When women talk about the joys—or not—of menopause, they typically find there are some things they can happily embrace. Menstruation stops so you no longer need to bother with the cost and, frankly, the annoyance of tampons and pads. You no longer need birth control. Those changes can be quite liberating. There are, however, a host of issues that are not so great. According to research out of Brazil, obesity can worsen some of those less-pleasant symptoms.
When a woman experiences menopause, the ovaries stop producing estrogen and progesterone. As the levels of these hormones diminish, women are at risk of experiencing a number of changes and symptoms:
Initially periods become irregular, then less frequent, and then disappear completely.
Hot flashes or hot flushes can occur variably and with different levels of severity. This is one of the most bothersome symptoms and can really impact quality of life.
Though sleep issues typically crop up with aging, menopausal night sweats in particular can instigate poor sleep patterns.
Vaginal dryness typically occurs because vaginal tissue becomes thinner and produces less lubrication. This is a direct result of lower levels of estrogen.
Many women experience some level of urinary incontinence or other urination issues, because estrogen is no longer supporting bladder and urethral health. Women can experience stress incontinence (when they sneeze, cough, laugh) or urinary urge incontinence, which is due to the difficulty of holding urine as they rush to the bathroom. Urinary incontinence is a significant quality-of-life issue for older women.
Women in early menopause can experience mood swings, feel depressed or crabby, even have crying spells. This is more likely to occur if you have a past history of postpartum depression or mood swings right before your periods. Mood swings are distinct from depression.
Despite no longer needing birth control, there can be diminished libido and interest in sex.
Osteoporosis risk is increased.
Weight gain is typical, particularly in the mid-section, especially if you continue to eat the same quantities of food without increasing physical activity, particularly resistance training. Losing muscle mass means you lose metabolic, calorie-burning potential.
Some women experience stiff, achy joints, though it’s not clear if the cause is diminished levels of hormones, the aging process itself, or menopausal weight gain. Being sedentary can raise the risk of joint pain as well.
Some of these post-menopausal complaints, and their severity, can be exacerbated by obesity, according to Brazilian researchers. The population-based study, published in the May 2017 issue of Menopause: The Journal of The North American Menopause Society, used a four-point symptom-severity scale.
The cross-sectional cohort study included 749 women between the ages of 45 and 60. Mean age of participants was 53, and mean age at onset of menopause was 46. From a weight perspective, 38 percent of the subjects were normal weight (body mass index, or BMI, under 25), 34 percent were considered overweight (BMI between 25 and 29.9), and 28 percent were diagnosed as obese (BMI greater than 30). The study lasted ten months. Trained interviewers visited subjects at home and administered a “menopause-rating” questionnaire and a second questionnaire that looked at lifestyle habits, ongoing health issues, and self-perception of health.
Obese woman scored 14 for hot flashes, compared to 12 for overweight women and 11 for normal-weight women. The researchers also noted that the obese women felt more so-called consequences (quality-of-life issues) from their hot-flash symptoms, compared with the normal-weight women. Those consequences included: more severe hot flashes, sleep interruptions, work activity disruptions, less enjoyable sexual activity, and even interruptions during leisure activities.
Severity scores for joint and muscle pain were also higher for women with higher BMIs. There was no clear association between excess weight and the risk of more severe mood swings. Based on the second questionnaire the researchers noted that obese women logged less exercise time and had higher rates of urinary incontinence and urinary urgency.They also had higher rates of high blood pressure.
The researchers suggest that excess weight, especially when it is high enough for a diagnosis of obesity, is associated with vasomotor symptoms (VMS) like hot flashes because the more predominant the layer of body fat, the more it acts as a “heat insulator,” which interferes with heat dissipation. This means that when you carry excess fat you feel hotter and the feeling persists for a longer period of time. The researchers suggest that a focused effort on weight loss can help to lower the risk of hot flashes as well as the frequency and severity. Losing weight can also help to minimize risk of heart disease and breast cancer.
Limitations of this study included recall bias, which can affect the accuracy of the information that the women offered. The design of the study also made it more observational rather than research that identifies “cause-and-effect” outcomes.
What is clear is that women who enter menopause and experience some or all of these symptoms often request treatment. Lifestyle adjustments including dietary changes and exercise can help to limit some of these symptoms, especially for women who are overweight or obese. Currently the guidelines for treating menopause issues and specifically for hormone therapy are quite specific with regards to indication, dosing, and duration of treatment. Losing excess weight should be a primary goal.