systemic and/or localized hormone therapy than women without obesity. Dr. Pershad told MNT that they were investigating why:

“It remains unclear if hormone therapy is less effective in women with obesity overall, or if the expected efficacy can be achieved with alternative design and administration routes. Our research group is actively looking into this area for further elucidation of this topic.”

“Women with obesity are also at risk for many conditions that may make them a poor candidate for hormone replacement, such as heart disease and breast cancer. There are nonhormonal treatment options available such as SSRIs, SNRIs, and vaginal estrogen, depending on the symptom a woman is looking to treat.”
— Dr. Ashley Parr

Dr. McElligot explained why women with obesity might find hormone therapy less effective:

“If we made the assumption that the findings […] were on the right track — the severity and experience of estrogen deficiency is related to multiple factors, and obesity is one of them.”

“Liver drug metabolism studies comparing adults [within a healthy BMI range] versus elevated BMI demonstrate that the amount of circulating drug in their body changes by BMI. […] The majority of studies on the efficacy of hormone therapy are performed in women with [a healthy] BMI. This means that the recommended dosing does not account for the effect of BMI on drug metabolism,” she added.

What is menopause?

Menopause occurs when a woman has not had a monthly period for 12 months and typically happens between the ages of 45 and 55. However, menopausal symptoms can occur for several years before menopause — known as perimenopause — and for some time afterward.

These symptoms, which include hot flashes, night sweats and disturbed sleep, vaginal dryness, mood changes, and a reduced sex drive, may be barely noticed by some women, but for others, they can be severe.

Hormone therapy (HT), to replace the estrogen and progesterone that the body is no longer producing, is often prescribed to help minimize the symptoms.

What are the alternatives to hormone therapy?

It is not only women with obesity who may want alternatives to hormone therapy to alleviate symptoms of menopause. Some women wish to use more natural alternatives, and others have health conditions that mean hormone therapy is unsuitable.

Dr. Ross suggested ways to cope with those symptoms:

“A healthy lifestyle goes a long way at any time in your life, but especially in this later chapter of life. Inactivity, an unhealthy diet (fast food!), smoking, obesity and excessive alcohol consumption, all have a negative impact on your quality of life, especially during menopause. All of these factors only make menopause worse than it needs to be.”

Additionally, she suggested:

• A healthy diet: A diet focused on fresh fruits, vegetables, whole grains, and fish, with limited alcohol intake and little red meat (similar to the Mediterranean diet).
• Regular exercise: Exercise makes you feel more confident and helps ease the stress of menopausal symptoms.
• Stop smoking: If not for the fact that smoking increases the risk of heart disease, stroke, lung cancer, and death, but because it makes hot flashes more frequent and severe during menopause.
• Sleep: It’s necessary and hard to come by in menopause. Getting at least seven hours a night is ideal.
• Acupuncture and relaxation techniques, including mindfulness, biofeedback, hypnosis, cognitive behavior therapy, yoga and Tai Chi may be helpful in controlling mood swings, depression, anxiety, hot flashes, and other mild symptoms of menopause.

However, she also advised that women with obesity should be encouraged to lose weight, as this “will not only help manage their menopausal symptoms, but will also reduce their incidence of heart disease, high blood pressure, cancer, adult onset of diabetes and other life threatening health problems.”

And Dr. Parr echoed this advice:

“Ultimately, weight loss, either prior to or after menopause, should be the goal. Any movement toward a healthy weight will help bring the hormone levels back to the intended physiologic level and will help reduce the compounding of symptoms that can be seen with menopause and obesity.”

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